Agency and university partnership to analyze restraints levels and psychotropic medication usage after the CARE program implementation

In this presentation the authors provide an example of Hamilton’s model of Translational Research in action at the agency level. We describe the efforts of the Waterford Country School and the Residential Child Care Project... [ view full abstract ]

In this presentation the authors provide an example of Hamilton’s model of Translational Research in action at the agency level. We describe the efforts of the Waterford Country School and the Residential Child Care Project (RCCP) at Cornell University to improve the quality of the interactions between the Waterford staff and the youth in their care. This agency-university collaboration illustrates ways in which the expertise of both communities can contribute to improvements in the well-being of youth.

An important aspect of the presentation is how the Waterford agency and Cornell University came to engage in this practice-based research through the implementation of the Children and Residential Experiences (CARE) program model developed by the RCCP. The CARE program model is a principle-based system whose impact on therapeutic residential care has been reported in literature (Holden, Anglin, Nunno, & Izzo, 2014), as well as in previous EUSARF conferences. CARE is a research-informed, principle-based, multi-component model designed to transform the setting of residential care. This setting level model structures social sciences research findings into six basic practice principles that inform inter-personal interactions among adults and children. By incorporating the principles throughout all levels of the organization and into daily practice, an ethos develops that supports and expects reciprocal and consistent developmentally appropriate relationships in a trauma-sensitive environment. The model articulates a theory of change (TOC) which outlines the causal pathways CARE is expected to improve children’s socio-emotional and developmental (Holden, 2009; Holden, et al., 2014).

The paper will address the Waterford leadership’s commitment to collecting long-term (10 years or more) time series data on two measures that mattered to their organization, the levels of physical restraints and psychotropic medication usage. The frequency of physical restraints is an important barometer for safety. Restraints are high-risk interventions that can elicit more coercive responses on the part of staff and have harmful or fatal consequences if used without sufficient safeguards, training, and supervision. They also hamper future opportunities for therapeutic interactions. Monitoring psychotropic medications usage is critical since children in care have higher psychotropic medication rates as compared with children who are not in care. While this may be related to their emotional and mental health needs, many experts question the therapeutic value of these medications, especially when they may cause minor to severe adverse effects. When agencies commit to identifying measures that matter and collecting data consistently at regular intervals over extended periods, they can evaluate the impact of local changes using standard analysis tools that are readily available and easy to use. By applying scientifically rigorous quasi-experimental methods and interrupted time series analysis to this data, researchers can increase the practitioner’s confidence in its usefulness in reflection and learning in an evidence-based way. Examined in another manner, this presentation illustrates an excellent example of a dynamic relationship between the practitioner and the research and their use of data to strengthen an agency’s quality improvement process while contributing to the science and wisdom of change.