Trauma-Integrative Treatment Foster Care (TI-TFC)

About This Program

Target Population: Foster parents, or potential foster parents, of children and youth age 0-21 years who have experienced complex trauma or neglect and may also have developmental disabilities and/or medically fragile conditions; the children and youth themselves, and the children’s and youths’ birth families

For children/adolescents ages: 0 – 21

For parents/caregivers of children ages: 0 – 21

Program Overview

TI-TFC is a component-based treatment framework that through specialized training for the treatment parent and social worker addresses complex trauma, development disabilities, and medically fragile conditions of children who are placed in foster care and the children’s families. In TI-TFC, the foster parent is referred to as the treatment parent. The primary focus of change in TI-TFC is the treatment parent’s relationship with the child and the child’s birth family. Key components are the recruitment, training, supervision, and support of treatment parents in developing and maintaining these relationships.

Social workers provide treatment parents with in-home training, supervision, support, and interventions within the focus of change. The Social Worker, in collaboration with the treatment parents and team, facilitates the development of a treatment plan which integrates permanency planning, outpatient treatments, school, and community services.

Assessment, treatment planning, and interventions are driven by the meaningful use of the Child and Adolescent Needs and Strengths (CANS) measure and its integration within the Attachment, Regulation, and Competency (ARC) Mapping tool.

A key component of TI-TFC is the recruitment, training, and supervision of Treatment parents and social workers.

Program Goals

The goals of Trauma-Integrative Therapeutic Foster Care are:

  • Quality treatment parents are recruited, trained, supervised, and supported in meeting the needs of the children and families they serve
  • Quality social work staffs are recruited, trained, supervised, and supported in meeting the needs of the children and families they serve
  • Children are kept safe from harm
  • Children have maximum family/kin, and treatment parent involvement while being reunified, adopted, or transitioned to adulthood
  • Minimum movement exists between families and other placements
  • Functional outcomes increase with significant reductions in needs and increases in strengths
  • Trauma symptoms decrease

Essential Components

The essential components of Trauma-Integrative Treatment Foster Care (TI-TFC) include:

