Trauma Informed Care: The CARE Therapeutic Framework

The CARE Therapeutic Framework:

A Whole-Of-Service Kinship Care Training and Implementation Programme

Author/Developer: Colby Pearce, Clinical Psychologist

The CARE Therapeutic Framework Logo NewestThe CARE Therapeutic Framework[1] is an evidence-informed, strengths-based approach. It draws attention to conventional aspects of caregiving and relating that support optimal developmental outcomes for children. The CARE Therapeutic Framework is trauma-informed. It supports recovery for children whose first care environment was inadequate, such that placement in out-of-home care was necessary.  The CARE Therapeutic Framework is also a practice framework. It supports the delivery of accountable social care services that promote carer fidelity to the Framework and optimal outcomes for children.

The CARE Therapeutic Framework does not seek to replace other approaches to trauma-informed, therapeutic re-parenting of children, and support for their carers. Rather, the Framework offers a back-to-basics approach that forms a solid foundation to build on. As a strengths-based approach, the CARE Therapeutic Framework complements other strengths-based approaches.

Central to the CARE Therapeutic Framework is the development of knowledge and understanding of the reasons why people behave in the manner that they do, and competencies that support these reasons being addressed. This is central to addressing one of the main casualties of adverse care – namely, the experience of having one’s needs met reliably and predictably that is the foundation for secure dependency and optimal developmental and interpersonal outcomes. The CARE Therapeutic Framework endeavours to promote addressing needs as a fundamental caregiving priority, as opposed to simply addressing behaviour(s) of concern in isolation of needs.

CARE embedded in AAA

The CARE Therapeutic Framework utilises the Triple-A Model[2] to support understanding of the reasons why people, including children who have experienced adverse care, behave in the manner that they do. The CARE Therapeutic Framework is drawn from the Triple-A Model of Therapeutic Care[3], a comprehensive approach to trauma-informed re-parenting of children recovering from adverse care that is entering its fourth year as the preferred model of care for TUSLA (Child and Family Agency) foster- and relative-carers in Donegal, Ireland.

AAA Irish Logo Revised

The CARE Therapeutic Framework promotes human Connection as a primary task[4], where the primary task is defined as the one task that we need to get right and upon which the success of all endeavour rests. There is a robust and ever-growing evidence base for the role of connection in supporting optimal emotional and behavioural outcomes for young people and adults alike[5], [6], [7].

The Kinship CARE Project

In March 2018 agreement was reached to implement the CARE Therapeutic Framework in the Department for Child Protection (DCP) Kinship Care Program in South Australia; inclusive of implementation training among kinship carers, Program staff and DCP psychology staff. The Kinship CARE Project was born. The project aims included:

  • Implement the CARE Therapeutic Framework in the Kinship Care Program in South Australia;
  • Establish a common knowledge, language and approach among kinship carers, kinship care support workers, and psychologists who support both;
  • Develop competencies related to trauma-informed, therapeutic re-parenting of children in kinship care, and competencies in the implementation of a practice framework that supports fidelity to the therapeutic re-parenting approach;
  • Develop competencies in self-care;
  • Support empowerment and self-efficacy in the respective roles of participants of the program; and
  • Improve connections between kinship children and their carers (reduce placement breakdowns and support attachment security), and connections between kinship carers and Agency staff who work in the kinship care space.
The Kinship CARE Project

Kinship CARE Project Implementation Methodology

Training for kinship carers incorporates four half-day workshops, scheduled two-weeks apart, followed by a call-back session three months after the initial four sessions. The format of the implementation sessions is as follows:

Session 1:

  • What is therapeutic care and what does it require of you?
  • The importance of achieving connection as a primary task.

Session 2:

  • Enriching children’s experience of caregiver consistency and accessibility.
  • Self-Care (Part 1)

Session 3:

  • Enriching children’s experience of caregiver responsiveness.

Session 4:

  • Enriching children’s experience of caregiver emotional connectedness.
  • Self-Care (Part 2)

 Call-Back:

  • Addressing behaviours of concern using the CARE Therapeutic Framework

Training for kinship carers recognises that, though it shares many similarities with foster care, kinship care has its own unique characteristics. The language used when delivering the CARE Therapeutic Framework is tailored to the unique characteristics of kinship care. Though the program is trauma-informed, reference to concepts such as trauma, abuse and neglect is de-emphasised, in favour of more generic concepts, such as adversity and children having had a tough start to life. This is extremely important in the kinship care space, where shame is a real consideration. There is an imperative to attract and retain kinship carers in such initiatives, rather than alienate them by invoking experiences of family shame.

