AN EVIDENCE-BASED PROGRAM MODEL FOR FACILITATING THERAPEUTIC RESPONSES TO PAIN-BASED BEHAVIOR IN RESIDENTIAL CARE

May combine two claims.

WCS staff recognized the relatively sharp increase in the day student restraint rate, reflected on possible causes, and implemented a plan of action based on the CARE principles.

“WCS staff recognized the relatively sharp increase in the day student restraint rate, reflected on possible causes, and implemented a plan of action based on the CARE principles.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

A community of practice has developed among organizations that implement the CARE program model.

“In addition, a community of practice has developed among organizations that implement the CARE program model.”

May combine two claims.

Most staff were trained during the first 12 months of implementation, so the primary increase in knowledge occurred over that time period.

“Most staff were trained during the first 12 months of implementation so the primary increase in knowledge occurred over that time period.”

May combine two claims.

More than 90% of participants reported that they plan to (80%) or already (10%) use the material in their jobs and that they definitely (45%) or probably (47%) know the material.

“More than 90% of participants reported that they plan to (80%) or already (10%) use the material in their jobs and that they definitely (45%) or probably (47%) know the material.”

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

The average length of stay was 6.7 months, so relatively few children completed more than one survey.

“The average length of stay was 6.7 months, so relatively few children completed more than one survey.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

In most organizations, full implementation of CARE is achieved towards the end of the 3-to 4-year initial implementation process.

“In most organizations, full implementation of CARE is achieved towards the end of the 3to 4-year initial implementation process.”

May combine two claims.

Children develop and thrive by turning to adults who provide support and comfort when they experience distress; in this way children learn to self-regulate and cope with these emotions.

“Children develop and thrive by turning to adults who provide support and comfort when they experience distress; in this way children learn to self-regulate and cope with these emotions.”

Classified as probably not a substantial claim.

With the focus on the developmental relationship as their primary therapeutic tool, staff are better equipped to diffuse momentary situations that could otherwise culminate in dangerous or destructive outcomes.

“With the focus on the developmental relationship as their primary therapeutic tool, staff are better equipped to diffuse momentary situations that could otherwise culminate in dangerous or destructive outcomes.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

This approach cultivates personal investment on the part of staff members and serves to reduce the sense of being constrained or controlled by bureaucratic rules.

“This approach cultivates personal investment on the part of staff members and serves to reduce the sense of being constrained or controlled by bureaucratic rules.”

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

Children in residential care often have a host of other risk factors that impair their healthy development.

“and a host of other risk factors that impair their healthy development (Ryan & Testa, 2005).”

• cites Ryan & Testa, 2005 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Potential crisis events become opportunities to work together with the children to make sense of their feelings and find other ways to cope with their emotions.

“Potential crisis events become opportunities to work together with the children to make sense of their feelings and find other ways to cope with their emotions.”

May combine two claims.

The child-adult relationship provides a safe haven for children when distressed and a secure base children need to seek out new experiences and take on new learning and challenges.

“This relationship not only provides a safe haven for children when distressed, but provides the secure base children need to seek out new experiences and take on new learning and challenges.”

May combine two claims.

Children learn to go to staff when they are feeling stressed and are flooded by emotions and see staff as a source of support and strength.

“Children learn to go to staff when they are feeling stressed and are flooded by emotions and see staff as a source of support and strength (Feeney & Collins, 2015).”

• cites Feeney & Collins, 2015Not matched

  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.

In residential care, children need to experience a therapeutic milieu that supports their rehabilitation and provides them opportunities to grow, develop and thrive.

“In residential care, children need to experience a therapeutic milieu that supports their rehabilitation (James, 2011) and provides them opportunities to grow, develop and thrive.”

• cites James, 2011Not matched

  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).

Providing a well-designed and nurturing developmental setting where children can develop a core set of assets such as competence, self-efficacy, relationship skills, emotional regulation, and empathy is the best way to accomplish therapeutic residential care.

