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

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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_at_kidspeace.org

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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.

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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)

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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.

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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

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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

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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)

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Method or delivery system? (cont)

• Delivery system
• Behavioral systems
• Cognitive behavioral interventions
• Systemic interventions
• Developmental interventions stemming from
  attachment theory
• Special medical needs

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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

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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)

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History of Foster Care

• Old Testament and Talmud
• 1500s Almshouses, English Poor Laws
• 1800s First adoptions in US, NY Childrens Aid
  Society, adoption trains, Mary Ellen and first
  child abuse laws, first state-sponsored subsidies
  to childrens aid (Mass, So Dakota)

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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

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The Roots of TFC 1950s and 1960s

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

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1960s

• 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

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1970s 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
• Bronfenbrenners Ecological Model changing role
  of the Professional.

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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

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1990s 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

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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)

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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.

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Current issues

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