Integrated CARE: Adaptation of Child-Adult Relationship Enhancement (CARE) Model for Use in Integrated Behavioral Pediatric Care

Abstract

The authors adapted the established Child-Adult Relationship Enhancement (CARE) interaction model for use in integrated behavioral health clinics. CARE was modified for delivery in the examination room, during routine primary care visits. Adopting a real-world implementation approach, clinical social workers were trained in the new model—IntegratedCARE—and provided the brief, 3-session treatment to 30 different parent-child dyads. Measurements included the Parental Stress Index–4 Short Form (PSI 4-SF), the Eyberg Childhood Behavior Inventory (ECBI), and the Therapy Attitude Inventory (TAI). There was a statistically significant mean score decrease on the both subscales of the ECBI at pre- and posttreatment. Scores on the TAI indicated that participants were satisfied with the treatment. Attrition rates were somewhat lower than similar studies. Findings indicate the IntegratedCARE model is feasible for sustainable delivery by trained behavioral health professionals in primary care.

Skills Training for Family Medicine Residents to Attenuate the Impact of Childhood Trauma: A Pilot Study

“…This baseline behavior contradicts the recommendations of traumainformed practice. 14,16,18 Residents remarked that modifying this behavior was challenging for them because they often had applied the concept of asking questions as a way of gaining relationship.…”

“…The curriculum was based on Child-Adult Relationship Enhancement (CARE), an interactional model derived from evidenced-based parent management training models such as Parent-Child Interaction Therapy (PCIT) and the Positive Parenting Program. 16,17 Although CARE has been adapted into team-based primary care settings to be used with parents, 18,19 that model was designed primarily to provide professionals with skills to improve child-adult relationships. 18 CARE has been designated by the National Child Stress and Trauma Network as a TIC approach.…”

“…16,17 Although CARE has been adapted into team-based primary care settings to be used with parents, 18,19 that model was designed primarily to provide professionals with skills to improve child-adult relationships. 18 CARE has been designated by the National Child Stress and Trauma Network as a TIC approach. 16 The curriculum used in the resident training described here was based on foster parent 20 and psychiatry residents' CARE training, 21 with minor adjustments relevant to family medicine, and was highly informed by parent management training literature, [22][23][24][25][26][27] the American Academy of Pediatrics practice guidelines for TIC, 4,5 and the literature on the relationship between developmental trauma and externalized behavior disorders.…”