  • Treatment Parent Training - Parent training is the key component of TI-TFC and as such is integrated throughout the program. All staff is involved in treatment parent training. Treatment parent training is accomplished through a four-phase process:
    • Phase 1- Recruitment, orientation, preservice training, and the home-study/approval process
    • Recruitment efforts include targeted and child specific recruitment activities
    • Previously trained and experienced TI-TFC treatment parents and social work staff are involved in the delivering the 3-day 24-hour preservice parent treatment training to new treatment parents
      • Day 1: Topics include:
      • Day 2: Topics include:
        • Treatment of Complex Trauma
        • Permanency
        • Cultural Considerations
        • Home Study Process
        • Developmental Disabilities and Medically Fragile Conditions
        • Impact of Placement on Treatment Parents
      • Day 3: Topics: include:
        • Attachment, Regulation, and Competency (ARC) Treatment Framework – both client- and system-level target audiences
        • Focus on Attachment and Use of the TI-TFC Trauma Toolkit
        • Self-care: Stress & Vicarious Trauma
    • Phase 2 consists of the completion of a Structured Analysis Family Evaluation (SAFE) Home Study, licensing, and approval of the treatment parent
      • Making an appropriate placement, matching a certified family with a child based on the needs of the child
      • Child-specific training to ensure the family can meet the child’s needs
    • Phase 3 consists of formal in-service and in-home child specific training
      • The in-service is a combination of two or more evening and day time topic and support groups each month
      • Quarterly 6-hour trainings on Saturdays
      • Schedule and topics are developed each year based on a focus group of treatment parents
      • Child-specific training is based on preservice and in-service knowledge and skills tailored to learning needs of the treatment parent and child
      • Training utilizes the Adult Learning Model, which allows parents to learn through role play, group activities, and opportunities for mutual learning
      • May obtain in-home training through FosterParentCollege.com® and self-learning packets
    • Phase 4 consists of the annual review of the treatment parent’s needs
  • Treatment Parent support
    • 31 days of planned respite as well as emergent respite as needed
    • 24-hour on-call crisis intervention and support proved by the social worker
    • Annual recognition of service, self-care events, and awards
    • Per Diem payment of board and stipend
  • Social Worker Training - Social work staffs should have a master’s degree in social work and be licensed by their state agency. Additional training includes:
    • Treatment parent preservice
    • Two-day training and monthly consultation in the Attachment, Regulation, and Competency (ARC) Framework – both client- and system-level target audiences
    • Motivational Interviewing
    • Transition to Independence Process (TIP) Model
    • Structured Analysis Family Evaluation (SAFE) Home Study Certification
    • Child and Adolescent Needs and Strengths (CANS) training and annual certification
    • Cognitive-Behavioral Therapy Plus
    • Crisis Prevention Intervention (CPI)
    • Training and consultation on developmental disabilities and medically fragile conditions
    • Weekly clinical consultations
    • Minimum weekly supervision
    • Monthly peer supervision
    • Leadership development
  • Focus of Change - The primary focus of change is the relationship between the treatment parent, the child, and the child’s birth family.
    • Key focus is on treatment parent’s capacity to develop a safe and secure holding environment and be self-reflective.
    • Treatment parent’s ability to develop a therapeutic relationship with the child and their family is a critical element.
    • Therapeutic relationship supports the child’s working through trauma responses and serves to increase the meaningful involvement of the birth family.
  • Roles of Treatment Parent and Social Worker
    • Integrated roles of social worker (i.e., clinician, case manager, parent supervisor and trainer, and treatment team leader all in one)
    • Integrated roles of the treatment parent (change agent and treatment team member all in one).
    • Both Social Worker and treatment parent integrate necessary services and specialty treatments for the child and the child’s family as outlined in the individual treatment developed by the treatment team.
  • Birth parent and family involvement from beginning
    • Engagement of the child’s family by the clinical social worker and the treatment parent is critical in supporting their relationships with the child.
    • Child’s family is integrated to the maximum extent possible.
    • Barriers to family involvement such as multigenerational trauma, substance abuse, housing, and employment are addressed by ancillary services.
  • Treatment of Complex Trauma – The Attachment, Self-Regulation, and Competency (ARC) is a manualized framework for the treatment of complex trauma.
    • Social workers and treatment parents are trained in the ARC treatment framework.
    • Social Workers received monthly consultations from one of the ARC developers.
    • Parents are trained during preservice and receive on going in-service training.
    • CANS/ARC mapping tool is used in the engagement, assessment, treatment planning, decision support in developing interventions, and measuring change over time.
    • The CANS/ARC Mapping tool is completed quarterly.
  • Integration of collateral evaluations and treatment
    • Outpatient mental health- trauma-informed and manualized practice
    • Specialty developmental and medical treatment
    • Psychiatric evaluation and treatment
    • Psychological evaluation
  • Permanency - Permanency and permanency planning is critical. Permanency includes legal permanency as well as other permanent relationships with meaningful adults.
    • The social worker takes an active role with the local department of social services and the courts in seeking permanency for children.
    • Reunification
      • Focus of change is designed to support the timely and successful reunification of families.
      • Efforts are made to support continuity of relationships between the child, their birth family, and treatment parents.
    • Adoption
      • Collaboration with the local department of social service and courts is designed to enhance decision making around termination and adoption.
      • Eligible children can be adopted by treatment parents in the program.
      • Efforts are made to maintain continuity with the child’s birth family postadoption.
      • Continued needs for service and support for the child and families are planned and carried out.
    • Transition Age Youth – Treatment parents and social workers are trained in the Transition to Independence Process (TIP) Model.
      • Social workers in collaboration with treatment parents use TIP guidelines and core practices (e.g., problem solving, in-vivo teaching, and prevention planning of high-risk behaviors) in supporting youth transition.
      • Transition Planning Assessment (TPA) tool is used to assess the youth’s current functioning, support the development of service and treatment planning, and measure progress over time.

