Enriching Relational Environments as a Critical Pathway for Healing from Trauma: Helping Adults Use Purposeful Interactions and Build Developmental Relationships with Children in Out of Home Care

大多数生活在家庭外护理（OOHC）的美国儿童都有调节情绪的衰弱障碍， 这些儿童的行为和治疗工作的成功主要取决于照顾者的能力， 提供发展丰富的治疗护理。在OOHC生活时，照顾这些孩子的成年人 在正规治疗之外的关键时间，儿童在治疗中发挥着核心作用。然而，OOHC 照顾者很少接受教育，不知道如何满足他们所服务的儿童的独特关系需求， 对自己在每个孩子康复中的治疗作用缺乏清晰的认识。此外，最 OOHC中针对护理人员的常用培训计划涵盖了一系列不拘一格的主题，但没有具体的 专注于关系技能，很少有实证支持。最终，为了优化OOHC服务， 儿童的康复和减轻发展创伤的长期后遗症，必须 为护理人员提供机会，以发展技能，引发有益于发展的互动（DI） 在日常护理中。为了实现这一目标，我们提出了两个具体目标。目标#1：制作视频- 基于发展互动研讨会系列（DIWS），使护理人员能够反复观察和 实践特定形式的DI，并创造机会在日常护理中增加其频率。 DIWS将包括两个4小时的护理人员和监督员会议，以及两个90分钟的会议 对于监督者来说。测试版将在一个住宿护理（RC）机构实施，并根据需要进行修订， 然后在三个驻地协调员机构全面实施。目标2：使用混合方法（工作人员和 儿童调查、工作人员访谈和人种学），以记录其在四个驻地协调员机构的初步证据。 影响力、可接受性和可行性。我们希望DIWS能引导（1）护理人员变得更有能力， 有动机，有目的地诱导DI发挥其替代作用，以及（2）照顾者和儿童， 在日常活动中，他们认为DI的患病率更高。我们还将确定个人， 与吸收有关的组织和实施相关因素。DIWS将提供一个 了解和加强儿童与成人关系的发展框架， OOHC。混合方法评价结果将为该项目未来的RCT提供基础 有效性，告知方案改进，并促进其更广泛的传播。

Most U.S. children living in out of home care (OOHC) have debilitating impairments regulating emotions and behavior and the success of treatment efforts for these children depends principally on caregivers’ capacity to provide developmentally enriching, therapeutic care. While living in OOHC, the adults who care for these children during the critical hours outside of formal therapy play central roles in their treatment. Yet, OOHC caregivers receive little education about how to meet the unique relational needs of the children they serve and lack a clear understanding of their own therapeutic role in each child’s rehabilitation. In addition, the most commonly-used training programs for caregivers in OOHC cover an eclectic range of topics without a specific focus on relational skills, and few have empirical support. Ultimately, in order for OOHC services to optimize children’s rehabilitation and mitigate the long-term sequelae of developmental trauma, it is imperative to provide opportunities for caregivers to develop skills for eliciting developmentally enriching interactions (DIs) during their ordinary care routines. Toward that goal, we propose two specific aims. Aim #1: Produce a video- based Developmental Interaction Workshop Series (DIWS) that enables caregivers to repeatedly observe and practice specific forms of DI and to create opportunities to increase their frequency during daily care routines. The DIWS will include two 4-hour sessions for caregivers and supervisors, as well as two 90-minute sessions for supervisors. A beta version will be implemented in one Residential Care (RC) agency, revised as needed, and then fully implemented in three RC agencies. Aim #2: Evaluate the DIWS using mixed methods (staff and child surveys, staff interviews, and ethnography) in four RC agencies to document preliminary evidence of its impact, acceptability, and feasibility. We expect the DIWS to lead (1) caregivers to become more capable, motivated, and purposeful about eliciting DIs in their caregiving role, and (2) caregivers and children to perceive a greater prevalence of DIs during routine daily activities. We will also identify individual, organizational, and implementation-related factors related to uptake. The DIWS will provide a developmentally-informed framework for understanding and enhancing the child-adult relationships in OOHC. Mixed-method evaluation results will provide the foundation for future RCTs of the program’s efficacy, inform program improvements, and facilitate its wider dissemination.