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Cited by 56Child Welfare and AdoptionCrime Patterns and InterventionsBehavioral and Psychological Studies

Intervening at the Setting Level to Prevent Behavioral Incidents in Residential Child Care: Efficacy of the CARE Program Model

Open access
Izzo, Charles V., Smith, Elliott G., Holden, Martha J., Norton, Catherine I., Nunno, Michael A., Sellers, Deborah E.·2016·Prevention Science
DOI 10.1007/s11121-016-0649-0PMC PMC4887550
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Abstract

The current study examined the impact of a setting-level intervention on the prevention of aggressive or dangerous behavioral incidents involving youth living in group care environments. Eleven group care agencies implemented Children and Residential Experiences (CARE), a principle-based program that helps agencies use a set of evidence-informed principles to guide programming and enrich the relational dynamics throughout the agency. All agencies served mostly youth referred from child welfare. The 3-year implementation of CARE involved intensive agency-wide training and on-site consultation to agency leaders and managers around supporting and facilitating day-to-day application of the principles in both childcare and staff management arenas. Agencies provided data over 48 months on the monthly frequency of behavioral incidents most related to program objectives. Using multiple baseline interrupted time series analysis to assess program effects, we tested whether trends during the program implementation period declined significantly compared to the 12 months before implementation. Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away. Effects on aggression toward peers and self-harm were also found but were less consistent. Staff ratings of positive organizational social context (OSC) predicted fewer incidents, but there was no clear relationship between OSC and observed program effects. Findings support the potential efficacy of the CARE model and illustrate that intervening "upstream" at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions.

AI snapshot

Written from the paper’s full text.

TL;DR

This multiple-baseline interrupted time series of 11 residential group care agencies found that implementing the CARE setting-level program was associated with significant declines in monthly behavioral incidents, especially aggression toward staff, property destruction, and runaways. Effects on peer aggression and self-harm were less consistent across cohorts, and positive organizational social context predicted fewer incidents but did not clearly moderate program effects.

Key findings

  • Across 11 agencies over 48 months, CARE implementation was associated with significant program effects for aggression toward staff (IRR = 0.87, 95% CI [0.81, 0.94]), property destruction (IRR = 0.86 [0.79, 0.92]), and runaway (IRR = 0.93 [0.87, 0.99]); implementation-period declines were 4–8% per month in cohort 1.
  • Effects for aggression toward peers and self-harm were less consistent: overall program effects were IRR = 0.89 [0.84, 0.93] and 0.92 [0.85, 0.99], but cohort 1 showed declines (0.79 [0.73, 0.86]; 0.85 [0.78, 0.95]) while cohort 2 did not (0.98 [0.91, 1.04]; 0.97 [0.88, 1.08]).
  • More positive baseline OSC predicted fewer incidents involving aggression toward peers (IRR = 0.31 [0.19, 0.51]) and property destruction (IRR = 0.29 [0.13, 0.62]); however, OSC did not clearly moderate observed program effects, and local implementation progress was not related to incident rates.
  • Baseline monthly incident rate averaged 0.26 per resident; training reached an average of 78% of agency staff (range 68–88%), and all agencies received 12 quarterly visits over 36 months.

Methods

  • Design: multiple baseline interrupted time series comparing a 12-month pre-implementation baseline to a 36-month implementation period in two successive cohorts (five agencies in 2010, six in 2011); 11 agencies served mostly youth referred from child welfare.
  • Data: monthly agency administrative incident reports for five types (aggression toward staff, aggression toward peers, self-harm, property destruction, runaways), converted to per capita rates using average monthly residents; baseline staff OSC survey; consultant training/visit records and retrospective local implementation progress ratings.
  • Analysis: mixed effects negative binomial regression estimating incidents per resident per month, with fixed effects for baseline and implementation trends, cohort, parent organization, OSC profile, exposure ln(Residents), and random effects for agency-level intercepts and trends.

