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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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Spring 2017 Talks at Twelve

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This semester we welcome speakers from across campus and across the U.S. for our spring 2017 Talks at Twelve series. Talks at Twelve are held in the Beebe Hall second floor conference room and lunch is served. These talks are free and open to all. No RSVP or registration is required, but notice is appreciated if a larger group is planning to attend (email pmt6@cornell.edu).

 

Wednesday, February 22, 12:00-1:00pm
Mental and Behavioral Health Facilities: Critical Research and Design Recommendations
Mardelle M. Shepley, Design and Environmental Analysis, Cornell University

 

 

comfortTuesday, March 7, 12:00-1:00pm
Beyond the Peer-Reviewed Article: Making Research Relevant for Community Stakeholders and Policymakers
Megan Comfort, Behavioral Health and Criminal Justice Research Division, Research Triangle Institute

 

 

Thursday, March 16, 12:00-1:00pm
Pain and Presence: The Clinical Use of Media
Andrea Stevenson Won, Communication, Cornell University

 

 

 

Thursday, April 13, 12:00-1:00pm
Healthy Base Initiative: Evaluating Programs to Encourage Healthy Eating, Active Lifestyles, and Tobacco-Free Living
Marney Thomas, BCTR, Cornell University

 

 

Thursday, April 20, 12:00-1:00pm
Data Driven Policy-Making in Child Welfare
Dana Weiner, Chapin Hall Center for Children, University of Chicago

 

 

 

Tuesday, April 25, 12:00-1:00pm
Weill Cornell Behavioral Geriatrics: Cognitive Impairment in Hospitalized Adults & Palliative & Mental Health Care
Elissa Kozlov and Keiko Kurita, Weill Cornell Medical College

 

 

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Holden receives lifetime achievement award

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holden

The National Staff Development and Training Association (NSDTA) Career Achievement Award is presented to an individual who has made a career commitment to the profession of human service training and development; making significant contributions in terms of leadership, new ideas and education as measured by improved organizational outcomes, impact on the field, or improvement in national best practices at a state or national level. This year’s award recipient is the BCTR's Martha Holden, director of the Residential Child Care Project (RCCP). Martha has made significant contributions to human services through training and development activities throughout her working life.

Over the course of her career, Martha has trained thousands of human service professionals and, through her training of trainers, indirectly impacted many more throughout the U.S., Europe, Israel, and Australia. As noted in her nomination letter, some of her many contributions and achievements include:

  • In the late 1970s and early 1980s, serving as a founding steering committee member of the Ohio Committee for Child Care Worker Training, creating various certification systems and curricula for child and youth care workers
  • As director of the RCCP, she oversaw:
    • The development of several curricula used throughout the U.S., Canada, Europe, Israel and Australia, including:
    • Organizing RCCP International Conferences focusing on child safety and training.
    • The development and use of an organizational development/systems approach. In addition to the training-of-trainers model, the RCCP recognizes the role of training within the organizational system. The RCCP uses tools such as organizational climate inventories to assess the readiness for change and evaluate the impact of training and other organizational interventions such as coaching and team-building. The RCCP curricula is not viewed as a stand-alone intervention but part of a more comprehensive organizational intervention.
  • Serving as co-project leader of the North American Certification Project, Martha co-led the initial efforts to organize more than 100 volunteers to develop the North American certification system.
  • Conducting evaluation and research activities providing evidence of the effectiveness of the RCCP curriculum and organizational interventions
  • Co-authoring publications and conference presentations of research with program, curriculum, and policy implications, for example:
    • Holden, M.J., Izzo, C., Nunno, M., Smith, E., Endres, T., Holden, J.C., & Kuhn, F. (2010). Children and residential experiences: A comprehensive strategy for implementing a researched-informed program model for residential care. Child Welfare, 89(2), 131-149.
    • Nunno, M.A., Holden, M. J., & Tollar, A. (2006). Learning from tragedy: A survey of child and adolescent restraint fatalities. Child Abuse & Neglect:  An International Journal, 30(12), 1333-1342.
    • Nunno, M. A., Holden, M. J., & Leidy, B. (2003). Evaluating and monitoring the impact of a crisis intervention system on a residential child care facility, Children and Youth Services Review, 25(4). 295-315.
  • Developing an international cadre of certified trainers

 

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Conference explores Building a Community of Practice

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news-2015rccpconf-inpostThe Residential Child Care Project (RCCP) hosted its fourth international RCCP Conference this summer in Lake George, NY. The conference brings together professionals who work with vulnerable children and families to explore ways to provide the best care for the populations they serve.

