Trauma-Informed Psychoeducational Group

for Foster Parents

Group Proposal

By: Ashley Bigham

Agency Name and Mission Statement

• Agency: Tennessee Voices for Children

• Agency Mission Statement: “Tennessee Voices for Children speaks out as active advocates for the emotional and behavioral well-being of children and their families.” (Retrieved from: tnvoices.org/AboutUs).

TVC Goals and Objectives

• To encourage coalition building and collaboration among service providers and families to best meet the needs of all children

• To continue public awareness and education efforts through the presentation of statewide conferences focusing on topics of

interest to families and service providers

• To develop and empower the Statewide Family Support Network, providing emotional support, information and education to

families of children impacted by emotional and behavioral disorders

• To monitor children's services in Tennessee and to promote service and systems changes that enhance the emotional and

behavioral well-being of children

• To offer training and technical assistance opportunities to families and service providers

• To educate and mobilize Tennesseans to remove barriers negatively impacting services for children

• To promote a comprehensive and integrated system of service delivery responsive to the cultural diversity of the population

• To provide valid research and outcome evaluations of services for children (retrieved from: tnvoices.org/AboutUs)

The Planning Process

The Planning Process

• In order to maximize support and overcome obstacles to the initiation of the group at Tennessee Voices for Children I would utilize Supervision and treatment team meetings to introduce my concept for the support group.

• This approach would allow for collaboration and constructive feedback from my supervisor and peers. Through peer collaboration and supervision, I would be better equipped to: overcome obstacles, foresee possible ethical dilemmas, and maximize support within the organization.

Generating Outside Interest

• A Trauma-Informed Psychoeducational group for foster parents could generate interest and support from the community in numerous ways: By becoming a resource for the community.

By working with local organizations like DCS, mental health facilities, and CASA to promote trauma-informed care and services.

Allowing for outside services to submit referrals for potential group members.

By decreasing the number of foster placement transitions for children currently in DCS custody.

Client Needs

• The specific client needs I hope to address in and through the group are:

Understanding and tending to the foster-child’s needs.

How to handle the emotional rejection/stresses that often comes with providing care for a child who has experienced trauma.

Knowing about trauma-informed care and how to effectively implement it into their family system.

How to effectively work in conjunction with birth parents and support agencies.

How to cope with the emotional strain of child/children leaving their home or the foster care system.

Healthy and effective parenting skills.

Emotional support and constructive feedback from group members.

Consideration of Social and Cultural Factors

• There are many social and cultural factors (age, race, socioeconomic status, and religion) that could potentially have an effect on group dynamics and cohesion.

• However, the significant social/cultural factor for meeting this particular group’s criteria is that each participant is currently a foster parent and wanting to increase their awareness/knowledge of effects of trauma as well as improving parenting skills.

• Incorporating group members with varying social and cultural factors would provide useful in this particular group because foster parents do not get to choose factors such as the age, race, and religion of their foster child. Having that diversity among the group members would allow for additional insight into the sociocultural factors they may not consider or identify with.

Developmental Needs

• Based on Erikson’s Stages of Psychosocial Development, group members may vary among 3 stages of development and needs. Intimacy vs. Isolation: (19-40 yrs). “Need to form intimate, loving relationships with

others. Success leads to strong relationships, while failure results in loneliness and isolation.”

Generativity vs. Stagnation: (40-65 yrs). “Need to create or nurture things that will outlast them, often by having children or creating positive change that benefits other people. Success leads to feels of usefulness and accomplishment, while failure results in shallow involvement in the world.

Ego Integrity vs. Despair: (65-death). “Need to look back on life and feel a sense of fulfillment. Success leads to feelings of wisdom, failure results in regret, bitterness, and despair.”

(Retrieved from: psychology.about.com/library/bl_psychosocial_summary.htm)

Meeting the Need

• Group work can facilitate increased communication about one’s thoughts, feelings, and actions and can bring about a sense of connectedness and universality.

• A psychoeducational group would meet client needs by: Providing relevant education and information

Offering support and encouragement

Teaching parenting skills

Members sharing common experiences, insight, and feedback

Assisting members in creating support systems outside of the group.

The Driving Force

• During my internship with Tennessee Voices for Children I have worked with numerous foster parents that provided care to the youth on my caseload, the majority of which had suffered one or multiple traumas. Due to the lack of knowledge and understanding about the effects of trauma on child development and behavior caused them to become easily frustrated and overwhelmed.