Program Delivery

Child/Adolescent Services

Trauma-Integrative Treatment Foster Care (TI-TFC) directly provides services to children/adolescents and addresses the following:

  • Trauma and neglect related behaviors and symptoms (including anxiety, depression, disassociation, posttraumatic stress disorder [PTSD], and externalizing behaviors); developmental disabilities (including attention deficit hyperactivity disorder [ADHD], learning disabilities, communication disorders, autism spectrum disorder [ASD], mild/moderate/profound Intellectual disability, and gross and fine motor disorder); medically fragile conditions (including cerebral palsy, congenital genetic disorder, asthma, diabetes, seizure disorder, and hydrocephalus)

Parent/Caregiver Services

Trauma-Integrative Treatment Foster Care (TI-TFC) directly provides services to parents/caregivers and addresses the following:

  • Treatment parent of child or youth with complex trauma or neglect
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Birth family involvement is a crucial factor in the focus of change. This involve and supports include: Member of treatment team Involvement in outpatient treatment Involvement in school meeting Regular visitation and contact with their child Regular communication with treatment parent and social worker

Recommended Intensity:

Intensity of contacts is determined by treatment plan. Social workers have a maximum caseload of 8. They meet a minimum of twice per month face to face with the child and treatment parent in the home. These sessions are 90 minutes to 3 hours. Treatment teams meet formally quarterly to review treatment plan. Treatment parents and social workers collaborate and meet regularly with outpatient treatment providers (mental health providers, medical providers and developmental specialists).

Recommended Duration:

On average18 months but varies according to complexity of need of the child and their family as well as progress toward permanency plan.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Daily Living Settings
  • Foster/Kinship Care
  • Outpatient Clinic

Homework

Trauma-Integrative Treatment Foster Care (TI-TFC) includes a homework component:

The following items are considered homework: Completion of Log of Weekly Events (LOWES), Life book, Medical passport, Trauma Toolkit, Implementation of behavior plans, In-home training activities

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Staff:
    • Director/Administrator
    • Clinical Social Workers
    • Managers/Supervisors
    • Treatment Parents
    • Treatment Parent Recruiter
    • Office Manager/Administrative Professional Staff
  • Equipment:
    • Computers/Printers/Internet access
    • Cell phones
  • Facilities:
    • Staff office space
    • Conference/Training Room/Child care space
    • Family visiting room

Education and Training

Prerequisite/Minimum Provider Qualifications

The minimum education and experience requirements for the TI-TFC providers are as follows:

  • Treatment Parent - High school education or equivalent
  • Social Worker – Masters in Social Work (MSW), State Licensed, experience in child welfare and mental health
  • Supervisor – MSW, Licensed Social Work Supervisor, minimum 5 years of experience in child welfare, mental health, and developmental disabilities
  • Nurse – Registered Nurse (RN) with experience in community nursing

Education and Training Resources

There is not a manual that describes how to implement this program ; but there is training available for this program.

Training Contact:
Training is obtained:

Informal consultation is available.

Number of days/hours:

Varies based on amount of consultation.

Relevant Published, Peer-Reviewed Research

This program has been reviewed and it was determined that this program lacks the type of published, peer-reviewed research that meets the CEBC criteria for a scientific rating of 1 – 5. Therefore, the program has been given the classification of "NR - Not able to be Rated." It was reviewed because it was identified by the topic expert as a program being used in the field, or it is being marketed and/or used in California with children receiving services from child welfare or related systems and their parents/caregivers. Some programs that are not rated may have published, peer-reviewed research that does not meet the above stated criteria or may have eligible studies that have not yet been published in the peer-reviewed literature. For more information on the "NR - Not able to be Rated" classification, please see the Scientific Rating Scale.

Currently, there are no published, peer-reviewed research studies for Trauma-Integrative Treatment Foster Care (TI-TFC).

Additional References

AdoptionUSKids. (2015). Support matters: Lessons from the field on services for adoptive, foster, and kinship care families. Retrieved from https://www.adoptuskids.org/_assets/files/AUSK/support-matters/support-matters-resource-guide.pdf

Jamora, M. S., Brylske, P. D., Martens, P. M., Braxton, D., Coluntuoni, E., & Belcher, H., M. (2009). Children in foster care: adverse experiences and psychiatric diagnosis, Journal of Child and Adolescent Trauma, 2, 198-208.

Brylske, P. D., Rogers, R, & Belcher, H. (2010). Therapeutic foster program and promoting placement stability for child and youth in out-of-home care with special needs. CW 360 Promoting Placement Stability. Retrieved from https://cascw.umn.edu/wp-content/uploads/2013/12/CW360_2010.pdf

Contact Information

Paul Brylske
Title: MSW Director
Website: KennedyKrieger
Email:
Phone: (443) 923-5989

Date Research Evidence Last Reviewed by CEBC: April 2018

Date Program Content Last Reviewed by Program Staff: May 2018

Date Program Originally Loaded onto CEBC: May 2018