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

大多数生活在家庭护理(OOHC)中的美国儿童都有调节情绪和 这些儿童的行为和治疗努力的成功主要取决于照顾者的能力 提供有益于发展的治疗性护理。在OOHC居住期间，照顾这些的成年人 在正规治疗之外的关键时间段，儿童在他们的治疗中发挥着核心作用。然而，OOHC 照顾者几乎没有接受过关于如何满足他们所服务的儿童的独特关系需求的教育 对自己在每个儿童康复中的治疗作用缺乏清晰的认识。此外，最多的 OOHC中针对照顾者的常用培训计划涵盖了一系列折中的主题，而没有特定的 专注于关系技能，很少有经验支持。归根结底，为了让OOHC服务优化 儿童的康复和减轻发育创伤的长期后遗症，势在必行 为照顾者提供发展技能的机会，以激发促进发展的互动(DIS) 在他们的日常护理中。为了实现这一目标，我们提出了两个具体目标。目标1：制作一段视频- 基于发展互动研讨会系列(DIWS)，使照顾者能够反复观察和 实践特定形式的DI，并创造机会在日常护理中增加它们的频率。 DIWS将包括两次为期4小时的照顾者和监督者会议，以及两次90分钟的会议 给主管的。测试版将在一个住宿护理(RC)机构实施，根据需要进行修订， 然后在三个RC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)，以记录其初步证据 影响力、可接受性和可行性。我们预计DIWS将引领(1)照顾者变得更有能力， 有动机，有目的地在他们的照看角色中引发障碍，以及(2)照顾者和儿童 在日常活动中感觉到精神障碍的患病率更高。我们还将确定个人， 与采纳有关的组织因素和执行因素。DIWS将提供一个 发展知情框架，以了解和加强#年的儿童-成人关系 哇哦。混合方法评估结果将为该方案未来的随机对照试验提供基础 有效，告知计划的改进，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.