• Many of the youth on my caseload were moved to more than 3 foster homes in the past year.

• Providing education and support to foster parents through a psychoeducational group may assist in decreasing the number of foster placement transitions and allow for increased stability and healthy attachment and relationships for youth in foster care.

The Purpose of the Group

What’s the purpose?

• The purpose: To provide trauma-informed education and emotional support to foster parents.

• Relating to the clients’ needs: Assists foster parents with identifying and addressing some of their foster

children’s behaviors in a more healthy and effect way.

Allows for improved parenting and coping skills, effective communication, and self-awareness.

A group setting allows for needs such as: intimate/caring relationships, emotional support, and a sense of fulfillment, which can be met through the interacting and connecting among group members.

What’s your type?

• Type of group: Psychoeducational

• Theoretical Rationale: Education and information about the strengths-based perspective, theories surrounding the ARC model, and Trauma-Focused CBT strategies will be provided and discussed in group sessions.

• Evidence of effectiveness: Organizations such as Therapeutic Foster Care, located in Baltimore, MA, currently offer psychoeducational groups for foster parents. (See www.therapeuticfostercare.org). Youth Villages and Centerstone are two of the local organizations that offer support groups for parents with children in the foster care system. However, I was unable to identify any local organizations that provide foster parents with a psychoeducational group that is strengths-based and trauma-informed.

• As for research focusing on the effectiveness of trauma-focused psychoeducational groups with foster parents, the results appear to be more focused on the effectiveness of providing the educational component into the child-foster family dyad.

Strength in Numbers

• For this particular group, having 2 leaders alternating weekly between leader and co-facilitator would be ideal.

• I would also like to have an additional therapist or intern on-call in case one of the leaders is absent as to maintain the group setting.

• I prefer to have 2 therapist in a group setting because it provides the leader with additional support. The co-facilitator can bring added insight, observation, and feedback to the leader. By taking turns in the leadership role, both therapists will benefit.

• I would request the my supervisor consider having the 2 therapists differ in gender, race/ethnicity, and/or religion in order to be responsive to the cultural diversity within the targeted population. Strong consideration for a bi-lingual therapist should be made.

Anticipated Characteristics of Members

• Anticipated Descriptive Characteristics: • Age: 25-65

• Gender: Male and Female. My hope is that if the home has 2 caregivers, that both will attend, but would not be required.

• Racial/Ethnic Background: African American, Caucasian, and Mexican/Latino

• Language: Primarily English; but I would prefer to have a bi-lingual therapist to ensure cultural competency.

• Education: High school diploma or higher.

• Socioeconomic Level: Per www.tn.gov, there are no income or work requirements for foster parents.

• Previous Group Experience: I anticipate at least 1 or 2 members having previous group experience.

• Heterogeneity will be high due to the possibility of diverse characteristics and personalities.

Anticipated Characteristics Con’t

• Anticipated Behavioral Characteristics: • Interactional Styles: Due to the fact that this group is voluntary, I foresee most group

members as being eager to interact and connect with others. However, I do anticipate an overly zealous member and a silent or withdrawn member to be in the group as well.

• Motivations and Capacities to Change: I like to believe that every foster parent provides foster care because they love children and want to provide them with a safe and loving environment. My hope is that each member’s motivation for joining would be their foster children. Due to the fact that the group is that of a psychoeducational nature and voluntary, leads me to anticipate capacity and willingness to change as being high.

• Potential to Develop Individual Goals: Each member will enter the group with their own set of concerns, struggles, and experiences with their foster children and I anticipate each member wanting to improve at least one problem area. My plan is to have each member identify one goal they would like to work on in group and I will attempt to have one session that provides education and discussion to assist in working toward each goal.

Structure of the Group

Temporal Arrangements

• Duration of Meeting: 90 minutes. I would like to designate time to provide the topic and educational information as well as time for discussion, role-play, and feedback. Sixty minutes would not be enough time for educational material and discussion. Any amount longer than 90 minutes may cause members to become restless or bored.

• Frequency: Once per week. Meeting more than once a week could make it difficult for members to attend regularly.

• Time: Late afternoon or early evening. I would utilize supervision and tx meetings to collaborate on an appropriate meeting time. Sunday from 4-5 would allow for members to still have time to prepare for the following work week. A weeknight from 6:30-7:30 would allow for time to commute and tend to child/family needs.

