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Programs

Child-Adult Relationship Enhancement (CARE)

Overview

Delivery Approach:
  • Group
Delivery Format:
  • In-Person
  • Virtual
Provider Requirements:
  • Licensed/Certified Professional Led
Type of Experience Addressed:
  • Domestic Violence
  • Child Abuse 
  • Sexual Abuse
  • Community Violence
  • Neglect 
  • Family Separation
  • Homicide/Familicide 
  • Substance Abusing Caregiver 
  • Natural Disasters 
  • Grief/Bereavement 
  • Criminal Victimization 
  • Refugee/Immigration
  • Reunification
  • Medical Trauma
  • Homelessness
  • Verbal/Emotional abuse
  • Mental Health Issues/Concerns
  • Historical trauma
Engagement Methods:
  • Experiential
  • Play-Based
Level of Intervention:
  • Primary Prevention
  • Secondary Prevention
Length:
  • Less than 6 weeks
Setting:
  • School
  • Home 
  • Hospital-based
  • Residential 
  • Domestic Violence Shelter
  • Correctional
  • Homeless Shelter
  • Headstart and Early Education Programs
  • Day Care
  • Family service agencies
  • Health Services 
  • Foster Care 
  • Mental Health Setting
  • Community-based agency
Program Details:
Type of services:

CARE is a trauma-informed set of skills that can be used by any adult in any setting who interacts with children and teens who have experienced trauma. It is based on several evidence-based parenting programs, including PCIT, Incredible Years, Helping the Non-compliant Child, and PMTO. It may complement mental health treatments, but is not a therapy program. It has been used in a wide-variety of settings with varied audiences, including health, mental health, and allied health professionals, family members, and lay professionals. CARE has a building evidence-based including in medical settings and with foster parents. CARE is not appropriate for extreme disruptive behavior or aggression; it is not a stand-alone “treatment” intervention.

Types of providers:

Developed to be used by non-clinical professionals working with traumatized children and their adult caregivers. Providers working with CARE include:

  • domestic violence advocates and services
  • home visitors
  • graduate students in education, social work and
  • psychology; medical students and residents
  • social service caseworkers
  • staff at homeless shelters
  • day care providers
  • medical care providers, residents, fellows
  • foster parents
  • child protection workers
  • educators
  • disaster crisis counselors
  • medical facilities
  • law enforcement agencies
  • child welfare agencies
  • military families and support personnel
  • primary care settings
  • clergy
  • scout leaders/coaches
  • OT/PT
Program setting:

Wide variety of settings including child welfare agencies, foster care agencies, domestic violence shelters, and primary care settings

Length of program/number of sessions:

Ongoing service (versus specified number of treatment sessions); CARE skills can be taught in approximately 3-6 hours and can be done in a group setting.

Type(s) of trauma addressed:

Interpersonal complex trauma, acute trauma, exposure to domestic violence

Theoretical basis/core principles:

CARE uses the three P principles (Praise, Paraphrase, and Point-Out Behavior) to connect children with their caregivers and is based on evidence-based behavioral parenting programs (PCIT, IY, HNC, and PMTO). CARE teaches skills for improving attachment and/or strengthening relationships while reducing mild to moderate behavior concerns and skills for increasing compliance. All components are grounded in an understanding of the impact of trauma on relationships and behaviors.

Unique/Innovative Characteristics:

This intervention can be delivered by non-clinical professionals in a variety of settings. CARE allows broader access and application of core PCIT principles that have been shown to be effective with children experiencing behavioral problems/trauma.

