Overview of the CARE Model Implementation and Research Program NECA Conference Sao Paulo, November, 2014 Prof. James Anglin School of Child and Youth Care University of Victoria, BC, Canada

Core Concepts  Best Interest of the Child  Struggle for Congruence  Evidence Informed Program Model Holden, Anglin, Nunno, & Izzo (2014) 1

Evidence Informed Program Model  Based on existing research and best practices  Set of principles that guide policy, procedures, and practices  Well articulated, evidence-based theories of change Lee & Barth (2011) 2

3

Quasi-Experimental Wait-List Design 5

Purpose of Therapeutic Residential Care  Creates breathing room (a transitional service)  Provides a safe place to learn new skills and practice them  Provides adults who act as teachers, coaches, and mentors to help develop and practice necessary life skills  Helps children realize a more normal developmental trajectory while (often) dealing with the effects of trauma 4

5 Developmental Trajectory

What Works  Maintaining a positive organizational culture  Providing strong leadership communicating a clear vision  Building developmental relationships  Committing to reflective practice at all levels of the organization  Using data to inform decision-making  Developing a competent & skilled workforce  Creating a community of practice 6

CARE Principles  Relationship based  Developmentally focused  Family involved  Competence centered  Trauma informed  Ecologically oriented 7

Relationship Based  The ability to form relationships is associated with healthy development and life success  Secure attachments allow children and staff to take risks and challenge themselves  Developmental relationships are the key to helping children and adults develop (Li & Julian, 2012) The active ingredient of effective interventions Li & Julian (2012) 8

Developmentally Focused  All children have the same basic requirements for growth and development  Children need adult support to engage their innate capacity to grow and develop  Children & adults learn best when skills are within their zone of proximal development  Staff development also Children do well if they can. If they can’t, we need to figure out why so we can help them. –Greene & Ablon 9

Family Involved  Family contact has demonstrated positive outcomes for children  Planning for adequate community support is essential for a successful return  Including families links children to social orientation and cultural environments  Adults who are culturally competent can adapt interventions to the unique needs of children and families In every conceivable manner, the family is link to our past, bridge to our future. - Alex Haley

Competence Centered  Problem solving skills, flexibility, critical thinking, emotional regulation, social competence, and self-efficacy are necessary life skills  Personal strengths and resources are the biggest factor in making positive change  Developing competence is dependent on the developmental relationship, cognitive functioning & self-regulation Every child deserves a champion – an adult who will never give up on them, who understands the power of connection, and insists that they become the best that they can possibly be. - Rita F. Pierson

Trauma Informed  Trauma has a debilitating effect on children’s growth and development  Maintaining resilient non-coercive, safe environments is essential for children and adults to learn new responses to stressful situations  Challenging behavior is often pain-based behavior  Resilient organizations are ‘holding organizations’ (William Kahn, 2004) “in the shelter of each other we live” - Peig Sayer 12

Ecologically Oriented  Children and adults learn through interacting with their environment  The environment is influenced by the interactions with the children and adults  Environmental factors that protect children are:  Caring relationships  High expectation messages  Opportunities for contribution and participation When you plant lettuce and it doesn’t grow well, you don’t blame the lettuce. –Thich Nhat Hahn, Vietnamese Buddist Monk

Levels of the Organization  External agencies  Leadership and management  Supervisors and clinical staff  Direct caregivers  Children and families 14

What have we learned about the implementation of CARE?

The agency is the locus of learning. Rather than seeking training outside of the agency, the agency itself becomes the primary learning site. The agency is the unit of learning, rather than the individual (or even the team).

 The CARE consultants are engaged in a co-learning and co-creation process alongside the agency staff members; all participants are learners.  CARE consultants work to realize the potential of adult learners and to align their mindsets with the needs and experiences of the children. Anglin (2011) The Implementation Process 15

Best Interests of Children Six Core Principles Beliefs, Attitudes and Assumptions Change Facilitation Integrating CARE Model Staff Development Organizational Climate & Culture Interlocking “Nested” Elements in Translating the CARE Program Model into Practice

SIRCC Conference, June 8, 2011 The “holding” organisation, containing staff and children, and especially their anxiety and pain

SIRCC Conference, June 8, 2011 political change and expediency media criticism and attacks society’s anxiety and pain re: children makes people want to put the lid on

Commitment to CARE by agency Embracing 6 principles Understanding key concepts (beliefs, attitudes, assumptions) Working through applications Re Re - Re Integration of the CARE Philosophy Experiencing CARE effectiveness Gaining confidence Re

Putting CARE into practice requires the ability to move beyond technical thinking (“if x, then y”); it requires adaptive thinking (“what is going on here, and how can I be helpful?”) Two of the most common statements from agency staff about learning and implementing CARE were “it’s about changing your mindset” and “it’s thinking outside the box”.

