Abstract
Approximately sixty percent of children living in therapeutic foster care, enter the system with a diagnosis of moderate to severe mental health issues. These children, placed in therapeutic foster homes, can present disruptive behaviors. Maladaptive coping skills on the part of the child or stress inducing behaviors on the part of the caregiver can cause a crises leading to potential removal from the home. Solution focused brief therapy, could increase the quality of the relationship between foster parent and child. Foster children and parents can have a disparity between the perception of a situation and improper communication of opposing views may lead to crisis. Using tools and tenants of solution focused brief therapy could decrease placement disruptions. The purpose of this article is to identify common issues and challenges facing foster parents and children, and examples of interventions using solution based therapy. The strength-based interventions, coupled with the current evidenced-based training, will decrease placement disruptions, and increase the potential of successful transitions from foster care. The article will discuss current evidenced-based interventions, and solution focused therapy as an additional therapeutic approach. In this article, common issues and challenges facing foster parents and children are discussed; and strengths and limitations of implementing solution focused therapy techniques are explored.
Keywords: Therapeutic Foster Care, Foster Parents, Foster Children, Solution Focused Brief Therapy, Training
Foster Parents and Solution Focused Brief Therapy:
An estimated 541,000 children in America live in the foster care system today (U.S. Department of Health and Human Services, 2010). Residential treatment facilities, psychiatric group homes, and foster/ kinship care comprise most of these out of home placements. Therapeutic Foster Care, (TFC) is an additional type of out of home placement and is a specialized service designed to serve children with special needs (Berika, 1999). These special needs range from emotional, cognitive, and physical/medical and can serve as a step down between a residential treatment center and foster care (Strijker, Oijen, & Dickscheit, 2010).
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Each specific type of out of home placement offers differences in the goals and functions of foster care and therapeutic foster care are numerous. Maltreated children are placed in foster care primarily to receive protection, and stability. If the child exhibits the need for mental health or substance abuse therapy, the service is provided outside of the home (Farmer, Mustillo, Burns, & Holden, 2008). Transitioning statement from fc 2 tfc (on the other hand ) Therapeutic foster care combines the structure of a residential treatment facility with the care and protection of the home environment. Fifty nine percent of children entering therapeutic foster care address serious levels of emotional behavioral issues; and need rehabilitation (Hochstadt, Jaudes, Zimo, & Schacter, 1987). Therapeutic interventions take place within the home, with the goal of integrating newly acquired interpersonal skills into the home environment, which are necessary for future family reunification.
Multiple reasons exist facilitating the need to place a child outside of the home for treatment. High-risk family factors include poverty, divorce within the immediate family, (Williams at all, 1990), biological parental mental illness, witnessing domestic violence, and prior incarcerations within the immediate family (Johnson, 1989). The inability or unwillingness of the primary caregiver to care for the child is additional reasons for biological parental rights termination (Pecora, White, Jackson, & Wiggins, 2009). Alternatively, the child may have been removed from the home due to neglect or poor parenting. Substance abuse by the biological parents, or even the young person themselves, are additional factors in the decision to remove the child from the biological home. Thus, due to numerous reasons, the youth may have difficulty acclimating to new living situations.
Children placed in therapeutic foster care tend to exhibit poor coping skills, low frustration tolerance, and externalizing disorders such as Oppositional Defiant Disorder, Conduct Disorder, Attention Deficit Hyperactivity Disorder (Fiegelman & Harrington, 1993). The behaviors that accompany such externalizing disorders may cause foster parents to experience empathy fatigue (Lipscome, Moyers, & Farmer, 2004). Empathy fatigue is a leading cause for which a foster parent decides to surrender the foster child (Parker, 2009). This is known as a placement disruption or the child’s unscheduled removal from the foster home permanently.