Physical Arrangements

• Meeting Place: Tennessee Voices for Children large conference room. The facility is centrally located, close proximity to the bus line, and in a safe and secure neighborhood.

• Size of the Room: The large conference room holds at least 40 people comfortably.

• Physical Arrangements of the Room: Chairs will be in a U shape during the educational portion of the session. For the discussion, members and therapists will move into a circle formation. Two tables will be set against the back wall, one for educational handouts and the other for refreshments.

• Transportation: Members can arrive by city bus, Tenncare transportation, or by driving. Thoughts for providing transportation were considered but TVC dies not have a company vehicle or the funds to purchase one at this time.

Cost to Members

• Fee for Attendance: There will be no fee for group members due to TVC being a nonprofit organization.

• Funding: The group could be added onto one of our current programs to cover costs, submit request for funding to Director, or we would need to write a grant proposal.

Coordination and Collaboration

• In order to make arrangements regarding confidentiality, intra- and inter-agency coordination and collaboration I would request a meeting with the director of the Family Connections Program, the Direct of Tennessee Voices for Children, and Human Resources to ensure that we are following company policy and meeting the needs of the potential group members. When requesting the meeting, I would ask if there were any additional parties that need to be present during the meeting.

Supplies and Equipment Needed

• The large conference room is already equipped with 12 tables, 30 + chairs, projector screen and the equipment needed to make it work effectively, dry erase board, and a lecture podium.

• In addition to the items in the conference room, we would need access to the printer to print off pertinent information and resource.

• We would need additional funding for refreshments.

Pre-group Contact

Recruitment

• Recruitment/Reach Out Process: I would begin by emailing TVC staff, explain the purpose and target population of the group, and ask if any staff have clients they feel would benefit from the group. I would then ask for permission to contact each potential member and discuss the group in greater detail

• If we do not have enough potential group members within TVC, I would reach out via email and phone calls to inform DCS, CASA, and the guardian ad litem program that works with the juvenile justice system. I would also reach out to my cohort to spread the word to potential members.

Intake Process

• How intake will be done: TVC requires that the staff member(s) who will be working with the client(s) complete the intake in a face to face session. There is a specific billing code used for intake services.

• I would discuss intake options with my co-therapist(s) and decide whether we should conduct the intakes together so that both therapists can begin to build rapport and a therapeutic relationship or should we separate and complete more intakes in less time and take the chance that the members will likely form closer bonds with the therapist who completed their intake.

• Because rapport and the therapeutic relationship are vital to the therapeutic process, we would choose to complete the intakes together. This would also allow for two therapists observing and assessing potential members.

Determining Suitability

• Criteria: The only criteria that will be used to determine a potential client’s suitability for the group is that the potential member is currently a foster parent who wants to improve their knowledge and skills of parenting children who have experienced trauma. Being in the foster care system is a traumatic event in and of itself, and more than likely the child experienced something traumatic that caused them to be placed in foster care.

Assessing Potential Members

• In order to assess a potential member’s strengths, problems, and concerns we will use the Strengths, Needs, Culture, and Discovery (SNCD) assessment, as well as, the Caregiver Strain Questionnaire (CGSQ). Both are tools that TVC uses to assess these areas.

• SNCD: This tool assesses:• Why the family/parent is involved in the program/group

• The Family Vision-how they would like the family to function after services have ended

• The formal and informal supports for the individual/family

• The narrative-which allows the worker to select specific individual/family domains and highlight the strengths within each domain.

• The needs section allows the worker to chose a life domain area and specify the individual/family need and desired outcome.

Assessing Potential Members Con’t

• CGSQ: This tool is provided to the caregiver at intake and upon discharge from a program.

• The CGSQ assesses:• The effects of the child’s problem behaviors on the individual and the family, such as missing work and

disruption of family routines.

• Other family members suffering negative mental or physical health effects as a result of the child’s problems.

• Youth getting into trouble with neighbors, community and/or law enforcement.

• Financial and family relationship strain due to child’s problem behaviors.

• Level of disruption of family social activities and feelings of social isolation

• Level of exhaustion and toll child’s behavior is having on caregiver.

• Feelings of sadness, anger, resentment, guilt, and embarrassment as a result of child’s problems.

• How well they feel they relate to the child.

