In February 2026, the Center for Child and Family Policy received a transformative gift of $10.5 million from Bukhman Philanthropies to support five new research projects on some of the most pressing issues facing children and families today. The following is the first of a five-part blog series to introduce and share more about each of the newly funded projects.
Read on to learn about this second phase of work evaluating a statewide project in North Carolina that trains early care and education professionals as coaches in trauma-informed care.
Most commonly, conversations about early childhood development have centered on children themselves—but what if the key to better outcomes actually starts with the adults who care for them? Research from Duke University’s Center for Child and Family Policy has highlighted the powerful role that child care providers play in shaping infants’ emotional development and the importance of structured support systems. The Infant/Toddler Trauma-Informed Care (ITTI Care) research project was built on this simple but overlooked idea: when caregivers are supported, children thrive.
Often, early childhood education (ECE) professionals feel overwhelmed, underappreciated, and isolated. In the United States, early childhood educators are among the lowest-paid professionals and often lack insurance, despite the immense importance of their work and the physical and mental demands that come with it.
Katie Rosanbalm, Ph.D., ITTI Care Principal Investigator
Ennis Baker, MSW, LCSW, IMH-E®, ITTI Care Project Director
In 2018, the original ITTI (IH-tee) Care model focused on both bolstering workforce wellness and strengthening relationships in early childhood classrooms, ensuring ECE professionals feel “seen, heard, and held” in their workplaces. Developed by Dr. Katie Rosanbalm and Ennis Baker, the ITTI Care Project provides a professional development framework for the ECE workforce across North Carolina that promotes workforce wellness and trauma-informed practices.
Using a coach-the-coach model, ITTI Care coaches train and coach those who provide direct support to North Carolina early childhood teachers, family child care home professionals and child care administrators. Each year, the ITTI Care team runs a nine-month cohort-based learning collaborative for coaches working in early care and education. Participants work through 20 hours of training, 30 hours of independent work, and six months of implementation practice while receiving individual and group coaching support from ITTI Care staff. In turn, coaches help to promote trauma-informed practices among infant-toddler teachers and support provider mental health and wellbeing.
After six months of coaching, teachers in the ITTI Care classrooms significantly improved their responsive caregiving based on independent observer ratings. Additionally, across sites, 97% of coaches reported moderate to significant positive changes in educators, along with improvements in classroom climate and reduced burnout. Children in these classrooms also showed substantial increases in their socio-emotional development after this short period of time.
However, these successes also revealed a gap. While individual teachers reported higher resilience and lower stress, they did not report better relations with co-teachers, other staff, or directors. Moreover, their turnover rate (number leaving the field) remained high—creating an ongoing need for training and coaching new staff in every center.
This is where ITTI Care 2.0 comes in.
Building off this gap, ITTI Care 2.0 shifts its model to focus intensively on child care directors, who shape workplace culture and staff support. Unlike teachers, where quick turnover is an issue, directors are more likely to stay in their role over time, allowing them to influence the environment for longer periods of time. By focusing on directors, ITTI Care 2.0 aims to create more sustainable, system-wide change that helps support leaders in implementing policies and practices that better support their staff, strengthen team dynamics, and promote trauma-informed classroom practices.
In looking at the child care development system more broadly, Rosanbalm spoke about the variety of interconnected policy changes needed. Apart from improved pay, she spoke about the need for North Carolina to do a better job at supporting and investing in infant and early childhood mental health consultation, and more concrete support such as child care staff being able to buy into state employee health benefits. ITTI Care 2.0 is a step in the right direction; we’ve seen what is possible by working in the classroom, and now it is time to create lasting change in the workplace environment.
“If we want to take care of our children and our future, we have to start with the adults.”
Dr. Katie Rosanbalm
Ultimately, the message is clear: meaningful change in early childhood settings starts with the surrounding adults. When caregivers are supported, they can build the strong relationships that children need to thrive. As Rosanbalm described the most important takeaway to date, “If we want to take care of our children and our future, we have to start with the adults.”