Numerous publications report findings, that placement disruption has a detrimental effect on foster children. The American Academy of Pediatrics reported placement disruption, “Hinders the development and healing process of children” (American Academy of pediatrics 2000). Placement disruption jeopardizes the opportunity for children to develop trusting and secure relationships with adults (Robertson, 1989). The act of separating a child from biological families induces feelings of rejection, guilt, abandonment, and shame, (Garland et al., 2000, Simm at el 2000) regardless of the reason. “Multiple placements before the age of 14 are associated with higher rates of delinquency in youths”. Recent studies show a relationship between foster child placement disruption and the increase of foster care alumni homelessness, incarceration, and victimization. (Courtney, Dworsky, Lee, & Raap, 2009).
According to the Midwest Evaluation of Adult Functioning of Former Foster Youth, “Far too many foster youth are not acquiring the life skills or developing the interpersonal connections they need if they are to become productive young adults” (Midwest Evaluation of Adult Functioning of Former Foster Youth, 2010). Foster parents’ are to provide a safe and nurturing home, which will instill interpersonal communication and effective life skills to youth. The establishment of the connection between the foster parent and the foster child needs is critical due to beliefs that foster parents would benefit from the use of solution focused based therapeutic techniques with the foster child as these techniques provide____________________________________.
Multiple training programs have attempted to incorporate these skills within the juvenile’s daily routine (Price, Chamberlain, Landsverk, Reid, Leve, & Laurent, 2008). LIST PREVIOUS MODLES “Multidimensional Treatment Foster Care is a strengths-based intervention promoting child and adolescent resiliency in youth exposed to early adversity”. Application of MTFC within a treatment foster care home employs a point and level privilege system. Multiple studies show the effectiveness of using a reward level program (Fisher Chamberlain & Leve 2009). A second intervention model, which is a modified version of the multidimensional treatment foster care intervention designed for younger children is called keeping foster parents trained and supported (Price, Chamberlain, Landsverk & Reid, 2009). Other models of worth mentioning.
When a child faces the instability of placement disruption, they do not have a consistent environment where they feel safe to mature; instead, they must re-adapt the new living situation. We suggest following the tenants and techniques of solution focused brief therapy in addition to the aforementioned foster parent training will increase placement stability. Training the foster parents in solution focused therapy techniques we believe they will assist the youth in becoming solution oriented. This new set of skills taught to the child, by the foster parent has the potential to increase the foster child’s quality of life by decreasing placement disruptions.
Solution focused therapy lends itself well as an additional element training of foster parents. Through a question and answer conversation, it enables the foster parent to see the perspective of a given situation through the eyes of the child. Solution focused brief therapy is strengths-based and future oriented, while still validating the person’s experience (Littrell, 2006). Major tenants of this theory are (a.) change is constant (b.) there is always an exception to the problem (c.) there are many ways of looking at a situation, all equally important (Bannink, 2006/2010). It brings small successes to the child or foster parents awareness, and assists them in becoming solution oriented.
This article will discuss several solutions focused based therapy techniques with examples of their application. Scaling questions, including what identifies and increase or decrease of one point and the application will be discussed. Coping questions, which illuminates the caregivers and foster child’s strengths, will be investigated. The use of language tool statements, such as “You must have had a reason to”, will be explored. The identification of the child’s resources both internal and external will also be examined with examples illustrating the application.
The implementation of solution-focused therapy to increase foster care placement stability has been used in residential therapeutic treatment facilities. In a recent study it was found during the first year of treatment, the youth were counseled using the techniques of Cognitive behavioral therapy. In the second year they were counseled using solution focused brief therapy. It was discovered, the number of disruptions from these youth decreased from mean equaling 6.29 (standard deviation equaling 3.6) to mean equals 1.45 (standard deviation .68), P <001. Statistics show when used with displaced children solution focused brief therapy has the potential to decrease behavioral disruptions (. It is our belief using solution focused brief therapy techniques will increase interpersonal communication skills and problem-solving skills of these youth. It is also our belief that using solution focused brief therapy techniques in conjunction with proven training programs will decrease placement disruption and in turn decrease the negative societal effects of placement disruption.
