Regional CARE events share findings from 5-year study

RCCP director Martha Holden addressing attendees

The BCTR’s Residential Child Care Project (RCCP) disseminates model techniques and systems to prevent institutional child abuse and neglect. The RCCP’s CARE Model guides childcare agencies to support safe environments, strong programmatic elements, and a wide-variety of treatment programs and interventions that are trauma-sensitive and developmentally appropriate.

Supported by The Duke Endowment, the RCCP is completing a 5-year multi-site study of the CARE Model by analyzing data and writing papers to disseminate study outcomes. Additionally, the RCCP set up a series of Community of Practice regional events to share the new information with their CARE agencies, allowing agencies and the RCCP to not only learn from the research, but from one another in a collaborative way through discussion and networking.

One such Community of Practice regional event took place on August 12, 2015 at Waterford Country School in Connecticut.  RCCP staff began by providing the context for the research. Specifically, Debbie Sellers (BCTR director of research and evaluation) gave a presentation explaining translational research (TR) and the RCCP approach to TR.  Charlie Izzo (RCCP research associate) described the CARE Theory of Change, which outlines the change processes RCCP facilitates at each agency, and how these relate to the expected measurable outcomes.

Next, RCCP staff summarized the results from three related CARE studies. Charlie Izzo described the results of a study conducted across 11 agencies demonstrating that CARE implementation led to an average decline in three types of behavioral incidents: aggression toward staff, aggression towards peers, and property destruction. Izzo also presented findings from a study across 13 agencies demonstrating that CARE implementation led to a significant improvement in youth reports of the quality of their relationship with agency direct care providers. Finally, Michael Nunno co-presented with representatives from an experienced CARE agency about a study they conducted together. These findings replicated and extended the findings of the Duke study, demonstrating that CARE led not only to fewer behavioral incidents, but also fewer physical restraints and less frequent use of psychotropic medication.

The Connecticut audience was a diverse group, including agency administrators, program managers, and supervisors, as well as board members and those in research/evaluation roles. Of particular interest to attendees was the finding that as relationship quality improved, behavioral incidents decreased.  This information would support, encourage and validate the efforts of front line staff.  

Attendees were actively involved throughout the day in helping to clarify the interpretation and practical significance of the findings, and proposing future research directions that would help inform their efforts to implement CARE and better meet the needs of children and families. For example, during a discussion about their unique roles in implementing CARE, clinicians realized that they are a natural group to educate agency direct care staff about applying CARE principles in their daily work.  RCCP staff is incorporating this clinician input into a tool in development that measures implementation quality across agency sectors.  Agency clinicians also stimulated discussion about developing a tool to specifically assess practices that clinicians use to strengthen CARE implementation and sustainability over time.

The day ended with a series of interactive small-group discussions about the essential elements within the CARE implementation process led by Lisa McCabe and Frank Kuhn that were most likely to lead to positive outcomes and long-term sustainability. The ideas generated through these discussions not only helped the CARE team refine its implementation processes, but also pointed the way toward several promising research questions.

William Martin, executive director for Waterford was particularly pleased with the opportunities that this event provided for his staff, “I want to say that being asked to host this event provided an opportunity for my staff that they never could have gotten any other way,” and that RCCP “continues to do things that change our lives here at Waterford Country School and I could not be more appreciative.”

Two additional Community of Practice regional events were held on May 20, 2015 in Statesville, NC and on October 15, 2015 in Brisbane, Australia.

Supporting Young Families: The Role of Social Network Analysis

Young parents, especially teen parents, must depend on a network of support and multiple services to raise their children, achieve educational and financial goals, and keep their families healthy. Resources for expectant and parenting teens and young adults may come from many directions: supportive housing, child care, and employment services, to name a few – but often there is no clearly identifiable system that coordinates these efforts.

Pathways to Success, an initiative of the New York State Department of Health, aims to better connect parenting teens and young adults to key resources in Buffalo, Rochester, and the Bronx. The initiative funds one community college and one public school district in each community, with technical assistance provided by the BCTR’s ACT for Youth Center of Excellence. Specifically, ACT staff members Amanda Purington, Dora Welker, Divine Sebuharara, Mary Maley, Christy Heib, Jane Powers, and Heather Wynkoop-Beach have all played important roles on various parts of this initiative.

While Pathways grantees had a good sense of available services, coordinating these services to best serve youth in need was a daunting challenge. ACT staff recognized that social network analysis could be used in these communities to both create a distinct picture of existing networks and identify ways to strengthen collaborations.

Social network analysis is a set of methods for examining social structures and relationships within a network. Using the PARTNER social network analysis tool (created at the University of Colorado Denver), ACT staff worked with grantees to build customized online surveys and analyzed results in order to better understand collaborative activity within grantee networks and possibilities for new connections.

To define their networks, all the Pathways grantees were asked to compile a list of organizations with whom they already have relationships, or would like to be connected. ACT staff then developed PARTNER-based surveys tailored to each community. Next grantees distributed the surveys to their network lists, encouraging participation. Finally, ACT staff quantified the results, creating a visual representation of how the different organizations are -- or are not – connected.

These example maps show a city's grantees' (yellow dots) network with all collaborations (top) and then those at the "networking" and "coalition" levels of engagement.

Using the survey results, ACT staff created two types of network maps for the Pathways to Success initiative. The first map illustrates the level of collaboration. “Networking” is the most basic level: members of the network are aware of one another and may have informal relationships, but do not make any major decisions together. Networking is followed on the continuum by cooperation, coordination, and coalition, with collaboration at the highest level – when all major decisions are made collectively. The second map depicts frequency of contact among organizations. “Higher” and “more frequent” are not always ideal or feasible. The maps help spur discussion of what level of collaboration and frequency of contact would best serve young families in each community.

Three network indicators are also included in the analysis: 1) density -- the number of network ties relative to the total number of possible ties – which demonstrates the overall cohesiveness of the collaborative, 2) degree centralization, which refers to how well connected the members of the network are collectively, and 3) the level of trust among the members as a whole. For example, one community network had an overall trust score of 78%, indicating that a majority of responding organizations reported high levels of mutual trust. In addition to these whole network indicators, many other metrics can also be examined for each of the organizations in the network.

To discuss the findings, ACT for Youth held “data dialogue” sessions with grantees in each community. The network maps clarified where communication and collaboration are strong, and where there are opportunities to help the community better serve expectant and parenting young people. Some grantees were surprised that while their community was rich in resources, those resources were not being evenly accessed. Grantees also recognized a lack of coordination among certain organizations, resulting in some members of the network “doing the same job many times over.” Other grantees realized the need to focus on strengthening and building community systems to include organizations that may not have completed the survey, but should be at the table. For example, one group was surprised when they noticed that their county health department and a home visiting program had not responded to the survey, prompting the grantees to think about strengthening connections to include these valuable resources in future conversations.

Following these initial sessions, the grantees are holding meetings with their networks of community organizations. These meetings mirror the first data dialogue session, but allow an opening for the larger community to discuss how they can strengthen relationships in the entire network, bring others to the table, decrease duplication of services, and take steps to bridge gaps.

For the Pathways to Success initiative, this first implementation of the survey will serve as a baseline for the communities. ACT for Youth will help grantees administer the survey annually, documenting change over time, including stronger relationships among the vital organizations within each community.