Limitations

  • Stated: incident reports rely on staff judgment about whether to file (except runaways), lack severity distinctions, and are agency-level, so cannot identify highly disruptive individuals; follow-up beyond 36 months is unknown; mechanisms of change are not identified.
  • Stated/evident: cohort 2 did not show consistent effects for peer aggression and self-harm, so historical factors or cohort-specific conditions cannot be ruled out; increasing baseline trends for some outcomes may have contributed, though effects persisted after excluding agencies with baseline trends.
  • Evident: local implementation progress ratings were retrospective and available only for the final year; the small number of agencies limited stable three-way interactions and may constrain generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s11121-016-0649-0

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

1 of 17 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    Higher baseline OSC profile scores predicted fewer incidents of aggression toward peers and property destruction.

    “OSC profile, centered at 2.0a | 0.31 [0.19, 0.51]** | 0.39 [0.15, 1.06] | 0.29 [0.13, 0.62]** | 0.73 [0.30, 1.77] | 0.56 [0.22, 1.45]”
    Quote in the paperNot a substantial claim
  • Findingown data

    Effects of CARE on aggression toward peers were found but were less consistent.

    “Effects on aggression toward peers and self-harm were also found but were less consistent.”
    Quote in the paperSubstantial claim
  • Findingown data

    Effects of CARE on self-harm were found but were less consistent.

    “Effects on aggression toward peers and self-harm were also found but were less consistent.”
    Quote in the paperSubstantial claim
  • Findingown data

    There was no clear relationship between OSC and observed program effects.

    “Staff ratings of positive organizational social context (OSC) predicted fewer incidents, but there was no clear relationship between OSC and observed program effects.”
    Quote in the paperNot a substantial claim
  • Findingown data

    More negative OSC profiles were associated with a steeper baseline increase in aggression toward peers.

    “More negative OSC profiles were associated with a steeper baseline increase in aggression toward peers.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 24
  • The quote only partly states this claim. 3
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Interpretationown data

    The increasing baseline rates for some incident types may have contributed to the significant declines observed during implementation, but program effects persisted after excluding agencies with significant baseline trends, making regression to the mean a less plausible explanation for the findings.

    “The increasing baseline rates for some incident types may have contributed to the significant declines observed during implementation. However, program effects persisted after excluding agencies with significant baseline trends, making regression to the mean a less plausible explanation for our findings (Smith 2012).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Smith 2012 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • The quote only partly states this claim.

    Findingown data

    CARE implementation was associated with significant declines in monthly incident rates involving property destruction, compared with the 12-month pre-implementation baseline.

    “Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    CARE implementation was associated with significant declines in monthly incident rates involving running away, compared with the 12-month pre-implementation baseline.

    “Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    CARE implementation was associated with significant declines in monthly incident rates involving youth aggression toward adult staff, compared with the 12-month pre-implementation baseline.

    “Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In cohort 2, whose baseline period was in 2010, an increasing trend was evident for property destruction, while other incident types showed no change.

    “In cohort 2, for whom the baseline period was in 2010, an increasing trend was evident for property destruction, and other incident types showed no change.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Training sessions conducted in year 1 reached an average of 78% of agency staff (range 68 to 88%).

    “Training sessions conducted in year 1 reached an average of 78 % of agency staff (range 68 to 88 %).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Having a parent organization and having a positive organizational social context (OSC) profile were associated with substantially lower rates of aggression toward peers and property destruction.

    “Having a parent organization and having a positive OSC profile were associated with substantially lower rates of aggression toward peers and property destruction.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Significant variance between agencies was found in the frequency of incidents at the start of CARE and, to a lesser extent, in the trends over time.

    “Significant variance between agencies was found in the frequency of incidents at the start of CARE and, to a lesser extent, in the trends over time.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Cohort 2 implementation trends did not differ from cohort 1 for aggression toward staff, property destruction, and runaway, but they did differ for aggression toward peers and self-harm.

    “Cohort 2 trends did not differ from cohort 1 for sggression toward staff, property destruction, and runaway, but they did differ for aggression toward peers and self-harm.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Consultants trained at least one local CARE educator at each agency within the first year.

    “Consultants trained at least one local CARE educator at each agency within the first year, and additional educators were trained as needed to continue training new staff and provide refreshers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    All agencies established an implementation team that remained intact throughout the study period.