In this article, we will discuss various emotional health rehabilitation needs of foster children referred to therapeutic foster care. A concise exploration of current evidence-based therapeutic foster parent training models highlighting their strengths and weaknesses will take place. The core tenants of solution focused brief therapy will be explored with the intent purpose of identifying specific interventions for use with this population. Furthermore, examples of the preferred intervention techniques of solution focused brief therapy will be provided. Finally, the strengths and limitations of using solution focused brief therapy with this population will be discussed with suggestions for further research.
I. Socioeconomic ramifications of child maltreatment.
Neglecting the therapeutic foster care populations has a debilitating effect on the economy.
Homelessness (check tense and safe assign)
In studies focused on homelessness in adulthood, placement in foster care in childhood or adolescence frequently emerges as a risk factor. {{57 Fowler,P.J. 2009;}} For example a study conducted by the Casey Institute showed within a two year period shows homelessness for foster alumni exceeded 12.%, which is the rate for a single episode of homelessness amid US adults. One fifth of the adolescents taking part in the study experienced chronic homelessness. {{86 Anonymous ;}}
Homelessness in adolescence and young adulthood has been shown to be associated with elevated risks of a number of negative outcomes. {{57 Fowler,P.J. 2009;}} These services need to begin earlier, to be extended to all eligible children in foster care, and to remain available until former foster care youth have attained stability as young adults (Kushel et al., 2007; Pecora et al., 2006).
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Research findings indicate that services need to begin early when a family first arrives at a shelter or the child first enters foster care, particularly since early intervention for young children can reduce the magnitude of trauma and subsequent problems later in life {{80 Dozier M Higley E Albus, K Nutter A. (2002);}} Housing instability was related to emotional and behavioral problems, physical and sexual victimization, criminal conviction, and high school dropout. From this information Fowler concluded adolescents transitioning from foster care are at considerably higher risk of homelessness {{57 Fowler,P.J. 2009;}}
A.1 Maltreatment leading to out of home placement
Sixty four percent of cases involved in the child welfare system are due to parental neglect. Failure to attend to the child’s physical, emotional, or educational needs may cause severe, long term psychological challenges.
Domestic violence in the child’s presence; familial substance use that interferes with parenting abilities, Physical abuse (16%), sexual abuse (9%), and psychological maltreatment (7%) are other reasons children are reported to child welfare.({{72 Leve, L.D. 2009;}}
b. Needs of Those in Therapeutic Foster Care
Characteristics of Those in Foster Care
Social and Academic Health
Children involved in the foster care system are at a higher risk of low academic performance and school failure. Children facing challenges, usually present with psychosocial problems at a substantially increased rate than the general population. These range from impulse control, to Attention deficit hyperactivity disorder, to conduct disorders which maturate during young adult hood and beyond. Children who fail to develop successful peer relations during school entry are at increased risk for conduct problems, peer rejection, and academic failure throughout childhood and adolescence {{91 Anonymous 2001;24 Egelund, Tine 2009;}} emotional and behavioral problems, exposure to physical and sexual abuse, adolescent pregnancy, incarceration and high school dropout. {{57 Fowler,P.J. 2009;}}
A preponderance of children in the welfare system have been identified as experiencing cognitive delays as evidenced by the Denver Developmental Screening Test II {{91 Anonymous 2001;}}. This is the most widely used psychometric test utilized for this young population. Early behavior problems among children placed in foster care have predicted delinquency, substance use, and sexual behavior 6 years later {{62 Linares,L.O. 2006}}
Medical and Physical health
The gravity and extent of the health care problems facing abused and neglected children are truly alarming.
Specified underlying neurobiological systems are influenced by types of adversity witnessed by children in the system increase risk for negative outcomes. These include common childhood diagnosis are at uncommon levels such as ADHD, disruptive behavior, anxiety, and affective disorders.{{72 Leve,L.D. 2009}}
Studies observed increased shifts in the hypothalamic-pituitary-adrenal HPA Axis, a hormone affected by cortisol imbalances. This hormone controls reactions to stress and has been discovered among children experiencing stress in foster care. Increased atypical diurnal cortisol levels{{74 Pears, K.C. 2008;}} are known to be higher especially among young female children who have experienced biological caregiver neglect {{70 Fisher,P.A. 2007;}}.