“This is best accomplished by providing a well-designed and nurturing developmental setting where children can develop a core set of assets (McNeely & Blanchard, 2009) such as competence, self-efficacy, relationship skills, emotional regulation, and empathy.”

• cites McNeely & Blanchard, 2009Not matched

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

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

These adults provide the encouragement and security children need to move outside their comfort zone and take on new challenges.

“They provide the encouragement and security children need to move outside their comfort zone and take on new challenges (Feeney & Collins, 2015).”

• cites Feeney & Collins, 2015Not matched

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

Probably not a substantial claim: may not pass S4 (based).

As staff learn to understand and apply developmentally and trauma-sensitive approaches, they create fewer situations where children feel frustrated or angry.

“At the same time, as staff learn to understand and apply developmentally and trauma-sensitive approaches, they create fewer situations where children feel frustrated or angry.”

Probably not a substantial claim: may not pass S4 (based).

These same adults are key to motivating children to learn new skills and practice a new way of being.

“These same adults also are key to motivating children to learn new skills and practice a new way of being.”

Probably not a substantial claim: may not pass S4 (based).

Staff are able to respond with more sensitivity to emotionally distressed children and pain-based behavior.

“Staff are able to respond with more sensitivity to emotionally distressed children and painbased behavior.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Providing a safe place to breathe and practice new skills supported by competent and caring adults helps children to thrive and realize more of their potential.

“Providing a safe place to breathe and practice new skills supported by competent and caring adults helps children to thrive and realize more of their potential.”

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

Children in residential care often have a history of unsuccessful placement in foster care.

“children in residential care often have a history of unsuccessful placement in foster care (Zinn, DeCoursey, George, & Courtney, 2006)”

• cites Zinn, DeCoursey, George, & Courtney, 2006Not matched

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

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

Sixteen agencies agreed to participate, including seven which were part of a larger parent organization with campuses across the state, and each campus was treated as a separate entity.

“Sixteen agencies agreed to participate, including seven which were part of a larger parent organization with campuses across the state.Each campus was treated as a separate entity.”

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

The child perceptions survey asked respondents to rate how often staff interact well with them in six scenarios.

“The respondent was asked to rate how often the staff interact well with them in six scenarios listed in Table 2.”

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

The staff survey included the Organizational Social Context instrument as well as questions about the respondent's current practice, knowledge, beliefs, and demographic characteristics.

“The staff survey included the Organizational Social Context instrument (Glisson & Hemmelgarn, 1998) as well as questions about the respondent's current practice, knowledge, beliefs, and demographic characteristics.”

• cites Glisson & Hemmelgarn, 1998 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S4 (based).

The frequency of restraints is a meaningful indicator of interactional quality because the use of restraint typically represents a staff-child interaction that resolved unsuccessfully.

“The frequency of restraints is considered a meaningful indicator of interactional quality because the use of restraint typically represents a staff-child interaction that resolved unsuccessfully.”

• AssumptionRests on an assumption: The use of restraint typically represents a staff-child interaction that resolved unsuccessfully.

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

Of the 16 agencies, one became ineligible due to a change in their target population, one discontinued due to change in administrative priorities, and one closed before implementation began.

“Of the 16 agencies, one became ineligible due to a change in their target population, one discontinued due to change in administrative priorities, and one closed before implementation began.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

The addition of ongoing consultation is expected to help direct-care staff internalize the principles and incorporate them more readily and to help supervisors motivate and support their staff around the use of CARE principles.

“The addition of ongoing consultation is expected to help direct-care staff internalize the principles and thus incorporate them more readily and to help supervisors motivate and support their staff around the use of CARE principles.”

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

Across the 13 participating agencies and the 5-year duration of the study, 701 staff members contributed a total of 1488 completed surveys.

“Across the 13 participating agencies and the 5-year duration of the study, 701 staff members contributed a total of 1488 completed surveys.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Maintaining and sustaining fidelity of CARE implementation requires on-going attention.