    “All agencies established an implementation team that remained intact throughout the study period.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    During the baseline period for cohort 1 (2009), there was an increasing trend for aggression toward peers, aggression toward staff, and property destruction.

    “There was an increasing trend for aggression toward peers, aggression toward staff, and property destruction during baseline for cohort 1, which occurred in 2009.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    There was little variance in consultant-level implementation activities.

    “There was little variance in consultant-level implementation activities.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For aggression toward staff, property destruction, and runaway, there was a declining trend during implementation, and it was significantly different from the baseline trend, as predicted.

    “For aggression toward staff, property destruction, and runaway, there was a declining trend during implementation, and it was significantly different from the baseline trend, as predicted.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The three agencies with positive OSC profiles showed only sporadic progress, while the two in the negative range showed consistent progress.

    “The three agencies with positive profiles, ranging from 2.8 to 3.0, showed only sporadic progress, while the two in the negative range (1.1 to 1.3) showed consistent progress.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingnone given

    Although consultants followed a standard progression of activities, implementation unfolded in unique ways at different agencies, and what was essential at one agency may not have helped another.

    “Although consultants followed a standard progression of activities, implementation unfolded in unique ways at different agencies, and what was essential at one agency may not have helped another.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The same pattern of a declining implementation trend significantly different from baseline held for aggression toward peers and self-harm, but was limited to cohort 1.

    “This same pattern held for aggression toward peers and self-harm but was limited to cohort 1.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One agency was still considered to be in the planning stage and had made only minor progress, a rating of 2.

    “One agency was still considered to be in the planning stage and had made only minor progress, a rating of 2.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    All agencies participated in 12 quarterly visits over the 36-month implementation period.

    “All agencies participated in 12 quarterly visits over the 36-month implementation period, lasting from 1 to 5 days depending on mutually determined need.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The data do not support the assumption that positive OSC would facilitate better implementation; agencies rated as having the most consistent progress tended to have either negative or average OSC profiles.

    “The data do not support our assumption that positive OSC would facilitate better implementation; rather, agencies rated as having the most consistent progress tended to have either negative or average OSC profiles.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At the start of CARE (month 0), per capita incident rates were greater than zero for all incident types, and there were no differences between cohorts.

    “Per capita rates at month 0 were greater than zero for all incident types, and no cohort differences were found.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In post hoc analyses, significant effects of CARE on incident rates were found as previously described, but the LIP measure was not related to incident rates and did not moderate the relationship between CARE and the outcomes.

    “Within these reduced models, significant effects of CARE were found, as previously described. In no case, however, was LIP related to incident rates nor did it moderate the relationship between CARE and the outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In analyses excluding agencies with significant baseline trends, implementation trends decreased relative to baseline for aggression toward peers (IRR = 0.90, 95% CI [0.85, 0.97]), aggression toward staff (IRR = 0.91, 95% CI [0.84, 0.99]), property destruction (IRR = 0.88, 95% CI [0.79, 0.99]), and self-harm (IRR = 0.93, 95% CI [0.86, 1.00]).

    “Implementation trends decreased relative to baseline for four variables: aggression toward peers (IRR = 0.90, 95 % CI [0.85, 0.97]), aggression toward staff (IRR = 0.91, 95 % CI [0.84, 0.99]), property destruction (IRR = 0.88, 95 % CI [0.79, 0.99]), and self-harm (IRR = 0.93, 95 % CI [0.86, 1.00]).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The third hypothesis was not supported: moderation of implementation trend by OSC profile was observed in only one variable and showed steeper incident reductions when baseline profiles were negative.

    “Our third hypothesis was not supported. Moderation of implementation trend by OSC profile was observed in only one variable and showed steeper incident reductions when baseline profiles were negative.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Aspects of organizational social context can create shared expectations and beliefs that affect how providers work with consumers in children's services organizations.

    “Aspects of organizational social context can create a set of shared expectations and beliefs that affect how providers work with consumers in children’s services organizations (Glisson et al. 2008).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Glisson et al. 2008 source

  • May combine two claims.

    Interpretationown data

    Intervening upstream at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions.