Date Added/Updated:

08/02/2022

Population Served

Age:
  • 0-5 (Early Childhood)
  • 6-12 (Childhood)
  • 13-17 (Adolescent)
Language:
  • English
  • Spanish
  • Other – Japanese
Ethnic Racial Group:
  • Asian
  • Black or African American
  • Hispanic or Latino
  • Indigenous People – American Indian/Native American, Alaskan Native
  • Native Hawaiian or other Pacific Islander
  • White
Client/Audience:
  • Child and Non-abusive Parent/Caregiver
  • Child
  • Family
  • Grandparents
  • Parent who uses Violence
  • Survivor parent
  • Community
  • Foster/Adoptive Parents
  • Other Client/audience
    • Any adult interacting with children ages 2-18. Adults participate in the workshop and children do not attend actual workshop.
Population Adaptations:
Age range of children:

2-18 years old

Adult caregiver included in intervention:

Adults who have contact with children

Ethnic/racial and other groups served:

No specific information provided

Languages available:

English, Spanish, and Japanese

Evaluation

Foundation:

CARE uses the three P principles (Praise, Paraphrase, and Point-Out Behavior) to connect children with their caregivers. CARE teaches effective positive commands and strategies for caregivers to redirect problematic behaviors. CARE includes a trauma education component to help caregivers understand behaviors associated with trauma and the appropriate application of these skills within the context of trauma.

Evaluation Studies:
Peer Reviewed Journals

Scott, B., Gurwitch, R. Messer, E., Kelley, L., Myers, D, & Young, K. (2021). Integrated CARE: Adaptation of Child Adult Relationship Enhancement (CARE) Model for Use in Integrated Behavioral Health Pediatric Clinics. Clinical Pediatrics, 60 (2) 100–108.

Wood, J.N., Kratchman, D., Scribano, P.V., Berkowitz, S., Schilling, S. (2021). Improving Child Behaviors and Parental Stress: A Randomized Trial of Child Adult Relationship Enhancement in Primary Care. Academic Pediatrics, 21(4), pp. 629-637.

Schilling, S., Ritter, V., Wood, J.N., Fine, J., Zolotor, A.J. (2020). Child-Adult Relationship Enhancement in Primary Care: A Randomized Trial of a Skill-Based Parent Training with Parent Mentor Adaptation Journal of developmental and behavioral pediatrics : JDBP 41(4), pp. 272-280

Murphy, K.G., Warner-Metzger, C.M., & Moreland, A.D. (April 2019). Child-Adult Relationship Enhancement (CARE): Expanding evidence-based child behavior management skills to an academic medical center. Behavior Therapist, 42 (4), 118-121.

Messer, E.P., Greiner, M., Beal, S., Cassedy, A., Eismann, E., Gurwitch, R.H., Boat, B., Bensman, H., Bemerer, J., Greenwell, S., & Eiler-Sims, P. (2018). Child adult relationship enhancement (CARE): A brief, skills-building training for foster caregivers to increase positive parenting practices. Children and Youth Services Review, 90, 74-82. doi:10.1016/j.childyouth.2018.05.017

Wood, J.N., Dougherty, S.D., Long, J., Messer, E.P. & Rubin, D. (2017). A pilot investigation of a novel intervention to improve behavioral well-being for children in foster care. Journal of Emotional and Behavioral Disorders. doi:10.1177/1063426617733715

Schilling, S., French, B., Berkowitz, S.J., Dougherty, S.L., Scribano, P.V., & Wood, J.N. (2016). Child-adult relationship enhancement in primary care (PriCARE): A randomized trial of a parent training for child behavior problems. Academic Pediatrics, 17 (1), 53-60. doi:10.1016/j.acap.2016.06.009

Gurwitch, R., Messer, E., Masse, J., Olafson, E., Boat, B., & Putnam, F. (2016). Child-Adult Relationship Enhancement (CARE): An evidence-informed program for children with a history of trauma and other behavioral challenges. Child Abuse and Neglect, 53, 138-145. doi:10.1016/j.chiabu.2015.10.016

Book Chapters

Gurwitch, R.H., Nelson, M.M., & Abner, J.P. (2019). Child-Adult Relationship Enhancement for children on the autism spectrum: CARE Connections. In C.B. McNeil, L.B. Quetsch, & C.M. Anderson (Eds.) Handbook of Parent-Child Interaction Therapy for children on the autism spectrum. Cham, Switzerland: Springer International Publishing, 321-338.

