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Collaboration lowers incidence of physical restraint for youth in care

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Michael Nunno and Elliott Smith

Michael Nunno and Elliott Smith

By Sheri Hall for the BCTR

Two BCTR researchers have been working with a Connecticut child welfare agency to implement and evaluate a program that promotes evidence-based approaches in supporting troubled youth. The Cornell researchers and two agency administrators published the results of their collaborative effort in March in the journal Child Welfare under the title “Benefits of embedding research into practice: An agency-university collaboration”.

Since 2009, Michael Nunno and Elliott Smith, members of the research team for the Residential Child Care Project (RCCP), have consulted with Waterford County School in Connecticut, which provides residential and day care to youth with mental health problems, behavioral issues, addiction and emotional problems.

A team of agency executives, clinicians, supervisors and staff members worked with RCCP staff and consultants to learn about and implement the Children and Residential Experiences: Creating Conditions for Change (CARE) program model.  The CARE model is a research-informed framework created at the BCTR by Martha Holden and her RCCP colleagues that focuses on improving interpersonal relationships between caregivers and youth.  Nunno and Smith were part of the effort to examine if CARE was making a difference in the day-to-day life of the children and staff. 

After the school implemented the program, agency administration reported a substantial decrease in physical restraints among the school’s residential population.  Physical restraints are safety interventions that hold a youth in order to contain physical behavior that is likely to result in injury to the youth or others.  They are, however, not without risks to both the child and the staff since they can have harmful or even fatal consequences. 

“The wonderful thing about the Waterford Country School from an evaluator’s perspective is that it has a thirty-year history of collecting and publishing administrative data on measures that matter to practitioners,” Nunno said.  Our job was to portray the data in relevant and meaningful ways so that it could inform practice, soften professional resistance to change, and add to the growing evidence that relationship-based, trauma-informed practice models can create safe and therapeutic physical spaces.”

“By examining the data, we documented a 48 percent decrease in restraint events within Waterford’s residential and shelter settings,” he said. “We were able to verify the staff perceptions and narratives that the Waterford agency was becoming a safer, calmer place.” 

Yet not all Waterford programs saw this decline.  “The day-school data showed an increase in restraints in the corresponding time frame,” Nunno said.  “Although we were all surprised at this finding, our analysis triggered the agency leadership to examine the children’s social and emotional regulation needs.  They involved day-school teachers and children’s families who designed unified approaches to meet those needs.  Within months of implementing these strategies we saw a significant decrease in the use of restraints.”

The partnership between RCCP and the school demonstrates RCCP’s success at monitoring and detecting problems, guiding solutions, improving practice, supporting learning organizations, and contributing more broadly to evidence-based practice. 

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RCCP at the 2014 EUSARF conference

(0) Comments  |   Tags: Charles Izzo,   conference,   Frank Kuhn,   Martha Holden,   Michael Nunno,   RCCP,  
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The 13th European Scientific Association on Residential and Family Care for Children and Adolescents Conference (EUSARF) 2014 was held in Copenhagen, Denmark on September 2-5, 2014 and the BCTR's Residential Child Care Project (RCCP) was well represented. This conference is held biannually and presents an opportunity for researchers and practitioners from Europe and around the world to exchange and discuss the latest international research and practice in child and family care. The heading for this year’s conference was "Making a Difference," focusing on ways to translate positive experiences and outcomes into best practices that make a difference in the lives of vulnerable children and their families.

Nunno, Holden, Izzo, and Kuhn

Nunno, Holden, Izzo, and Kuhn

The RCCP's Michael Nunno, Martha Holden, Charlie Izzo, Frank Kuhn, Bill Martin, and Sharon Butcher presented a symposium on Implementing, Evaluating and Sustaining a Research and Principle-based Program Model in Residential Care with Children and Adolescents: Learning from the Cornell CARE Program Experience. During this 2-hour symposium, the RCCP faculty

  • gave an overview of the CARE model and implementation process
  • shared the preliminary results from the 4- year quasi-experimental study of 14 agencies implementing the CARE model
  • discussed the complexity of implementing a principled-based model in residential therapeutic care organizations
  • and used a single case study to illustrate the impact of CARE and the RCCP’s Therapeutic Crisis Intervention (TCI) System on one organization that has a range of services to children and families

The conference also saw the launch of a new book, Therapeutic Residential Care For Children and Youth: Developing Evidence-Based International Practice, edited by J. Whitaker, J. del Valle and L. Holmes (Jessica Kinsgley Publishers). Martha Holden, James Anglin, Michael Nunno, and Charlie Izzo wrote the chapter, Engaging the Total Therapeutic Residential Care Program in a Process of Quality Improvement: Learning from the CARE Model, contributing the effort to take an international look at the current practice in therapeutic residential care.

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Nunno delivers keynote at British Institute for Learning Disabilities conference

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0089_12_024.jpgMichael Nunno delivered the keynote address at the annual British Institute for Learning Disabilities (BILD) conference in Glasgow, Scotland on May 9, 2014. His talk addressed "Elements of organisational toxicity in children's treatment facilities that leads to aggression and maltreatment." He was also a guest speaker at BILD's pre-conference research workshop, discussing "Managing the journey through the complexity of trauma informed care: Lessons from the implementation of a principle-based program model." Dr. Nunno is a senior extension associate with the Residential Child Care Project in the Bronfenbrenner Center.

The 2014 BILD conference outlined ways to turn research into daily practice and showed how positive behavior support approaches can be applied across a wide range of settings and supports. Additionally, speakers provided examples of frameworks for implementation, including qualitative outcomes from international perspectives.

A popular feature at the conference was the 20-foot-long graphic facilitation wall, where the messages from the event, and the role and future for positive behavior support were illustrated by artists from Creative Connection (detail featuring Michael Nunno below).

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