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Develop and Support Families

Fostering Healthy Futures, Colorado

This is one of 31 program profiles that appears in Support Matters, Lessons from the Field on Services for Adoptive, Foster, and Kinship Care Families (PDF – 2 MB), published March 2015.

Overview

Fostering Healthy Futures is a 30-week preventive intervention for children ages nine to 11 who are or have been in foster care. In addition to receiving mentoring from graduate students at local universities, the children participate in weekly therapeutic skills groups.

Operated as a research study since 2002, the program began to be offered by one Colorado community mental health organization in fall 2013.

Population Served

  • Maltreated children ages nine to 11 who entered any type of out- of-home care within the prior year.
  • During the clinical trial, Fostering Healthy Futures served 228 children in a five-county area around Denver. Of the children served, half were Latino and one-third were African American.

Theory of Change

Providing children in foster care with a healthy adult relationship and specific skills training can result in:

  • Reduced stigma of being in foster care
  • Improved outcomes in areas such as healthy relationships with peers and adults, positive attitudes about self and the future, better coping and behavior regulation skills, and improved mental health functioning

Provider

The research trial was conducted by the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine. Providers could be:

  • Mental health centers
  • Mentoring organizations
  • Youth-serving organizations
  • Other entities with the capacity to supervise graduate students and have connection to the child welfare community

Role of Public Child Welfare Agency

Local child welfare agencies make referrals to the program.

Key Service Components

 The program consists of 30 weeks of mentoring and skills groups, running from September through May:

  • Weekly therapeutic skills training — In these 1.5-hour sessions, groups of eight children meet other children in foster care. Facilitated by two adults, sessions enable children to explore their feelings about foster care, develop communication and anger management skills, and acquire tools for resisting peer pressure. The skills groups follow a written curriculum that combines the teaching of social skills with the opportunity for children to process their out-of-home care experiences. Topics include problem solving, cultural identity, change and loss, healthy relationships, and focusing on the future. The last half hour of each group is a meal and social time.
  • Two to four hours of one-on-one mentoring each week — Graduate students in social work and psychology serve as advocates and role models to the children, helping them build connections in the community and serving as liaisons between the children’s birth and foster families. Mentors help connect children with community-based activities such as sports, social activities, and recreation, with each child’s activities being different based on the child’s strengths and needs. Mentors also help children practice skills learned during the weekly skills sessions. Mentors provide transportation for the children to attend skills group and eat dinner with the group.
  • Respite — While children are with mentors or in skills sessions, parents receive a break.

Although it was not a core program component, children in the trial (and in a randomly selected control group) were given an initial assessment of their cognitive development and mental health status. For those receiving the Fostering Healthy Futures intervention, mentors were able to help ensure the child was connected with resources.

Outreach Efforts

During the study, researchers recruited all children nine to 11 who had entered foster care in the counties during the year.

Staffing

  • Mentors (18–20 hours per week) — graduate student interns in behavioral health fields such as social work or psychology from a nearby university served as mentors to two children each; these unpaid positions meet requirements for internships; mentors are reimbursed for transportation and out-of-pocket expenses.
  • Skills group facilitator — master’s or doctorate-level clinician prepare for and run each skills group.
  •  Skills group co-leader — a graduate student intern (unpaid) co-facilitates each group.
  • Skills groups assistants — students are paid $1,000 per year to order food and set up the sessions.
  • Project manager/coordinator — a staff member who supervises mentors and other staff.

Training Requirements

  • Mentors complete 24 hours of training that covers their role, cultural competence, foster care information, program policies, and more. In addition, they attend a weekly seminar to increase their capacity, learning about attachment or suicide assessment, for example. Mentors also receive one hour of individual supervision each week and one hour of group supervision (held during the child’s skills group).
  • Before they begin work, skills group co-leaders receive eight hours of training on clinical skills for leading these groups based on the curriculum, behavioral management strategies, minimizing deviance, and common issues for children in out-of-home care. In addition, they receive 1.5 hours per week of ongoing training for leading groups and supervision.

Evaluation and Outcomes

Evaluation Design

From 2002 to 2009, the program was run as a research study with children randomly assigned to a control group or to the Fostering Healthy Futures intervention. Researchers assessed the children’s mental health using the child’s self-report on the posttraumatic stress and dissociation scales of the Trauma Symptom Checklist for Children, and an index of mental health problems with reports from caregivers and teachers. In addition, caregivers reported on the child’s use of mental health services and psychotropic medicines.


Key Findings

  • Six months after participating, children served saw significant reductions in mental health symptoms, particularly in the areas of trauma, anxiety, and depression.
  • Children who participated were also less likely to access mental health treatment or receive psychotropic medication.
  • One year after the intervention, children who participated in Fostering Healthy Futures were 71 percent less likely to be in residential treatment than children in the control group.
  • Children in non-relative placements had 44 percent fewer placement changes, and were five times more likely to achieve permanence within one year of participating in the program. (For the overall program sample, there were not statistically significant differences in placement changes or permanency.)
  • Of the 32 children whose parental rights were terminated, 26 percent of those who received program services (five of 19) were adopted within one year after program completion, compared to only 8 percent (one of 13) in the control group.

The California Evidence-Based Clearinghouse for Child Welfare rated the program as supported by the research evidence, and the Washington State Institute for Public Policy rated the program as research-based.

Budget

About $5,000 to $7,000 per child

Funding

The research study was funded through 10 years of grants from the National Institute for Mental Health plus significant state and foundation funding.

The program is currently being offered by a community mental health agency in three counties with funding from the county’s core service dollars. Other sites interesting in replicating the program are exploring other funding strategies, including the use of Medicaid dollars.

Partnerships Required or Recommended

  • Local universities who can arrange for graduate student interns
  • Connections with child welfare agency to refer children

Challenges

  • Retaining children in the program after they were adopted
  • Affording mileage reimbursement for transportation
  • Maintaining boundaries between children and mentors, particularly in social media (for example, some children sought to friend or follow their mentors on Facebook)

Background and Future Directions

 
Associate professor Heather Taussig created the program in 2002 to research ways to help children who were in foster care. She sought a strengths-based approach to reduce stigma associated with out-of-home care. To design the program, Taussig held focus groups with youth in care, biological parents, foster families, caseworkers, and kinship caregivers.

In 2013, a community-based mental health organization in Colorado began to offer the program. Other communities are also considering implementing the model.

Researchers are currently conducting an analysis of the program’s cost effectiveness, with results to be available in about 2015. They are also planning to test a similar program for teenagers.

Learn More

Sources

  • Heather Taussig, interview, June 25, 2013.
  • Heather N. Taussig, and Sara E. Culhane. “Impact of a Mentoring and Skills Group Program on Mental Health Outcomes for Maltreated Children in Foster Care,” Archives of Pediatrics & Adolescent Medicine, 164 (2010): 739–746.
  • Heather N. Taussig, Sara E. Culhane, Edward Garrido, and Michael D. Knudtson, “RCT of a Mentoring and Skills Group Program: Placement and Permanency Outcomes for Foster Youth,” Pediatrics, 130 (2012): e33–e39.
  • The California Evidence-Based Clearinghouse for Child Welfare, accessed June 20, 2013.
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