“As with any intervention, however, maintaining and sustaining fidelity of CARE implementation requires on-going attention.”

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

To participate agencies had to serve primarily children referred by social services, be licensed by a state agency, be willing to be placed on a 12-month waitlist, and have no previous exposure to the CARE program model.

“To participate agencies had to (a) serve primarily children referred by social services, (b) be licensed by a state agency, (c) be willing to be placed on a 12-month waitlist, and (d) have no previous exposure to the CARE program model.”

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

The child survey included questions about the child's relationship with and attachment to the staff, as well as gender and race.

“The child survey included questions about the child's relationship with and attachment to the staff, as well as gender and race.”

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

Ultimately, six agencies participated in the first cohort, which began implementation in 2010, and seven agencies participated in the second cohort which began implementation in 2011.

“Ultimately, six agencies participated in the first cohort, which began implementation in 2010, and seven agencies participated in the second cohort which began implementation in 2011.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

The CARE program model provides a principle-based compass for improving all relationships within the organization.

“In essence, the CARE program model provides a principle-based compass for improving all relationships within the organization.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

The milieu becomes therapeutic in that routine daily activities become opportunities for achieving small successes that reduce pain-based behaviors and eventually lead to accomplishing developmental milestones and enhancing a sense of normality.

“The milieu becomes therapeutic in that routine daily activities become opportunities for achieving the small successes that reduce pain-based bahaviors and eventually lead to accomplishing developmental milestones and enhancing a sense of normality.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

These perceptions are expected to contribute to improving children's social and emotional well-being and to reducing critical incidents involving pain-based behaviors.

“These perceptions are ultimately expected to contribute to improving children's social and emotional well-being and to reducing critical incidents involving pain-based behaviors (e.g., runaways, assault, and restraints).”

May combine two claims.

CARE has a scientific rating of 3 (promising research evidence) in the California Evidence-Based Clearinghouse and is listed under Higher Levels of Placement and Alternatives to Long-Term Residential Programs.

“a fact that is acknowledged in the scientific rating of 3 (promising research evidence) for CARE in the California Evidence-Based Clearinghouse (http://www.cebc4cw.org/program/children-and-residential-experiences-care/detailed),where CARE is listed under both the Higher Levels of Placement and the Alternatives to Long-Term Residential Programs topics.”

• cites California Evidence-Based ClearinghouseNot matched

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

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Implementation of the CARE program requires less reliance on rules and consequences and increased flexibility.

“Implementation of the CARE program requires less reliance on rules and consequences and increased flexibility.”

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

The results for the day students illustrate the benefits of on-going careful collection and monitoring of a measure that matters.

“The results for the day students illustrate the benefits of on-going careful collection and monitoring of a measure that matters.”

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

The agency provided individual client characteristics and agency-wide counts of behavioral incidents that occurred each month for the duration of the study.

“In addition, the agency provided individual client characteristics (e.g., type of placement and length of time at the agency) and agency-wide counts of the behavioral incidents (aggression toward staff or peers, property damage, runaways, and self-harm) that occurred each month for the duration of the study.”

Classified as probably not a substantial claim.

Interrupted time series regression models that controlled agency characteristics and accounted for nesting of incidents within agencies were used to compare trends during baseline to those during CARE implementation while controlling for agency characteristics.

“Interrupted time series regression models that controlled agency characteristics and accounted for the nesting of incidents within agencies were used to compare the trends during baseline to those during CARE implementation while controlling for agency characteristics (e.g., cohort, Organization Social Context profile).”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Staff who learn how to set developmentally appropriate expectations will create fewer opportunities for children to feel frustrated or angry when they are unable to meet expectations.

“For example, staff who learn how to set developmentally appropriate expectations will create fewer opportunities for children to feel frustrated or angry when they are unable to meet expectations.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Behavioral incidents indicate behavioral dysregulation and, in aggregate, represent a marker for the broader pattern of interaction between children and staff.