    “Findings support the potential efficacy of the CARE model and illustrate that intervening “upstream” at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Group care providers with little training in child development, behavior management, or dealing with complex trauma are less able to help residents manage emotions.
    • Rests on an assumption: Group care providers with little training in child development, behavior management, or dealing with complex trauma are more likely to respond to distressed youth in ways that trigger dangerous behavioral incidents.
    • Rests on an assumption: Incident reports are markers for a broader pattern of interaction among youth and adults, not simply indicators of behavioral dysregulation.
    • Rests on an assumption: Staff who understand and respond with more sensitivity to emotionally distressed residents will be better able to diffuse momentary situations that would otherwise culminate in dangerous or destructive behaviors requiring formal documentation.
    • Rests on an assumption: Staff who learn to set developmentally appropriate expectations will create fewer opportunities for youth to feel frustration or anger and more opportunities for success.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Prevention efforts can be enhanced by focusing on contextual factors that influence behavioral outcomes and provider practices.

    “Prevention efforts can be enhanced by focusing on contextual factors that influence behavioral outcomes and provider practices (Biglan 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Biglan 2004 source

  • May combine two claims.

    Premisecitation

    Behavioral incidents such as these can escalate into physical restraint or, in extreme cases, result in injury or death.

    “Given that incidents such as these can escalate into physical restraint or, in extreme cases, result in injury or death (Day 2002; Nunno et al. 2006), the potential benefits of reducing behavioral incidents can be profound.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Day 2002 source
    • cites Nunno et al. 2006 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The results say little about the mechanism of change responsible for the drop in incidents.

    “Finally, our results say little about the mechanism of change responsible for the drop in incidents.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Attributing a causal inference to the program effect is strengthened if key threats to internal validity are addressed, including maturation, history, and selection.

    “Attributing a causal inference to the program effect is strengthened if key threats to internal validity are addressed, including maturation, history, and selection (Shadish et al. 2002).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Shadish et al. 2002

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    The multiple baseline interrupted time series design is recommended for evaluating interventions when randomized controlled trials are not practical.

    “The multiple baseline interrupted time series design (ITS) is recommended for evaluating interventions when randomized controlled trials are not practical (Biglan et al. 2000; Shadish et al. 2002).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Biglan et al. 2000 source
    • cites Shadish et al. 2002

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Staff reported greater understanding of trauma's effect on youth behavior, leading to fewer confrontations and power struggles, less fear, and a more peaceful environment in the homes.

    “Staff reported greater understanding of trauma’s effect on youth behavior, leading to fewer confrontations and power struggles, less fear, and a more peaceful environment in the homes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Holden et al. 2014

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Approaches such as CARE may never replace individual-level program models, but they can create favorable conditions for effective prevention and health promotion.

    “Approaches such as CARE may never replace individual-level program models, but they can create favorable conditions for effective prevention and health promotion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The results are less consistent for aggression toward peers and self-harm; because significant declines were not observed in cohort 2, the decline in cohort 1 could be due to historical factors or conditions unique to those five agencies.

    “Our results are less consistent for aggression toward peers and self-harm. Given that significant declines were not observed in cohort 2, we cannot rule out the possibility that the decline in cohort 1 was due to historical factors or some other conditions unique to those five agencies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Poorer conditions at the start may make participants more motivated to try new innovation and more receptive to help, which would be consistent with the pattern that agencies with most consistent progress tended to have negative or average OSC profiles.

    “This would be consistent with an explanation that poorer conditions at the start may make participants more motivated to try new innovation and more receptive to help.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The data allow for estimation of trends during the 36-month implementation period, but it is unknown whether these improvements continued.

    “Our data allow for the estimation of trends during the 36-month implementation period, but it is unknown whether these improvements continued.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    CARE implementation did not address behavioral incident reporting or the conditions that should trigger a report, so the dependent variable was not confounded with the program content.

    “Notably, CARE implementation did not address behavioral incident reporting or the conditions that should trigger a report. Therefore, the dependent variable was not confounded with the program content.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Agency representatives indicated that there were no changes in the types of incidents requiring a formal report, the expectations or incentives to complete reports, or the definitions for any incident type.

