The Evolution of Treatment Foster Care and the Foster Family-based Treatment Association (FFTA)

1. The Evolution of Treatment Foster Care and the Foster Family-based Treatment Association (FFTA) Presenter: Ken Olson, LCPC; State Manager, KidsPeace National Centers of New England Past President, FFTA Kolson@kidspeace.org

2. Introduction. The basic idea. • A foster family, provided with specialized training, supervision, and other clinical supports can be a powerful agent of change for a child with special behavioral, emotional and/or medical needs.

3. Treatment Foster Care: a Definition • “In Treatment Foster Care, the positive aspects of the nurturing and therapeutic family environment are combined with active and structured treatment” (from FFTA definition, “What is Treatment Foster Care”)

4. “Traditional” vs. “Treatment” Foster Care • Treatment FC: applies treatment technologies usually utilized in more restrictive residential settings in the family itself • Traditional FC: nurturing, safe custodial care. Treatment, if required, occurs outside the home.

5. Treatment Foster Care: Basic Philosophy, Core Elements • Family itself is an agent of change. • Specialized training and supervision for foster parents • Professional supports: Reduced caseload – clinical oversight • Only 1 – 3 children placed per home

6. TFC Core Elements (cont.) • 24-7 emergency support • Case coordination with other community providers (schools, community mental health) • Planned and emergency respite care • Highly individualized treatment plan • Matching child to the skills and abilities of the foster parents

7. Treatment “method” or “delivery system”? • Method: Resilience research supports the importance of 3 protective factors. • Meaningful relationship with a caregiver. • Guardian angel • Development of socially valued skill. • TFC model maximizes the opportunity to develop these 3 factors while simultaneously reducing risk factors (such as association with negative peer group)

8. “Method” or “delivery system”? (cont) • Delivery system: • Behavioral systems • Cognitive behavioral interventions • Systemic interventions • Developmental – interventions stemming from attachment theory • Special medical needs

9. Foster Family-based Treatment Association (FFTA) • Over 400 agencies that provide TFC in the US and Canada • Annual conference; regional and specialty conferences • State/Province Chapters: Council of Chapter Chairs • Standards and COA sponsorship

10. Foster Family-based Treatment Association (FFTA) • Public Policy (national and regional support; advocacy) • Research and Outcomes • Publications (FOCUS, Public Policy Position Papers, Annotated Research) • Communication (list serves and website)

11. History of Foster Care • Old Testament and Talmud • 1500’s: Almshouses, English Poor Laws • 1800’s: First adoptions in US, NY Children’s Aid Society, adoption trains, Mary Ellen and first child abuse laws, first state-sponsored subsidies to children’s aid (Mass, So Dakota)

12. History of Foster Care II • 1909: White House Conference on Children: focus on rehabilitation • 1935: Social Security Act requires welfare services to children, foster care joint funded by feds • 1938: Fair Labor Standards act; first child labor laws

13. The Roots of TFC: 1950’s and 1960’s • First published advocacy of Specialized Foster Care. (1950’s) • Foster parents as ancillary service providers. • Beginnings of Systems Theory – leading to the development of Family Therapy • 1960’s: Social Security Act amendment gives states responsibility for caring for kids and allows payment of premium rates

14. 1960’s • 1963 Battered Child Syndrome is identified • 1966 Hobbs Re-Education Model: treatment using an ecological approach: use of paraprofessionals • 1967 Achievement Place: the Teaching Family model; applied behaviorism in group homes

15. 1970’s: The Age of Innovation • Foster Parents as the primary agents of change • Practice models emerge, small agencies develop • Milieu therapy constructs from residential tx applied to family settings; • Bronfenbrenner’s Ecological Model: changing role of the Professional.

16. 1980s: De-institutionalization comes of age • Adoption and Assistance Act: identification of “foster care drift” as a social problem • North Carolina meeting; precursor to FFTA (1985) • CASSP (NIMH) community based options to institutionalization (1988) • Formation of FFTA

17. 1990’s: The Model Matures • Increasing use of Medicaid $ to fund TFC • Experimental use of in home support staff and more intensive clinical service models • Managed Care • Research and Outcomes

18. Efficacy • Serves kids similar to kids in residential settings with equal or better outcomes • Better placement stability than traditional foster care (20 – 30% fewer disruptions) • Demonstrated best practice with delinquent (reduced runaways, recidivism, & delinquent peer associations)

19. Economy • Serves many kids otherwise placed in residential tx at higher cost • Often prevents or shortens length of stay in residential placements • Compares favorably to traditional foster care when all costs and outcomes are considered.

20. Current issues: • Is TFC a mental health program or a child welfare program? • Professionalization of foster parents • Permanency (ASFA) • Other populations? (aging)