Overview of the CARE Model Implementation and Research ProgramNECA Conference

Sao Paulo, November, 2014

Prof. James AnglinSchool of Child and Youth CareUniversity of Victoria, BC, Canada

Core Concepts

Best Interest of the Child Struggle for Congruence Evidence Informed Program Model

Holden, Anglin, Nunno, & Izzo (2014)

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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)

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Quasi-Experimental Wait-List Design

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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

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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

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CARE Principles

Relationship based Developmentally focused Family involved Competence centered Trauma informed Ecologically oriented

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Levels of the Organization

External agencies Leadership and management Supervisors and clinical staff Direct caregivers Children and families

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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

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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 peoplewant to putthe lid on

Commitment to CARE by agency

Embracing 6 principles

Understanding key concepts(beliefs, attitudes, assumptions)

Working through applications

Re

Re-

Re

Re

Integration of the CARE Philosophy

Experiencing CARE effectiveness

Gaining confidence

Re

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.

SocializedMindset

Self-authoringMindset

Self-transformingMindset

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!

ReferencesAnglin, 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), 253-266.

Li, J. & Julian, M.M. (2012). Developmental relationships as the active ingredient: A unifying working hypothesis. American Journal of Orthopsychiatry, 82 (2) 157-166.