Similar to the HPA axis studies, problems with executive functioning are more common in foster children than in the general population {{74 Pears, K.C. 2008;}}. However therapeutic interventions designed for foster children may positively affect the HPA axis activity as it has been noted decreasing stress decreases the levels of cortisol{{70 Fisher,P.A. 2007;}}. (More research needs done) Fisher Suggests interventions which decrease stress levels of younger juveniles in out of home placements may produce increased outcomes on the social cognitive level and increase the functioning of an neurobiological systems.
{{95 Fisher,P.A. 2008;}}{{72 Leve,L.D. 2009}}
d. REHABILITATION NEEDS OF CHILDREN IN FOSTER CARE:
EVIDENCE-BASED INTERVENTIONS
Evidence-based interventions were formed and assessed to supervise the psychological and physical welfare of children in foster care. Stress inducing behavior on the part of the parent can cause disruptive behavior in the foster child which leads to early termination from the home. Maladaptive coping skills of the child that haven’t been rectified affect the child’s relationship with their caregiver and over time start to give negative connotations to authority figures. Implementing the interventions has shown a decrease in the need for extraneous mental and physical health care by increasing the probability of attaining placement stability. Interventions must target young people while they are still in foster care, before the age of 17 years, to ensure connection to services such as tuition assistance, employment training, and health insurance. {{57 Fowler,P.J. 2009;}}
Models
MTFC
The MTFC model acknowledges and identifies the affect of emotional hardships on the physical and psychological missing word of the foster care population. It originated in 1983 in response to an Oregon State request for proposals from the juvenile justice system to develop community-based alternatives to incarceration for adolescent placements in residential/group care. (Leve,2009) This model gives an evidence based solution to strengthen the self-esteem of the foster children and teach them resiliency to improve behavioral problems. Additionally, consistent with research on resiliency, the model now incorporates key positive individual and interpersonal relationships, adaptive neurobiological functioning, and adaptive social behavior. (Leve, 2009)
How it works
The MTFC intervention teaches caregivers how to give positive mentoring, improve parental skills and the importance of consistency through training, supervision and the endorsement of a skills coach. MTFC was selected by the Office of Juvenile Justice and Delinquency Prevention (Elliott, 1998) as 1 of 10 evidence-based National Blueprints Programs; was selected as 1 of 9 National Exemplary Safe, Disciplined, and Drug-Free Schools model programs; was highlighted in 2 U.S. Surgeon General reports (U.S. Department of Health and Human Services, 2000a, 2000b) (Leve,2009) These reports recorded government savings, showed improvement of behavior in child, and helped stress level of caregiver. State Public Policy group reported a $32,915 cost savings in 2006 to taxpayers for each (Leve,2009) In order for the intervention to be effective, the foster child needs positive reinforcement, individual and family therapy, along with social skills and academic mentoring.
The team
The skills coach is conditioned to focus on beneficial skills and actions rather than past behaviors or problematic situations. The foster parents and program supervisor work together to carefully monitor youth adjustment in the classroom. (Leve,2009) Classroom observations and evaluations allow the caregiver to evaluate behavioral changes without excessive amounts of external influences in a neutral setting. These caregivers are taught to use the same incentives or point systems employed in the foster home to provide positive feedback and brief, non-emotional consequences for problem behavior. (Leve,2009)The consistency from one environment to another eases the transition process for the foster child. Positive outcomes, including the likelihood of achieving permanency ( this effect is particularly marked for children who have had multiple prior foster placement failures), children’s attachment to caregivers, foster-parent stress levels, older children’s delinquency and antisocial behavior, participation in school and subsequent time incarcerated. (Fisher P.A. 2009)
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