Pearl, E. & Minnick, J. L. (2007). Parent-Child Interaction Therapy (PCIT) and Child-Adult Relationship Enhancement (CARE). In C. Huff & H.J. Sites (Eds.), An Integrated Model for Treatment of Early Childhood Abuse. Royal Oak, MI: Self-Esteem Shop, pp. 47-55.

Peer Reviewed Conference Presentations

Nelson, M. M., Bussing, R., & Warner-Metzger, C. M. (October 2019). Child-Adult Relationship Enhancement (CARE) training: Bringing good parenting behaviors to all who interact with children. Workshop presented to the American Academy of Child and Adolescent Psychiatry’s (ACCAP’s) 66th Annual Meeting in Chicago, IL. https://doi.org/10.1016/j.jaac.2019.07.336

Masse, J., & Warner-Metzger, C. M. (August 2019). Cultivating a culture for PCIT: Child-Adult Relationship Enhancement (CARE) in medical settings. Symposium presented at the 2019 Parent-Child Interaction Therapy (PCIT) International Biennial Convention, Chicago, IL.

Masse, J., Sarver, D., Garrett, G., Cox, A., & Cash, A. (August 2019). Using Child-Adult Relationship Enhancement (CARE) to reduce behavioral difficulties and augment interventions for among allied health professionals. In J. Masse (Chair) & C. M. Warner-Metzger (Discussant), Cultivating a culture for PCIT: Child-Adult Relationship Enhancement (CARE) in medical settings. Symposium presented to the 2019 Parent-Child Interaction Therapy (PCIT) International Biennial Convention, Chicago, IL.

Messer, E., Gurwitch, R., Scott, R. & Wood, J. (August 2019). PriCARE and Integrated CARE; Enhancing Ease of Access to Families. In J. Masse (Chair) & C. M. Warner-Metzger (Discussant), Cultivating a culture for PCIT: Child-Adult Relationship Enhancement (CARE) in medical settings. Symposium presented to the 2019 Parent-Child Interaction Therapy (PCIT) International Biennial Convention, Chicago, IL.

Murphy, K., Moreland, A., & Warner-Metzger, C. M. (August 2019). CARE Training in an Academic Medical Center: Extending Skills to Medical Trainees and Staff. In J. Masse (Chair) & C. M. Warner-Metzger (Discussant), Cultivating a culture for PCIT: Child-Adult Relationship Enhancement (CARE) in medical settings. Symposium presented to the 2019 Parent-Child Interaction Therapy (PCIT) International Biennial Convention, Chicago, IL.

Gurwitch, R., Fukumaru, Y., Messer, E. & Kamo, T. (August 2019). Child-Adult Relationship Enhancement (CARE™): Dissemination in community settings in the US and globally. In S. Wagner (Chair) Symposium, Expanding our reach: The utility of PCIT-informed approaches in community settings. Symposium presented to the 2019 Parent-Child Interaction Therapy (PCIT) International Biennial Convention, Chicago, IL.

Davis, J. O., & Warner-Metzger, C. M. (August 2019). CARE Groups for Caregivers (CG2): Use of a pilot program for PCIT waitlist families to increase accessibility of services. Poster presented at the 2019 Parent-Child Interaction Therapy (PCIT) International Biennial Convention, Chicago, IL.

Gurwitch, R. H., & Abner, J. P. (June 2018). Child-Adult Relationship Enhancement (CARETM): Building new bridges in the PCIT and parent training world. Symposium presented to the 2018 Parent-Child Interaction Therapy (PCIT) World Congress, Schweinfurt, Germany.

Warner-Metzger, C. M. (June 2018). CARE in schools: Meeting mental health needs of students in communities facing violence and civil unrest. In R. Gurwitch (Chair) & J. P. Abner (Discussant), Child-Adult Relationship Enhancement (CARETM): Building new bridges in the PCIT and parent training world. Symposium presented to the 2018 Parent-Child Interaction Therapy (PCIT) World Congress, Schweinfurt, Germany.

