Child–Adult Relationship Enhancement (CARE): An evidence-informed program for children with a history of trauma and other behavioral challenges

Abstract

Child maltreatment impacts approximately two million children each year, with physical abuse and neglect the most common form of maltreatment. These children are at risk for mental and physical health concerns and the ability to form positive social relationships is also adversely affected. Child Adult Relationship Enhancement (CARE) is a set of skills designed to improve interactions of any adult and child or adolescent. Based on parent training programs, including the strong evidence-based treatment, Parent-Child Interaction Therapy (PCIT), CARE was initially developed to fill an important gap in mental health services for children of any age who are considered at-risk for maltreatment or other problems. CARE subsequently has been extended for use by adults who interact with children and youth outside of existing mental health therapeutic services as well as to compliment other services the child or adolescent may be receiving. Developed through discussions with Parent-Child Interaction Therapy (PCIT) therapists and requests for a training similar to PCIT for the non-mental health professional, CARE is not therapy, but is comprised of a set of skills that can support other services provided to families. Since 2006, over 2000 caregivers, mental health, child welfare, educators, and other professionals have received CARE training with a focus on children who are exposed to trauma and maltreatment. This article presents implementation successes and challenges of a trauma-informed training designed to help adults connect and enhance their relationships with children considered at-risk.

Child–Adult Relationship Enhancement in Primary Care (PriCARE): A Randomized Trial of a Parent Training for Child Behavior Problems

“…16 CARE was designed as a prevention model for children with behavior concerns who may be at risk for maltreatment. 16 Although CARE encompasses principles similar to existing evidence based parenting program, CARE is considerably shorter and lends itself more readily to implementation in a medical home.…”

“…CARE therefore emphasizes attending to positive child behaviors and establishing firm and appropriate parental control over disruptive child behaviors by targeting the parent-child interaction. 16 The goals of this study were to: pilot a modified CARE program in a primary care clinic (PriCARE); and assess the efficacy of PriCARE to reduce behavioral problems in preschool-aged children and improve positive parenting attitudes.…”

“…The second and third interviews measured behavioral problems and parenting attitudes. The second interview occurred at a median of 9 (interquartile range 7-11) weeks following the baseline interview (immediately after completion of PriCARE for the intervention group) and the third interview occurred at a median of 16 (interquartile range [15][16][17] weeks. Study data were collected and managed using REDCap (Research Electronic Data Capture), a secure, web-based application designed to support data capture for research studies.…”

Barriers and facilitators for access to mental health services by traumatized youth

“…Children with polytrauma often end up in multiple child-serving systems (e.g., mental health, child welfare, education, juvenile justice) with needs that are both complex and severe (SAMHSA, 2014). Fortunately, effective trauma-focused treatments exist (Cohen, Mannarino, Kliethermes, & Murray, 2012; Gurwitch et al, 2016; Lucio & Nelson, 2016). Thus, there is a need to train service providers in trauma-informed care (TIC), specifically, how to recognize and respond to youth in a way that does not re-traumatize them, as well as how to promote referrals of trauma-affected youth to the appropriate support systems to heal from trauma (SAMHSA, 2014).…”

Evaluation of Parent-Child Interaction Therapy on Anxiety Level in Pre-Elementary School Children: A Randomized Controlled Trial

“…The treatment is given to children aged between 2 and 8 years with destructive behavior background. This therapy was first developed and conducted with the aim of filling the treatment gap in children psychological hygiene services in different age groups (Gurwitch et al, 2015). PCIT has been successfully used in America and some other countries due to its cost-effective approach, but its application is limited in Asia (Chen & Fortson, 2015).…”