In addition, there is a focus on supporting carers to develop an understanding of how to implement a therapeutic re-parenting approach in their own individual circumstances. That is, there is a focus on assisting carers to know what to do, and to develop a tailored therapeutic re-parenting Plan. Psychological theory is presented sparingly and only in support of the rationale (and evidential basis) for recommended approaches. Accessibility of the content is supported through a multi-modal approach to delivery that includes practical activities, demonstrations and audio-visual content in support of verbal content. Regular individual and group reflective activities also support understanding of the program content. Kinship care support workers regularly attend sessions with carers on their caseload, further supporting caregiver accessibility to the content and shared experience of the program.

Training for kinship care support workers and psychology staff is scheduled across two full days initially, with call-back sessions scheduled to support fidelity to the Care Therapeutic Framework and extend delivered content to addressing behaviours of concern using the Framework. The content and delivery is similar to that which is delivered to kinship carers, except that there is a focus on the implementation of the Framework in kinship care support workers’ practice with kinship carers, and psychologists’ practice with kinship care support workers. That is, there is a layered approach to implementation, whereby kinship carers experience CARE from their support workers, and support workers experience CARE from psychologists trained in the Framework. Participant psychologists and the leadership of the Kinship Care Program have regular opportunity to meet with the trainer/developer, thereby experiencing CARE in practice. Implementation is layered in this way to support fidelity to the framework and embeddedness across the Kinship Care Program.

 Quality Assurance and Evaluation

Three types of outcome data is collected from participants:

  • Session Ratings of Satisfaction (Value)
  • Pre and Post Competency Questionnaire (Impact)
  • Post-implementation Survey (Value and Impact).

Outcomes (What to expect)

Quality assurance and evaluation data support the following expected outcomes where the CARE Therapeutic Framework is implemented:

  • Strong uptake of the implementation training among kinship carers;
  • High retention of carers across the implementation process;
  • High levels of satisfaction with the CARE Therapeutic Framework, including in terms of how informative, practical and useful kinship carers have found each training session, whether they would recommend the training to other kinship carers, and their overall satisfaction with the training;
  • Improved understanding of kinship children, including the reasons for their behaviours of concern, and knowledge of care and management strategies that address behaviours of concern therapeutically;
  • Carer-reported improvements in their relationship with kinship children; and
  • Carers feeling more confident in their role.

What to do next

Please contact me if you are interested in discussing a potential implementation project in your service. I currently implement in Australia and Ireland, and am fielding interest in the United Kingdom. My contact details are:

Phone: +61403350411

Email:  colby@securestart.com.au.

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Follow the links below to my two new resources supporting consistency of care and effective communication between home and school for children recovering from a tough start to life:

Click here for more information and to access our resource for carers who are supporting children who are recovering from a tough start to life.
Click here for more information and to access our new resource for teachers who are managing children who are recovering from a tough start to life.

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CARE embedded in AAA

Triple-A Model of Therapeutic Care

The CARE Therapeutic Framework

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References

[1] Pearce, C. (2016). A Short Introduction to Attachment and Attachment Disorder – Second Edition. London, Jessica Kingsley Publishers

[2] Pearce, C.M. (2010). An Integration of Theory, Science and Reflective Clinical Practice in the Care and Management of Attachment-Disordered Children – A Triple A Approach. Educational and Child Psychology (Special Issue on Attachment), 27 (3): 73-86

[3] Pearce, C & Gibson, J (2016), A Preliminary Evaluation of the Triple-A Model of Therapeutic Care, Foster, 2, 95-104

[4] Kahn, W. A. (2005). Holding Fast: The Struggle to Create Resilient Caregiving Organisations. Hove and New York: Brunner-Routledge

[5] Dooley, B & Fitzgerald, A (2015). My World Survey: National Study of Youth Mental Health in Ireland. UCD School of Psychology, Headstrong

[6] Ottman, G, Dickson, J, & Wright, P. (2006). Social Connectedness and Health: A Literature Review. Cornell University GLADNET Collection

[7] O’Rourke, H. M., & Sidani, Souraya. (2017). Definition, Determinants, and Outcomes of Social Connectedness for Older Adults: A Scoping Review. Journal of Gerontological Nursing, 439(7), pp 43-52.

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About colbypearce

I am a Clinical Psychologist and author who assists children and familes overcome adversity and experience strong and secure attachment relationships.
This entry was posted in trauma informed, trauma informed care, trauma informed practice and tagged , , , , , , , , , , , , , , . Bookmark the permalink.

1 Response to Trauma Informed Care: The CARE Therapeutic Framework

  1. Pingback: Trauma-informed in South Australia: the Kinship CARE Project | Attachment and Resilience

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