    “Agency representatives indicated that there were no changes in the types of incidents requiring a formal report, the expectations or incentives to complete reports, or the definitions for any incident type.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The data collection process remained consistent except for one agency that assigned a staff member to complete the incident record form for half the study period but provided incident reports for the research team to code for the other half.

    “Our data collection process remained consistent except for one agency that assigned a staff member to complete our incident record form for half the study period but provided incident reports for our team to code for the other half.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Organizational social context can facilitate or stifle attempts to adopt evidence-based practices and innovations.

    “These can either facilitate or stifle attempts to adopt evidence-based practices and innovations (Aarons and Sawitzky 2006).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Aarons and Sawitzky 2006 source
40 of 40

  • The paper relies on this without support.

    Group care providers with little training in child development, behavior management, or dealing with complex trauma are less able to help residents manage emotions.

    “With little training in child development, behavior management, or dealing with complex trauma, they are less able to help residents manage emotions and more likely to respond to distressed youth in ways that trigger dangerous behavioral incidents (e.g., aggression, self-harm, running away).”

  • The paper relies on this without support.

    Group care providers with little training in child development, behavior management, or dealing with complex trauma are more likely to respond to distressed youth in ways that trigger dangerous behavioral incidents.

    “With little training in child development, behavior management, or dealing with complex trauma, they are less able to help residents manage emotions and more likely to respond to distressed youth in ways that trigger dangerous behavioral incidents (e.g., aggression, self-harm, running away).”

  • The paper relies on this without support.

    Incident reports are markers for a broader pattern of interaction among youth and adults, not simply indicators of behavioral dysregulation.

    “Incident reports are not simply indicators of behavioral dysregulation but also represent markers for a broader pattern of interaction among youth and adults.”

  • The paper relies on this without support.

    Staff who understand and respond with more sensitivity to emotionally distressed residents will be better able to diffuse momentary situations that would otherwise culminate in dangerous or destructive behaviors requiring formal documentation.

    “For example, staff that understand and respond with more sensitivity to emotionally distressed residents will be better able to diffuse momentary situations that would otherwise culminate in dangerous or destructive behaviors that require formal documentation.”

  • The paper relies on this without support.

    Staff who learn to set developmentally appropriate expectations will create fewer opportunities for youth to feel frustration or anger and more opportunities for success.

    “Similarly, by learning to set developmentally appropriate expectations, staff will create fewer opportunities for youth to feel frustration or anger and more opportunities for success.”

  • The authors state this as an assumption.

    Positive organizational social context (OSC) would facilitate better implementation of CARE.

    “The data do not support our assumption that positive OSC would facilitate better implementation”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A recent review found the design of the CARE evaluation to be the only one of seven studies that met inclusion criteria to have moderate rather than high risk of bias.

    “a recent review of organization-wide, trauma-informed care models in out-of-home care settings found the design of the CARE evaluation, as reported in Izzo et al. (2016), to be the only one of seven studies that met inclusion criteria to have moderate rather than high risk of bias (Bailey et al., 2018).”

    From AN EVIDENCE-BASED PROGRAM MODEL FOR FACILITATING THERAPEUTIC RESPONSES TO PAIN-BASED BEHAVIOR IN RESIDENTIAL CARE (2019) · cites this paper as Izzo et al. (2016)

  • In a previous quasi-experimental study of CARE involving 11 agencies, Izzo et al. (2016) found that CARE implementation led to significant reductions in behavioral incidents.

    “In a previous quasi-experimental study of CARE involving 11 agencies (all of which were included in the current study), Izzo et al. (2016) used interrupted time series analysis to show that CARE implementation led to significant reductions in behavioral incidents”

    From Improving relationship quality in group care settings: The impact of implementing the CARE model (2020) · cites this paper as Izzo et al. (2016)

  • Child perceptions of the quality of their relationship with staff improved during the implementation of CARE.

    “As depicted in Figure 5 (Izzo & Smith, 2016), child perceptions of the quality of their relationship with staff improved during the implementation of CARE.”

