Effectiveness of Child Adult Relationship Enhancement (CARE) Training for Preschools in Rural Communities

Background and Purpose: Behavior problems in preschool is a serious public health concern affecting up to 20% of children (Graziano et al., 2015). Rural preschool settings face unique challenges in addressing this behavioral health need due to high urban migration of young professionals, understaffed preschools and limited funding. However, most studies showing positive outcomes of interventions on classroom behavior management skills have been conducted in controlled urban settings. To address this knowledge gap, Child Adult Relationship Enhancement (CARE), a trauma-informed training model adapted from Parent-Child Interactive Therapy (PCIT) ), was developed into a school based universal program and applied in rural preschool settings. This presentation focuses on the effects of CARE on social-emotional competence and reduction of externalized behavior problems in young children by addressing the following research questions: 1) Is CARE more effective at improving preschool children’s social-emotional competence and reducing behavior problem scores compared to usual care, and 2) To what extent do CARE training, gender, consultation hours, behavior problem scores, intervention by gender, and intervention by behavior problem explain variation in social emotional competence?

Methods: A convenience sample of 43 preschool classrooms in rural Ohio were recruited and assigned to either intervention (n=10 teachers, n=123 children) or care as usual (n= 44 teachers, n=340 children). At baseline, teachers in the intervention group received 4 hours of CARE training, followed by 6 weekly and another 6 bi-weekly coaching sessions during 2018-2019 academic year. Teachers of usual care children received universal mental health consultation from a licensed mental health professional. Changes in preschool children’s social-emotional competence and behavior problems were measured by the standardized teacher rating scales: Devereux Early Childhood Assessment for Preschoolers, Second Edition (DECA-P2) and Sutter-Eyberg Student Behavior Inventory-Revised (SESBI), before and after the intervention.

Results: The Paired-samples t-test findings indicate that children in the intervention group experienced higher social-emotional competence (d =0.5, p <.0001) and self-regulation (d = 0.3, p<.05,) scores compared to children in the control group. A statistically significant regression model of social emotional competence was developed (F (6, 407) =60.85, p < .0001), with an R² of 0.128. Generally, children in the intervention group had greater positive change in all measures of social emotional competence and behavior problems than the control but this was moderated by the level of behavioral problems at baseline.

Conclusions and Implications: CARE training is a brief, inexpensive intervention focused on equipping teachers with a set of skills that they can use to strengthen children’s social-emotional competence. This study indicates that CARE training holds promise in helping teachers address children’s behavioral health needs while requiring a limited investment in time and finances. Social workers in rural communities are few and need to be equipped with best practices that can expand the ability to meet needs in a sustainable fashion. Thus more research with randomized design is needed to build the rural setting evidence-based prevention programs for preschool behavior problems.