Approximately 250 people from 13 countries, including Australia, Canada, England, Scotland, N. Ireland, Bermuda, Ireland, Burundi, Israel, Switzerland, Uganda, and South Korea, as well as 18 different states, attended.

In keeping with this year’s theme, Building a Community of Practice, the event encouraged conversation and collaboration through a variety of workshops, community of practice forums, and social events. The unique format included:

  • Community of Practice forums where professionals met in facilitated groups to share experiences and learn from each other.
  • Children and Family Experiences sessions where attendees heard the voices of children, families, and adults who live or have lived in care settings.
  • Stories of Practice sessions where professionals could record their stories of experiences with children and families in order to share them with other professionals.  RCCP plans to release the stories of practice recordings in a series on their web site.
  • Therapeutic Crisis Intervention (TCI) program instructors and Children And Residential Experiences: Creating Conditions for Change (CARE) practice model consultants were available to answer questions about their program's implementation and training.
  • Workshops on understanding self-injury, research, proposal writing, trauma and healing, CARE principles and implementation, TCI implementation, threshold concepts, TCI training innovations using modern media, and many others.

The conference opened with a performance of original songs by The Hillside Youth Voice Band, made up of children in care from the Varick Campus, which is part of the Hillside Family of Agencies in Rochester, NY. Songs included,“I’m Gonna be Me,” “Can You See Who We Are,” and “You Make a Difference.”

Highlights included presentations by Anthony Burrow on Purpose in Life: Evidence of a Psychological Resource, Howard Bath on Translating Trauma: From Complexity to Clarity, Junelei Li on Simple and Deep Right Before Our Eyes – Simple Interactions as the Active Ingredient for Human Development, Xavier McElrath-Bey with No Child Is Born Bad, and John Lyons on Managing the Business of Personal Change: Transformation Collaborative Outcomes Management.

Keynote speaker Xavier McElrath-Bey has noted,

My childhood traumas of living in poverty, having a mother diagnosed with mental illness, living in fear of an abusive step-father, and being placed in and out of foster care made me ripe for the occasions of impulsive and destructive behavior -- especially gang involvement which gave me the sense of having a new family.

I am a firm believer that no child is born bad...and that all children deserve another chance for positive change.

The final event of the conference, was the panel presentation Children and Families Speak out on “What Works.” The panel was moderated by James Anglin and featured youth and young adults formerly in care and parents of children/youth who have been in care facilities. Panelists spoke of the pain and difficulties surrounding being in care, but also of facility staff that helped and encouraged both the youth in care and their families.

Please see the conference page for further information, including some presentation powerpoints.

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Doing Translational Research podcast: Charles Izzo

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Wednesday, March 2, 2016

Charles Izzo
Bronfenbrenner Center for Translational Research, Cornell University

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Regional CARE events share findings from 5-year study

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RCCP director Martha Holden addressing attendees

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.

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Register for RCCP’s “Building a Community of Practice” conference

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SAVE THE DATE

The BCTR's Residential Child Care Project (RCCP)  is hosting its fourth International Conference for Therapeutic Crisis Intervention (TCI) and Children and Residential Experiences: Creating Conditions for Change (CARE) on June 21-24, 2016 in Lake George, NY. This event will highlight the importance of communities of practice in creating conditions for learning which lead to improving our practice and outcomes for children and families.

Preliminary Program

Featured Speakers

  • Junlei Li, PhD, Co-Director and Associate Professor of the Fred Rogers Center for Early Learning and Children’s Media at Saint Vincent College, Latrobe, PA
  • John Lyons, PhD, Senior Policy Fellow, Chapin Hall at the University of Chicago, Chicago, IL
  • Howard Bath, PhD, Former Children’s Commissioner of The Northern Territory, Brisbane, Australia
  • Xavier McElrath-Bey, MA, Youth Justice Advocate, Campaign for the Fair Sentencing of Youth, Chicago IL
  • James P. Anglin, PhD, Professor, School of Child and Youth Care, University of Victoria, BC Canada
  • Laura Steckley, PhD, Course Director, MSc Advanced Residential Child Care;Joint Editor, Scottish Journal of Residential Child Care; School of Social Work & Social Policy/CELCIS; University of Strathclyde, Glasgow, UK
  • Graham McPheat, Msc, Bed, Dip SW; Course Leader MSc Child and Youth Care Studies by Distance Learning; Senior Teaching Fellow, Social Work Lead, School of Social Work and Social Policy; University of Strathclyde Glasgow, UK
  • Janis Whitlock, PhD, MPH, Cornell Research Program on Self-Injury and Recovery, Bronfenbrenner Center for Translational Research, Cornell University, NY
  • Angela Stanton-Greenwood, MA, Med, CQSE, Lead Mentor and Positive Behaviour Coach, Hesley Group and Instructor, TCI Europe coordinator, Doncaster, UK
  • Troy Kennedy, Assistant to the Associate Executive, LaSalle School, Albany, NY USA

Panel Discussions

A panel made up of young people in care and family members will discuss their experiences and share what they need from a system of care.

Small Group Sessions

There will be opportunities to meet in groups and community of practice sessions to share innovations in trauma-informed interventions, implementing TCI in School settings, supporting developmental relationships, struggling for the congruency in the application of CARE principles or TCI practices throughout an organization.

Research Papers and Focus Groups

Researchers will have a forum to present research papers, conduct focus groups, and work with other researchers to discuss research, dissemination of research findings, and translational research.

Writing Workshop

Participants desiring to write a paper, an article, or presentation can receive assistance from published and experienced writers.

Trainer Certification

TCI trainers may attend this conference in lieu of a TCI update and apply for recertification. Opportunities for recertification testing will be made available on June 21, the afternoon before the opening conference reception.

CARE trainers may attend this conference in lieu of a CARE recertification workshop and apply for recertification. Opportunities for recertification testing will be made available the morning of June 22 before the opening session.

Registration

The registration fee at this 3-day conference is $725.00 USD. The conference fee will cover all programs including the Tuesday evening reception, Wednesday and Thursday lunches, Wednesday night BBQ dinner, Thursday night dinner cruise on Lake George, conference keynotes, panel presentation, small group sessions and workshops, as well as morning and afternoon refreshments.

Early Registration Fee of $675.00 USD will be charged to those individuals or organizations that can register participants by January 15, 2016. In order to qualify, you must fill out the attached registration information and send a check or purchase order postmarked prior to January 15, 2016. If you have registered and cannot attend the conference, 50% of the fee will be refunded if we receive notice prior to March 31, 2016. After March 31, 2016 this early registration fee is non-refundable.

Group rate (registration of 3 or more participants) $650.00 USD per person.

A rate of $600.00 USD is being offered to individuals who are presenting conference workshops (2 presenters per workshop) and professionally certified TCI trainers.

Please address any questions regarding registration to: Alissa Medero at ab358@cornell.edu.

Request for Proposals

Conference organizers are requesting proposals for workshop sessions, research paper presentations, and innovation group discussions. The proposals must be post marked, faxed, or e-mailed no later than November 30, 2015 to be considered. Authors of proposals accepted for the conference will be notified by January 15, 2016. The conference sponsors reserve the sole right to accept or reject any proposal, and to limit to 2 the number of presenters listed in the program. Only 2 presenters per workshop will receive the presenter registration rate of $600.00 USD.

We invite you to submit your proposal on one of the following or related topics:

  • Family engagement
  • Improving the quality of adult/child relationships
  • Trauma informed interventions and programs
  • Reflective practice
  • Innovative training strategies
  • Quality improvement models
  • Integration of evidence informed practices into programming
  • Creating a safe environment/culture of safety
  • Enhancing programming and enriching the environment
  • External agency influences on residential care, foster care, schools, juvenile justice programs
  • Cultural competence
  • Data informed decision-making
  • Implementation strategies
  • Organizational congruence

If you have a proposal that does not fit any of these tracks, please explain fully in a cover letter. In order to have your proposal reviewed, please follow the directions below. Any proposal that does not conform to the outline and requirements below or that has missing information is likely to be rejected.

Full conference and registration information is available here.

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RCCP in Israel, meeting and presenting on their Therapeutic Crisis Intervention system

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Linda Avitan, Dr. Renata Gorbatov, Martha Holden, Andrea Turnbull, and Yael Bohak.

Linda Avitan, Dr. Renata Gorbatov, Martha Holden, Andrea Turnbull, and Yael Bohak.

Martha Holden (director) and Andrea Turnbull (extension associate) of the Residential Child Care Project (RCCP) visited Israel to participate in meetings with the Ministry of Social Affairs and Services and the National Therapeutic Crisis Intervention (TCI) steering committee. They presented on current research and the status of the TCI program to directors, teachers, and residential personnel, compared survey results with Israeli researchers, re-certified Israeli TCI instructors, and visited two residential programs that use TCI. The RCCP's  TCI system provides a crisis prevention and intervention model for residential child care organizations.

TCI Israel continues to be a very effective and impressive model of how government can support residential programs in their implementation of TCI and keep fidelity to the model. Negotiations with the Ministry to adopt TCI as their crisis prevention and management model for residential facilities began in 2002. Since then, TCI has been successfully implemented in twenty-seven facilities and the Ministry hopes to expand the program in the coming year. Considering TCI their most important program, the Ministry has devoted more resources to its implementing than to any other initiative.

Part of the program delivered to Ministry personnel, regional and residential directors, TCI trainers, and residential personnel included results from the U.S. TCI fidelity study examining how agencies implemented TCI and the subsequent impact on staff and programs. Israeli researchers Dr. Renata Gorbatov and Yael Bohak had conducted a similar study in Israeli agencies using TCI with similar findings. There was much discussion about how many more commonalities than differences are found in the residential care agencies across nations.

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RCCP at the 2014 EUSARF conference

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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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RCCP retreat plots new directions for residential child care

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Martha Holden speaks at the 2014 Residential Child Care Project (RCCP) Retreat.

RCCP Director Martha Holden addressing the group.

In August, the Residential Child Care Project (RCCP) hosted its bi-annual, four-day International RCCP Retreat. In attendance were over 50 colleagues from the United States, Europe, Israel, and Australia. The group included RCCP staff, instructors, researchers, staff and faculty from other BCTR projects, as well as staff from nearby agencies. The RCCP’s mission is to develop and disseminate model techniques and systems to improve the quality of care for children living in out-of-home care and to prevent institutional child abuse and neglect through its major programs: Therapeutic Crisis Intervention (TCI) and Children And Residential Experiences (CARE).

Historically, the function of the retreat has been to evaluate and further develop RCCP’s outreach, technical assistance, and training programs in an effort continually improve those programs, as well as to re-certify RCCP instructors so they best facilitate the RCCP’s programs. The 2014 retreat fulfilled its traditional function, and achieved much more. Using a collaborative format, the retreat began by focusing on trends in the various countries represented. Specifically, attendees explored trends in policy and regulations, economics, research, and evidence-based practice, as well as patterns in the RCCP representatives’ daily practice experiences.

In looking at presentations about translational research, attendees examined the ways RCCP programs fit into the translational process. Discussions then flowed to consider what the RCCP is learning from its ongoing research, evaluation, and implementation of the TCI and CARE programs. The group then considered how their accumulated knowledge informs the possible future paths that RCCP could take in each of these areas. Finally, several small work groups were formed to look at the various options for:

  • Frank Kuhn speaking to the group.

    RCCP Senior Extension Associate Frank Kuhn speaking.

    a curriculum revision of TCI

  • the future direction of TCI for Schools
  • the future direction of CARE
  • training innovations
  • the status and direction of an RCCP web site redesign
  • the use of social media to keep the RCCP connected with its colleagues
  • and a fourth TCI/CARE conference for 2016

On the last day of the retreat the RCCP invited Dr. Junlei Li, from the Fred Rogers Center for Early Learning and Children’s Media at St. Vincent’s College in Latrobe, PA, to present his work on developmental relationships. The core concepts of Dr. Li’s work directly connect with all of the RCCP programs. His work can be best summarized with a few quotes from Dr Li himself:

Fred Rogers often said to his colleagues and friends, ‘I feel so strongly that deep and simple is far more essential than shallow and complex.’ This core conviction guided Fred Rogers and his colleagues to develop television programs, books, speeches, and curricula that reached out to millions of children, parents, and professionals for nearly half a century.

and

Today, as so many of us are striving to serve more children, work with less resources, and comply with an increasingly complex and demanding system of standards and regulations, the need to focus on “deep and simple” is ever more important.

I believe at the core of Fred Rogers’ work with parents and educators is this essential message – Enriching interactions with another human being is the most important ingredient in a child’s development. Real and lasting change can start with finding what ordinary people do well with children in everyday moments.

The RCCP looks forward to forging ahead in the new directions discussed in this dynamic retreat, as well as continuing to provide the best programs, support, innovations, and practices to its colleagues around the world.

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