| Therapeutic Foster Care | ||
What Is Therapeutic Foster Care? How Is Therapeutic Foster Care Different From Foster Care In General? What Are The Essential Elements Of Therapeutic Foster Care? How Are Child Placement Decisions Made?
What Is Therapeutic Foster Care? Therapeutic foster care has been defined in a variety of ways in the literature. At its core, it is a specialized form of mental health treatment in which the relationship between the child, foster parent(s), and other family members is the agent of therapeutic change. Instead of living in a facility to receive treatment, children and youth in therapeutic foster care are maintained in the community and benefit from structured experiences in a home, in a neighborhood, and in a community school. Here are some descriptions others have offered: “A service which provides treatment for troubled children within the private homes of trained families. The approach combines the normalizing influence of family-based care with specialized treatment interventions, thereby creating a therapeutic environment in the context of a nurturant family home.” (Stroul, 1989, p. 13)
* Careful selection of foster parents to work with children with special needs; In Kentucky, therapeutic foster care is defined in the law (KRS 159.135) as follows: “Therapeutic foster care” means a remedial care program for troubled children and youth that is in the least restrictive environment where the foster parent is trained to implement planned, remedial supervision and care leading to positive changes in the child’s behavior. Children served in this placement have serious emotional problems and meet one (1) or more of the following criteria: (1) imminent release from a treatment facility; (2) aggressive or destructive behavior; (3) at risk of being placed in more restrictive settings; or, (4) numerous placement failures.”
How Is Therapeutic Foster Care Different From Foster Care In General? Therapeutic foster parents are expected to be committed to serving children with much more severe needs, and to exhibit skills that are specialized and sophisticated. They are more likely than regular foster parents to have to deal with high levels of acting out and troubled behavior, possible property damage, and even false allegations of abuse. The children they will work with are much more troubled and needy. Therapeutic foster parents are also expected to collaborate with many more professionals in facilitating the care and treatment of the troubled children living in their home than are regular foster parents. Therapeutic foster parents are expected to develop and sustain their relationship with the child despite all of these challenges, because the core needs for most of these children are stability, continuity, and attachment to an adult caregiver. All foster parents undergo a rigorous selection process and core preparation training in areas such as foster care roles and functions, perspectives on parenting, teamwork, children’s history and behaviors, bonding and attachment, grief and loss, family functioning and values, behavior management, discipline, medication administration, and state and agency policies. Therapeutic foster parents receive additional pre-service and in-service training in areas such as child and adolescent development, therapeutic communication, behavior management, medications, skill teaching, expectations of treatment parents, CPR, First Aid, dynamics of the sexually abused child, and the effect of chemical dependency in family systems on children.
Where Does Therapeutic Foster Care Fit In, Compared To Other Forms of Treatment, Such As Residential Treatment Or Hospitalization? Prior to the age of twelve, cognitive, affective, and social development occurs at a rapid pace, and early experiences have been shown as critical for cognitive and affective development. There is emerging brain research showing that certain types of experiences are critical for young children. Naturally, they have physical needs, such as for food, clothing, shelter, and safety. Children also have social and emotional needs, such as the need for a caring and responsive adult to whom they can attach, and a predictable and consistent environment. Many of the children referred for therapeutic foster care have not had experiences that facilitate their optimal development, particularly with respect to their need for a secure attachment with an adult caregiver. For children who are in the state’s custody, this is made worse by the fact of having been removed from their biological family. Specially-trained, structured, and caring (i.e., therapeutic) foster families can serve a critical role in providing remedial and corrective experiences for maltreated or neglected children. In general, there seems to be consensus in the field that, whenever possible, children’s developmental needs are most likely to be met within family environments. This does not argue against the need for residential treatment for some children, whose needs cannot be met by biological, foster, or adoptive caregivers. There are some children whose needs are so great that they cannot be served safely in the community, or whose problems are such that they cannot benefit from a family-based approach to treatment. Rather, therapeutic foster care assumes (as one of its core values) that family and community environments are the most natural and conducive places to promote child development. Unfortunately, the needs of children entering care are more challenging than they were even a few short years ago. They appear to come from more troubled backgrounds, and to have longer and more complex clinical histories. Many come from families where substance abuse and similar problems are predominant concerns. Most importantly, many of these children have not had exposure to engaged and consistent parental caregivers, resulting in serious problems with relationships, regulation of emotions, and behavioral self-control. These are core issues that can be addressed through a family-based therapeutic foster core treatment program. Therapeutic foster care can be a critical part of the system of care for troubled or maltreated children, because it creates opportunities for: (1) family-based learning; (2) integration and normalization; (3) transition into re-unified, adoptive or kinship care settings; and, (4) shared parenting and support for natural or adoptive families. There are some children whose substantial needs are such that planned permanent living arrangement is the appropriate goal, and for many of these therapeutic foster care may be the least restrictive program alternative.