• Concerns about the child/family’s future.

Orientation and Preparation

• According to Yalom (2005), “There is highly persuasive evidence that pregroup preparation expedites the course of group therapy.” (p.294).

• Yalom (2005) goes on to state that “Group leaders must achieve several specific goals in the preparatory procedure: Clarify misconceptions and expectations, anticipate and diminish the emergence of problems in the group’s development, provide clients with a cognitive structure that facilitates effective participation, and generate realistic and positive expectations about group therapy.” (p.294-95).

• Due to the information stated above, I would follow Yalom’s preparatory procedure.

Additional Contacts and Referrals

• Referral sources, no matter if the potential member is already receiving services from TVC must be notified to collect additional information, understanding of why the source feels the group would be beneficial for their client, goals they feel need to be addressed, and to what degree they perceive their client is ready to work towards change.

• I would also reach out to family members or others who may assist with caregiving responsibilities to gain additional insight into the child’s behaviors and strengths, as well as the foster parents’ responses and skills.

• As Social Workers, we are taught to gather information from the relevant people in a client’s life and consider all areas of their life, not just the one they identify as the problem in order to gain better insight and understanding.

Content

Content of Group Meetings

• Due to the fact that this is a psychoeducational support group, content in group meetings will be a mixture of didactic materials and discussions that are trauma-informed and family focused.

• Materials such as: handouts, videos, and relevant social media coverage on related issues will be used in order to provide group members with different forms of educational information.

• Changing the form of delivery may prevent members from getting bored or distracted.

• The discussion portion allows for members to process, share, and provide feedback about the information presented at the beginning of the session.

Planning of Content

• Both therapists will be responsible for planning group content. Each session’s content will be based on a problem/goal identified at intake by one or more group members. I would recruit interns to assist with planning of group content and materials.

• I anticipate members identifying 1-2 problems/goal that are similar in nature, which would allow for the therapists to focus on addressing areas of similar interest among the members.

Facilitating Interaction

• Providing educational information that is relevant to the current problem areas in each members family should facilitate interaction among group members.

• Asking members for feedback on how the information was presented may increase interaction and conversation as well.

• The discussion portion is to promote and facilitate group interaction.

Supplies and Equipment

• The large conference room is already equipped with 12 tables, 30 + chairs, projector screen and the equipment needed to make it work effectively, dry erase board, and a lecture podium.

• In addition to the items in the conference room, we would need access to the printer to print off pertinent information and resource.

• We would need additional funding for refreshments.

Evaluation

Measuring Effectiveness

• Caregiver Strain Questionnaire: This evidence-based tool is provided to the caregiver at intake and upon discharge from a program. However, I would implement this measurement tool more frequently to assess the effectiveness of the group.

• The CGSQ assesses:• The effects of the child’s problem behaviors on the individual and the family, such as missing work and

disruption of family routines.

• Other family members suffering negative mental or physical health effects as a result of the child’s problems.

• Youth getting into trouble with neighbors, community and/or law enforcement.

• Financial and family relationship strain due to child’s problem behaviors.

• Level of disruption of family social activities and feelings of social isolation

• Level of exhaustion and toll child’s behavior is having on caregiver.

• Feelings of sadness, anger, resentment, guilt, and embarrassment as a result of child’s problems.

• How well they feel they relate to the child.

• Concerns about the child/family’s future.

Measuring Effectiveness Con’t

• Pre-Test/Post-Test: I would also provide members with a pre and post test to determine their level of understanding surrounding trauma and it’s effects on youth.

• By providing members with the Caregiver Strain Questionnaire and the pre/post test regarding trauma knowledge, we will be able to determine the effectiveness of the group in improving the parent/family’s emotional and mental strain, their feelings/perceptions of the child’s problem behaviors, and their level of knowledge about their foster child’s previous, and possibly current, trauma and its effects on the child and family.

References

• Cobblestone, (n.d.). Mission statement, goals and objectives. Retrieved from www.tnvoices.org/AboutUs.

• Cherry, K. (2015). Erikson’s psychosocial stages summary chart. Retrieved from www.psychology.about.com/library/bl_psychosocial_summary.htm

• Tennessee Government, (n.d). How to become a resource parent. Retrieved from http://www.tn.gov/youth/fostercare/becomefosterparent.htm.

• Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy. 5th ed. New York, NY: Basic Books.