Improving relationship quality in group care settings: The impact of implementing the CARE model

Abstract

The current study examined the effects of implementing a new program model on the quality of relationships between direct care providers and residents in group care agencies. Children and Residential Experiences (CARE), an organization-wide program model that involves a range of structural change and staff-development activities, was implemented in 13 group care agencies in one Southeastern state. CARE implementation lasted three years and involved the application of six evidence-informed principles throughout the organization in order to create more therapeutic environments and improve the quality of care for children.We used a stepped-wedge design in which one cohort of agencies began CARE immediately and a second cohort waited 12 months before beginning, allowing them to serve as a comparison group during the waiting period. Children in each agency were surveyed annually about the perceived quality of their relationships with staff using a new instrument developed for this study. Results of a linear mixed model indicated that after accounting for clustering at the agency and cottage levels and controlling for several important covariates, child perceptions of relationship quality increased significantly in the three years after CARE implementation began. The strength of the CARE effect was stronger for residents with several previous placements, but did not differ by age, gender, race, length of stay, DSS referral, or problem behavior. Results provide evidence that supports the effectiveness of CARE as an intervention to help group care agencies improve the quality of children's daily interactions with caregiving staff, a critical aspect of their experience while living in care. The process requires a long-term commitment and an organization-wide focus on serving the best interests of children.