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Child Abuse Negl. 2016 Mar;53:138-45. doi: 10.1016/j.chiabu.2015.10.016. Epub 2015 Nov 22.

Child-Adult Relationship Enhancement (CARE): An evidence-informed program for children with a history of trauma and other behavioral challenges.

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Duke University Medical Center, Center for Child and Family Health, 1121 West Chapel Hill Street, Suite 100, Durham, NC 27701, USA.
Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 3008, Cincinnati, OH 45229, USA.
University of Massachusetts Dartmouth, 285 Old Westport Road, LARTS 390, North Dartmouth, MA 02747-2300, USA.
Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, 311 Albert Sabin Way, Floor R, Cincinnati, OH 45229, USA.
University of Cincinnati Academic Health Center, Cincinnati Children's Hospital Medical Center, 311 Albert Sabin Way, Floor R, Cincinnati, OH 45229, USA.
University of North Carolina at Chapel Hill, 422 Brushy Fork Lane, Stuart, VA 24171, USA.


Child maltreatment impacts approximately two million children each year, with physical abuse and neglect the most common form of maltreatment. These children are at risk for mental and physical health concerns and the ability to form positive social relationships is also adversely affected. Child Adult Relationship Enhancement (CARE) is a set of skills designed to improve interactions of any adult and child or adolescent. Based on parent training programs, including the strong evidence-based treatment, Parent-Child Interaction Therapy (PCIT), CARE was initially developed to fill an important gap in mental health services for children of any age who are considered at-risk for maltreatment or other problems. CARE subsequently has been extended for use by adults who interact with children and youth outside of existing mental health therapeutic services as well as to compliment other services the child or adolescent may be receiving. Developed through discussions with Parent-Child Interaction Therapy (PCIT) therapists and requests for a training similar to PCIT for the non-mental health professional, CARE is not therapy, but is comprised of a set of skills that can support other services provided to families. Since 2006, over 2000 caregivers, mental health, child welfare, educators, and other professionals have received CARE training with a focus on children who are exposed to trauma and maltreatment. This article presents implementation successes and challenges of a trauma-informed training designed to help adults connect and enhance their relationships with children considered at-risk.


Child behavior problems; Child maltreatment; Dissemination; Evidence-informed; Implementation; Parent–Child Interaction Therapy (PCIT)

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