CHAPTER FOURTreatment Foster Care as a Correctional Strategy

Treatment Foster Care as a Correctional Strategy

• Tens of thousands of troubled youth each year are placed in these therapeutic settings• 19th century orphanages were the cornerstone for the development of the placing out

program, where youth and young adults were provided the opportunity to live with rural families in hopes of assisting them to become productive citizens by providing an education and proper care

• Between 1854 and 1930, 154,000 youth were moved from NYC and placed in homes throughout the Midwest

• Youth selected to be placed out were usually homeless, abandoned, dependent or neglected

• In the 1920s, boarding out programs became popular, where a child was sent to live with a family and that family was paid to care for the child, with that money going toward the child’s education

• Foster care has been shaped by two federal Acts:• Title IV of the Social Security Act of 1935 (Aid to Dependent Children) – allowed states to

become financially involved in care for children; later amendment created matching funds for children placed in foster care

• Adoption Assistance and Child Welfare Act (1980) – provided money to states for preventative programs and family reunification efforts

Recent Developments in Therapeutic/Treatment Foster Care

• In the 1950s and 1960s, TFC programs were used as supplements to existing institutional treatment facilities (halfway houses)

• In the late 1960s, TFC programs began to be used as alternatives to institutionalization

• The goal of TFC programs are:• Reinforce youth’s appropriate and positive behaviors• Closely supervise youth at all times• Carefully monitor peer associations• Specify clear, consistent rules and limits• Consistently follow through with consequences• Encourage youth to develop academic skills and positive work habits• Encourage family members to improve communication skills• Decrease conflict between family members

• Most children who are placed in TFC are from dysfunctional families and the greatest benefit of a TFC is to see how a “normal” family operates

Recent Developments in Therapeutic/Treatment Foster Care

• Three major elements of the treatment philosophy of TFC programs:• Behavior/Learning Based Approaches – parents are trained to use a behavioral approach

and learning-based therapy. Uses programs aimed at specific behaviors, is easily communicated to both TFC parents and children, and the effectiveness of these programs is easy to measure

• Supportive Family Setting – the family setting is a vital part of the intervention, as the child benefits from a stable, supportive family environment. This healthy family is seen as the most important ingredient of TFC

• Family Systems Approach – one of the key factors in some children with behavior problems is their biological family encourages deviant behavior. By removing children from that environment, TFC reduces the negative influences of the natural family with the hope that the child will learn the skills needed to manage negative family environment while in TFC

• TFC programs use intensive supervision strategies – children are closely supervised by TFC parents and program staff and they are not allowed unsupervised free time in the community; as they successfully advance in the program, levels of structure and supervision are reduced

Children in 21st Century Foster Care

• It is difficult to determine the true number of children currently in foster care, but the number grew rapidly in the 1990s

• By 1990, placement with relatives (kinship care) became an important part of foster care services

• More recent numbers show a steady decline of children in foster care, from 552,000 children in 2000 to 510,000 children in 2006

Therapeutic/Treatment Foster Care

• Uses treatment parents in an explicitly defined treatment program, views treatment parents as change agents that provide treatment services to children with emotional, behavioral, and/or medical problems, and perceives treatment parents as members of the treatment team

• TFC’s primary focus is to provide a treatment environment for troubled children and is considered the least restrictive form of out-of-home therapeutic placement

• Children are placed in private homes supervised by foster parents trained to provide specific services and interventions

• Originated because of dissatisfaction with the institutional care for children

• Provides cost effective care compared to institutional placement• Funded by state juvenile justice, child welfare, and/or mental health

agencies

TFC Program Delivery

Phase 1: Pre-Placement• When a youth is referred to TFC, information is collected about the youth and a

committee reviews his profile to determine if TFC is appropriate• If youth is determined to be a good fit for the program, they are matched with a TFC

family, who is given information about the youth and typically watches an interview involving the child

• Some programs even allow the child to stay overnight with the potential TFC parents • The placement process may take from two weeks to several months

Phase 2: Intervention• Programs create a program, with short and long-term goals, based on the child’s

profile• TFC programs provide treatment within the home (with the parents playing the major

role), telephone and face-to-face support services, crisis intervention services, and ancillary services, such as special education services, substance abuse counseling, after school and weekend programs, tutoring, extracurricular lessons in music, athletes, crafts, and independent living skills

TFC Program Delivery

Phase 3: Discharge and Follow-up• The goal of TFC programs is to eventually return all children to

their natural families• In order for the child to be allowed back home, he has to have

made significant progress toward treatment goals (favorable discharge)

• The average length of stay varies from one month to five years• After most youth are discharged, limited or nonexistent follow-

up or aftercare services are provided• Youth can be terminated prior to favorable discharge for not

advancing toward treatment goals, being charged with a new crime, or if a problematic family member is removed from the natural family because of death, abandonment or imprisonment

Characteristics of TFC Parents

• TFC parents undergo an extensive application process and are required to have specific training such as:• Crisis management• Observation and documentation• Implementation of positive behavior modification techniques• Parenting techniques• Treatment plan implementation• Involving the child’s family in the delivery of treatment• CPR, First Aid, and HIV/AIDS awareness• Medication management

Effectiveness of TFC

• TFC programs have a wide variety of titles, making it difficult to establish their effectiveness

• Reddy and Pfeiffer (1997) found that TFC was associated with a number of positive social psychological changes, such as improvement of children’s social skills

• The research suggests TFC placement increases family stability and improves their social skills and reduces behavioral problems

• Hahn et al. (2005) found that TFC was more effective than placement in group homes in reducing general and serious delinquency.

Advantages and Challenges of TFC

Advantages• Provides a minimally restrictive, natural environment

for the treatment of youth in a community setting• TFC is highly flexible and highly individualized, it can

be used to meet the needs of a wide range of youth• TFC programs provide the participants with a sense

of family connectedness• This bond is so strong that children often stay in touch with the TFC

parents for years after their discharge

• Start up costs are much cheaper and they are less expensive to operate

Advantages and Challenges of TFC

Challenges• Finding qualified parents capable and willing to work with children with

behavioral challenges• Developing and maintaining a reliable referral system since TFC programs

are relatively unknown• Maintaining a collaborative relationship with schools to ensure the best

educational options• Engaging natural families in the treatment portion of the program because of

refusal to work with TFC parents and staff and obstacles such as transportation costs, geographic distance, and lack of reimbursement to natural families

• Handling allegations of abuse and mistreatment against treatment parents • Dealing with disturbing behaviors of children (such as acting out, committing

crime, or destroying property)• Preventing burnout among TFC parents and staff because of the stressful

nature of the job

Conclusion

• Better data are needed regarding TFC programming in order to determine the future effectiveness of TFC programs

• Need to make TFC parenting more attractive to qualified parents and develop better communications with local educational systems so TFC children are given every educational opportunity to succeed

• Without aftercare services, the positive behaviors and strategies learned by TFC parents and staff will erode over time. As such, TFC programs need to foster relationships with both the school and the juvenile probation systems to develop strategies to ensure that youth who leave TFC programs have an effective support system to help them remain successful when they return to their natural families