Gurwitch, R.H., Warner-Metzger, C.M., & Berkowitz, S. (November 2017). Child-Adult Relationship Enhancement (CARE): Building skills to strengthen trauma recovery in children and youth. Pre-Meeting Institute presented at the annual meeting of the International Society for Traumatic Stress Studies, Chicago, IL.

Gurwitch, R. H., & Abner, J. P. (September 2017). Child-Adult Relationship Enhancement (CARE): Expanding capacity of PCIT principles. Symposium presented to the 2017 Biennial Parent-Child Interaction Therapy (PCIT) International Convention, Traverse City, MI.

Messer, E.P., Dougherty, S., Schilling, S., & Wood, J. (September 2017). CARE in foster care and primary care settings: Helping caregivers address needs of high-risk youth. In R. Gurwitch (Chair) & J. P. Abner (Discussant), Child-Adult Relationship Enhancement (CARE): Expanding capacity of PCIT principles. Symposium presented to the 2017 Biennial Parent-Child Interaction Therapy (PCIT) International Convention, Traverse City, MI.

Warner-Metzger, C. M. (September 2017). CARE in schools: Meeting mental health needs of students in communities facing violence and civil unrest. In R. Gurwitch (Chair) & J. P. Abner (Discussant), Child-Adult Relationship Enhancement (CARE): Expanding capacity of PCIT principles. Symposium presented to the 2017 Biennial Parent-Child Interaction Therapy (PCIT) International Convention, Traverse City, MI.

Masse, J. (September 2017). DelaCARE: An Overview of a State-Wide Dissemination of the CARE model. In R. Gurwitch (Chair) & J. P. Abner (Discussant), Child-Adult Relationship Enhancement (CARE): Expanding capacity of PCIT principles. Symposium presented to the 2017 Biennial Parent-Child Interaction Therapy (PCIT) International Convention, Traverse City, MI.

Gurwitch, R.H., Kelley, A., & Berkowitz, S. (April 2017). Child-Adult Relationship Enhancement (CARE): A new program for adults making a difference in the lives of children. Pre-Meeting Institute presented at the National Child Traumatic Stress Network Meeting, Washington, DC.

Gurwitch, R.H. & Wray, E. (January 2017). Child-Adult Relationship Enhancement (CARE) in the Classroom. Workshop presented at the Annual Meeting of the American Council for School Social Work, New Orleans, LA.

Gurwitch, R.H. (April 2016). Child-Adult Relationship Enhancement (CARE): Addressing behavior concerns in the pediatric practice. Workshop presented at the Annual Meeting of the Alabama Academy of Pediatrics, Mobile, AL.

Messer, E. (September 2016). Child-Adult Relationship Enhancement (CARE): Connecting with children and improving compliance. Workshop presentation for the Ohio GAL Celebrate Kids Conference, Columbus, OH.

Messer, E. (October 2016). Child-Adult Relationship Enhancement. Workshop presentation for the Tristate Trauma Network Conference, Erlanger, KY.

Warner-Metzger, C. M., Barnett, A., Reaves, S. (April 2016). Child Adult Relationship Enhancement (CARE): Developing trauma-informed interaction skills. Workshop presented to the 2016 EverThrive Illinois Innovate, Collaborate, & Elevate Conference, Oak Lawn, IL.

Pearl, E. (November 2008). Child Adult Relationship Enhancement (CARE) training: Connecting with children. Workshop presentation for the 25th Annual All Ohio Counselors Conference, Columbus, OH.

Rated/Reviewed by Evidence Based Registries:

The National Traumatic Stress Network Treatments and Practices, Trauma Interventions 

Training & Resources

Training Language
  • English
  • Spanish
  • Other Training Language
    • Japanese
Training Available:
  • Yes
Training Details:
Training manuals/protocols:

Yes; Manual is available to trained CARE Facilitators

Training available:

icarecollaborative.org

Training costs:

Varies for individual/agency rates

Training Contact: