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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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(0) Comments.  |   Tags: article    collaboration    Elliott Smith    evaluation    Michael Nunno    RCCP    research    residential care    youth   
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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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Talks at Twelve: Mardelle Shepley, Wednesday, February 22, 2017

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shepley

Mental and Behavioral Health Facilities: Critical Research and Design Recommendations
Mardelle Shepley, Design and Environmental Analysis, Cornell

Wednesday, February 22, 2017
12:00-1:00 PM
Beebe Hall, 2nd floor conference room



Research on the design of mental and behavioral health facilities is available but limited, although the shortcomings of these facilities are well-known. Dr. Mardelle Shepley will describe design features that are believed to positively impact staff, patients, and families in psychiatric environments and provide information related to their presence in existing facilities. Her research project involved both qualitative and quantitative methods. Dr. Shepley will share results involving a variety of topics including the appropriateness of private rooms, deinstitutionalization, access to nature, and open nursing station design. She will also provide guidelines for mental and behavioral health facilities.

Mardelle Shepley is a professor in the Department of Design and Environmental Analysis and associate director of the Institute for Healthy Futures. She serves on the graduate field faculty in the Department of Architecture. A fellow in the American Institute of Architects, she has authored/co-authored six books, including Healthcare Environments for Children and their Families (1998), A Practitioner’s Guide to Evidence-based Design (2008), Design for Critical Care (2009), Health Facility Evaluation for Design Practitioners (2010), Design for Pediatric and Neonatal Critical Care (2014) and Design for Mental and Behavioral Health (2017).

This talk is open to all. Lunch will be served. Metered parking is available in the Botanic Gardens lot across the road from Beebe Hall. No registration or RSVP required except for groups of 5 or more. We ask that larger groups email Patty at pmt6@cornell.edu letting us know of your plans to attend so that we can order enough lunch.

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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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RCCP receives Duke Foundation funds to study CARE Model

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The Duke Endowment of Charlotte, NC has granted a sixth-year funding allocation to the Residential Child Care Project (RCCP) through to January 31, 2015. The funding allows the RCCP to gather and analyze longer-term data in their quasi-experimental field study of the Children and Residential Experiences (CARE) Model in North Carolina. The results of the study will be submitted to the California Evidence-based Clearinghouse for Child Welfare for consideration as a Promising Practice.

The CARE model is a research-informed, principle-based, multi-component program designed to build the capacity of residential care and treatment organizations to serve the best interests of the children. The research-informed CARE principles support a theory of change (TOC) which outlines the causal pathways by which CARE is expected to improve socio-emotional and developmental outcomes for children (Holden, 2009; Holden, Izzo, Nunno, Smith, Endres, Holden, & Kuhn, 2010). This TOC lays the foundation for quality therapeutic residential care and provides a working model to guide agency planning and evaluation. The principles are applied throughout the organization to inform adult-to-adult interactions and adult-to-child interactions, guide data-informed decision-making, and set priorities for serving the best interests of the children. By incorporating the principles throughout all levels of the organization and into daily practice, an organizational culture is developed to help sustain the implementation of the principles.

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Holden advises Australian Children’s Commissioner

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holdenIn March Martha Holden (Director of the Residential Child Care Project) traveled to the Northern Territory, Australia at the invitation of Howard Bath, the Children's Commissioner of the region. The Children's Commissioner, whose core function is to ensure the well-being of vulnerable children, is working to overcome disadvantages that Indigenous children and families face and improve their quality of life. Currently there are a large number of Indigenous children placed in out-of-home care. Residential programs (mainly smaller group homes) have grown rapidly in response to demand, but with little theoretical coherence or regulation. The current departmental administrators are well aware of this issue and are seeking to chart a new course. Holden's visit was seen by administrators as an opportunity to gain information on theory, structure, monitoring, and quality care that will shape their thinking and planning.

Additionally, youth services and residential care staff and professionals attended Children and Residential Experiences (CARE) Seminars presented by Holden in Alice Springs and Darwin. The attendees were introduced to the CARE therapeutic care model and its six key principles of being:

  • developmentally-focused
  • family-involved
  • relationship-based
  • competence-centered
  • trauma-informed
  • ecologically-orientated

 

(0) Comments.  |   Tags: Australia    CARE    childhood    children    international    Martha Holden    RCCP    residential care   
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