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Cornell University

The CARE Program Model

A Framework for Creating Conditions for Change

One of the core challenges for residential group care organizations is to achieve congruence throughout the agency in serving the best interests of the children who reside there. There are always competing interests including resources, children’s needs, staff’s needs, regulations, and placing agencies’ needs. Providing an environment in which children can thrive is dependent on the quality of the milieu and the interactions among the adults and children who live, work and play there. Children And Residential Experiences (CARE): Creating Conditions for Change is designed to support safe environments, strong programmatic elements and a wide-variety of treatment programs and interventions that are trauma-sensitive and developmentally appropriate.

What is the CARE Practice Model?

CARE is a multi-level program model for improving services for children in out-of-home care. The model enables child caring agencies to organize and deliver quality care of children according to research-informed principles based on the best interest of the child. The aim of CARE is to bring agencies’ current practices closer to well-researched best practices in residential care and to help them achieve congruence between all levels of staff in order to improve how the agency works as a whole. Based on six guiding principles, the CARE model is designed to profoundly influence the way residential childcare professionals think about working with children. CARE principles include:

  • Developmentally Focused
  • Family Involved
  • Relationship Based
  • Competence Centered
  • Trauma Informed
  • Ecologically Oriented

How Was CARE Developed?

In 2005, the South Carolina Association of Children’s Homes and Family Services, the Duke Endowment, and the SC Department of Social Services partnered with Cornell to develop a competency-based curriculum based on best practices and current research to support strong programmatic elements in residential care. A group of experts convened by Cornell selected key competencies from researched and published national and international child care worker competencies and over 100 South Carolina residential child care personnel including supervisors, clinicians and managers verified the importance of the selected competencies to their work. In 2006 and 2007 the CARE practice model was introduced to South Carolina residential care organizations to test its potential impact on the daily life of the facility. This pilot phase used the OAS culture and climate surveys developed by the University of Tennessee Children’s Mental Health Services Research Center. These instruments and protocols facilitate organizational assessment and measurement of both the culture and climate of the agency. These are important elements that have been linked to positive child outcomes in the research and the evaluation will test whether the CARE practice model can influence more positive climates specifically, and the general organizational culture overall.

Evaluation of CARE Effectiveness

The evaluation data gathered on the CARE project since 2006 has been positive. The initial testing shows that participants achieve knowledge gain and have satisfaction with the CARE curriculum. Participants are utilizing both self and organizational reflection to examine whether they and their agencies follow and support these principles in their practice and programs. The plan for continuing the evaluation is in collaboration with an ongoing outcomes research project at the Institute for Social Capital (ISC) at UNC-Charlotte as well as the Kids Integrated Data System. The evaluation of the project hopes to find evidence of:

  • Improved organizational climate scores as evidenced by an increase in engagement and functionality and reduced stress measured by the OAS culture/climate survey
  • Decreases in critical incidents such as fighting, verbal abuse, runaways, physical interventions, etc. measured by the Kids Integrated Data system
  • Increased organizational congruence as measured by staff perceptions and observations
  • Improved organizational culture scores as evidenced by an increase in proficiency, less rigidity, and less resistance to change measured by the OAS culture/climate survey
  • Improved child outcomes measured by the instruments used in the University of North Carolina-Charlotte Child Outcomes study

For additional information regarding the CARE program, or to discuss its implementation at your organization, please contact Tom Endres at To order CARE reference, training, testing, and survey materials please contact Trudy Radcliffe at or 607-254-8723.