What Are The Essential Elements Of Therapeutic Foster Care? What Support Services Help To Make This Approach Work? The core and most essential element of therapeutic foster care is the therapeutic relationship that is developed between the child and the family. Therapeutic foster care presumes that all children need to form a trusting and secure attachment to an adult caregiver, and that this increases their potential to grow and develop in their thinking, emotions, and social lives. Many of the children coming into care experience extreme difficulties in their ability to relate and “attach” to others on an emotional level. Many of their acting-out behaviors are really just a way to express that they are fearful of getting hurt, abandoned, or rejected. It often takes a long time and a lot of patience to overcome these concerns, and it is even more difficult to do this when you have been moved from setting to setting. Therapeutic foster care works because caring foster parents are committed to this relationship, not just because they are good at behavior management. In fact, we believe that without a strong and abiding relationship, no amount of behavior management technique will make a long-term difference. Therapeutic foster care is therapeutic because of the bond that is developed between parent and child. Thus, some of the most important therapeutic activities are those that occur within the family system and community in "real settings" and between "real people". Therefore, therapeutic foster parents are the central agents of change and given a prominent role in all decision making and planning.
* Child therapy by mental health professionals (REACH staff or other providers) to address issues such as loss and grief, attachment, child sexual abuse, self-esteem, or behavioral self-control; REACH operates an extensive wraparound and summer recreation program that is totally community-based (YMCA, bowling alley, parks). REACH has also acquired approximately 80 acres of woodland near Hodgenville, Kentucky, and is actively pursuing the development of outdoor recreation programs for the children and families it serves. In sum, as a relatively small organization, REACH of Louisville, Inc. is committed to coordinating treatment planning and implementation. In addition to receiving various "in house" services and supports from within our agency, many of our children are seen by child psychiatrists and family physicians for psychotropic medication management, as well as by therapists in the community mental health system. We communicate closely with these professionals, as well as with school, child care, and other community agency personnel. Additionally, children committed to DCBS retain their Family Services Worker, and these individuals collaborate with regard to treatment needs as well as more traditional social services issues (e.g., Medical Card, transportation).
How Are Child Placement Decisions Made? R.E.A.C.H. of Louisville recruits, trains, and supports therapeutic foster care providers and shared parenting families, with special emphasis on serving hard-to-place children, youth, and young adults who experience behavioral and emotional disabilities. These individuals tend to carry a range of psychiatric labels, including ADHD, oppositional defiant, conduct disorder, mental retardation, pervasive developmental disorder, autism, and related developmental problems of learning and behavior. Placement availability is determined on an individual level based on the match between the child and prospective foster parent. The agency does not reserve a number of "slots" or "beds" and does not maintain a waiting list. The primary criteria for acceptance into the program are: (1) the expectation that the focus person will benefit from the family-based treatment model; (2) the "goodness of fit" between the needs of the focus person and the strengths of the prospective family; and (3) the ability of involved providers and agencies to work together in a collaborative, integrated manner.
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