Changing a mindset is not about simply adding new information or developing new technical skills. Using the analogy of a computer, it’s not about adding new files or programs, it’s about changing the entire operating system. Self-transformation involves being ready, willing and able to put your beliefs, attitudes and assumptions to the test, and to form a new sense of your own identity and potential as a person and as a professional.

The slides that follow are based on the work of Robert Kegan and Lisa Lahey outlined in their text Immunity to Change (2009). Their research identifies the struggle that people in many walks of life have in adapting to the increasing complexity of the world in which they work, and offers an explanation for how and why some agency staff members are able to embrace and act in accordance with the CARE model while others are not.

Socialized Mindset Self- authoring Mindset Self-transforming Mindset Increasing complexity Adapted from R. Kegan & L.L. Lahey, Immunity to Change (2009)

Socialized Mindset Prefers dealing with concrete realities rather than abstract concepts Focuses on technical solutions (“if x, then y”) More at ease following rules than being self-directed Holds beliefs, values and assumptions and is not self-aware or self-critical about them Comfortable following external authority

Self-authoring Mindset Works from a framework of understanding Is comfortable working with basic concepts Seeks to create adaptive responses to new and complex situations Is generally self-directed and comfortable taking responsibility for own actions Is reflective and self-critical about own beliefs, values and assumptions Is able to question external authority and draw on inner resources (thoughts, feelings, understandings)

Self-transforming Mindset Understands relations between concepts and can create new concepts as required Thinks systemically and is comfortable with changing systems and creating new systems Is self-authoring and self- transformative (i.e. can change own beliefs, values and assumptions) Is highly self-aware and able to self- criticize Is comfortable with ambiguity & uncertainty Is comfortable leading others with sensitivity to their needs and realities

For work of a technical nature, a “socialized mindset” is often perfectly adequate to the task. However, to be able to implement CARE, one needs to have developed, or at least be willing and able to begin the task of developing, a “self-authoring” mindset. It is also preferable if supervisors are functioning to a significant degree at this level in order to model and support others to progress in this direction. The most effective agency leaders demonstrated characteristics of a “self-transforming mindset”.

As a result of experiencing CARE concepts, materials and workshop sessions, agency leaders become aware of the need to review and revise their agency policies, procedures, practices, and structures, in order to be congruent with CARE. Workers in CARE agencies often report that things are more calm and peaceful in the cottages, there is less fear, and there are fewer confrontations and power struggles. Many workers report they are happier and feel more satisfaction in their work.

In the past, there has been a tendency in the child welfare field to oversimplify the needs of children in residential care, thus oversimplifying the nature of residential care work, and therefore what it takes to do this work well. Summary

The CARE Program Model embodies a deep appreciation of the complexity of residential care, and offers a framework for systematically improving residential care practice at both the worker and agency levels. At the same time, CARE is a work in progress.

Implications for Future Research 1.Residential care services are highly complex, and require more research that appreciates this complexity. 2.We need to understand much more about the processes of adult/professional development, and how to support the development of mindsets

3.We need to find ways to assist agencies to sustain the CARE model (and other positive program models), and achieve ongoing fidelity to the core principles.

Residential care is not rocket science; It’s far more complex than that!

References Anglin, J.P. (2012). The process of implementing the CARE program model. Paper presented at EUSARF/CELCIS Looking After Children Conference, September 6, Glasgow, Scotland. Holden, M.J. (2009). Children and residential experiences: Creating conditions for change. Arlington, VA: Child Welfare League of America. Holden, M.J., Anglin, J.P., Nunno, M.A. & Izzo, C.V. (2014) Engaging the total therapeutic residential care program in a process of quality improvement: Learning from the CARE model. In Whittaker, J.K, del Valle, J. F. & Holmes, L. (Eds.) (2014) Therapeutic Residential care for Children and Youth: Developing Evidence-Based International Practice. London: Jessica Kingsley Press. Kahn, W.A. (2005). Holding fast: The struggle to create resilient caregiving organizations. New York: Brunner-Routledge. Lee, B.R. & Barth, R.P. (2011). Defining group care programs: An index of reporting standards.Child and Youth Care Forum, 40 (4), Li, J. & Julian, M.M. (2012). Developmental relationships as the active ingredient: A unifying working hypothesis. American Journal of Orthopsychiatry, 82 (2)