“These behavioral incidents indicate behavioral dysregulation and thus, in aggregate, represent a marker for the broader pattern of interaction between children and staff.”

Probably not a substantial claim: may not pass S4 (based).

When staff-child interactions are enhanced as outlined, children develop more positive perceptions about themselves and their relationships and interactions with staff.

“The TOC further indicates that when staff-child interactions are enhanced as outlined, children develop more positive perceptions about themselves and their relationships and interactions with staff.”

Classified as probably not a substantial claim.

The CARE Theory of Change articulates pathways through which CARE is expected to improve socio-emotional and developmental outcomes for children.

“The CARE Theory of Change (TOC; see Figure 1) articulates the pathways through which CARE is expected to improve the socio-emotional and developmental outcomes for children (Holden et al., 2010;Holden, Anglin, Nunno, & Izzo, 2014).”

• cites Holden et al., 2010Not checked — no full text of the source
• cites Holden, Anglin, Nunno, & Izzo, 2014Not matched

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

Classified as probably not a substantial claim.

In the child perceptions survey, the sum of responses to 33 questions measured the quality of the relationship with staff as perceived by the respondent.

“In the child perceptions survey, the sum of responses to 33 questions measured the quality of the relationship with staff as perceived by the respondent.”

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

Across the 13 participating agencies and the 5-year duration of the study, 933 children completed 1264 surveys.

“Across the 13 participating agencies and the 5-year duration of the study, 933 children completed 1264 surveys.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

By working in alignment with the six principles and building a developmental relationship, staff are able to be genuine within their individual relationships with children and, at the same time, provide a consistent, predictable environment for the children.

“By working in alignment with the six principles and building a developmental relationship, staff are able to be genuine within their individual relationships with children and, at the same time, provide a consistent, predictable environment for the children.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

The environment becomes less chaotic, more predictable, and feels more normal to all involved.

“The environment becomes less chaotic, more predictable, and feels more normal to all involved.”

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

The first annual survey served as the baseline for Cohort 1 and the pre-baseline for Cohort 2.

“The first annual survey served as the baseline for Cohort 1 and the pre-baseline for Cohort 2.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

If the agency has not met the certification criteria, concrete recommendations for improvements will facilitate the agency's effort to improve their implementation of CARE and meet the certification criteria.

“If the agency has not met the certification criteria, concrete recommendations for improvements will facilitate the agency's effort to improve their implementation of CARE and meet the certification criteria.”

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

Data collection included anonymous staff and confidential child surveys completed annually for 4 years in Cohort 1 and 5 years in Cohort 2.

“Data collection included anonymous staff and confidential child surveys completed annually for 4 years in Cohort 1 and 5 years in Cohort 2.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

The CARE model honors the true complexity of residential work and strives to help staff develop their abilities and achieve the necessary growth mindset to deal effectively with such complexity.

“The CARE model honors the true complexity of residential work and strives to help staff develop their abilities and achieve the necessary growth mindset (Dweck, 2008;Kegan & Lahey, 2009) to deal effectively with such complexity.”

• cites Dweck, 2008Not matched

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

• cites Kegan & Lahey, 2009Not matched

  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), S4 (based).

Leaders and supervisors support their staff by modeling the CARE principles in their relationships with all staff.

“Leaders and supervisors support their staff by modeling the CARE principles in their relationships with all staff, from direct care to upper management to maintenance and other support staff.”

Probably not a substantial claim: may not pass S4 (based).

Intensive agency-wide training sessions and technical assistance activities are expected to help personnel learn to enhance interactions with children by consistently using CARE principles.

“As outlined in the TOC, intensive agency-wide training sessions and a variety of technical assistance activities are expected to help personnel at all levels of the facility learn how to enhance interactions with children by consistently using the CARE principles (see Table 1) to guide those interactions.”