    From AN EVIDENCE-BASED PROGRAM MODEL FOR FACILITATING THERAPEUTIC RESPONSES TO PAIN-BASED BEHAVIOR IN RESIDENTIAL CARE (2019) · cites this paper as Izzo & Smith, 2016

    The Method > Measures section identifies behavioral incidents, staff-rated organizational social context, and consultant-rated implementation progress as measures; it does not describe children's ratings of their relationships with staff. The Discussion suggests improved youth–adult relationships as a possible explanation for declining incidents, but does not report improved child perceptions. Searches for child perceptions, relationship ratings, and Figure 5 found no passage establishing the claimed change. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Changes in staff childcare beliefs occurred during the first year of implementation.

    “Changes in beliefs that occurred during the first year of implementation are presented in Figure 4 (Izzo & Smith, 2016).”

    From AN EVIDENCE-BASED PROGRAM MODEL FOR FACILITATING THERAPEUTIC RESPONSES TO PAIN-BASED BEHAVIOR IN RESIDENTIAL CARE (2019) · cites this paper as Izzo & Smith, 2016

    The Results (Program Implementation; page unavailable) report first-year staff training, not changes in staff childcare beliefs. The Discussion (page unavailable) mentions staff understanding of trauma in a separate study after four years of implementation. Searches for childcare beliefs and Figure 4 found no first-year belief-change finding in our copy. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Aggression-toward-peers estimate falls outside its confidence interval

    Minor

    Table 3 reports a baseline trend estimate of 1.09 for aggression toward peers, but its stated 95% confidence interval ends at 1.05. A point estimate cannot lie outside its own confidence interval.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Eckenrode, J. E., Izzo, C. V., & Campa, M. (2003). Innovations in parent education and family support. In R. M. Lerner, F. Jacobs, & D. Wertlieb (Eds.), Promoting positive child, adolescent, and family development: A handbook of program and policy innovations. Thousand Oaks, CA: Sage Publications.
  2. Holden, M. J. (2009). Children and residential experiences: Creating conditions for change. Arlington, VA: Child Welfare League of America.
  3. 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 J. K. Whittaker, J. Fernandez Del Valle, & L. Holmes (Eds.), Therapeutic residential care with children and youth: Identifying promising pathways to evidence-based international practice. Philadelphia, PA: Jessica Kingsley.
  4. James, S. (2014). Evidence-based practices in therapeutic residential care. In J. K. Whittaker, J. Fernandez Del Valle, & L. Holmes (Eds.), Therapeutic residential care with children and youth: Identifying promising pathways to evidence-based international practice (142-155). Philadelphia, PA: Jessica Kingsley.
  5. StataCorp. (2013). Stata multilevel mixed-effects reference manual, Release 13. College Station, TX: Stata Press.

Cited by

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Related

Authors
Izzo, C. V., Smith, E. G., Holden, M. J., Norton, C. I., Nunno, M. A., & Sellers, D. E.
Affiliations
Cornell University (US)
Corresponding author
Izzo, Charles V.
ORCID
Venue
Prevention Science
Publisher
Springer Science and Business Media LLC
Published
2016-05-03
Volume
17
Issue
5
Pages
554-564
ISSN
  • 1389-4986 (ISSN-L)
  • 1573-6695
DOI
10.1007/s11121-016-0649-0
PMC
PMC4887550
OpenAlex
W2345931275
Cited by
56
References
40
Citations by year
2026: 6 · 2025: 3 · 2024: 7 · 2023: 7 · 2022: 5 · 2021: 11 · 2020: 5 · 2019: 5 · 2018: 6 · 2017: 1
FWCI
8.76
Type
journal article
Language
en
Open access
Licence
Locations
  • Prevention Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
The Duke Endowment (1819-SP)
Topics
  • Social Sciences › Safety Research › Child Welfare and Adoption
  • Social Sciences › Sociology and Political Science › Crime Patterns and Interventions
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
Keywords
residential care for children, group care, youth aggression, property damage, running away, self-harm, child welfare, personnel management, upstream interventions, relational dynamics
MeSH terms
Adolescent, Child, Child Behavior, Child Care, Female, Humans, Interpersonal Relations, Male, Models, Theoretical, Organizational Innovation, Surveys and Questionnaires, Social Work, Evidence-Based Practice

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-11-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-11-05.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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