Fostering Healthy Futures (FHF)

2  — Supported by Research Evidence
High
2  — Supported by Research Evidence
High
2  — Supported by Research Evidence
High

About This Program

Target Population: Preadolescent children (ages 9-11) who have current or previous child welfare involvement due to experiencing one or more adverse childhood experiences (ACEs)

For children/adolescents ages: 9 – 11

Program Overview

FHF is a mentoring and skills group program for preadolescent children who have current or previous child welfare involvement due to experiencing one or more adverse childhood experiences (ACEs). These ACEs may include the experience of maltreatment, out-of-home placement, housing, caregiver or school instability, violence exposure and/or parental substance use, mental illness, or incarceration.

Skills Groups: Children attend skills groups which meet for 1.5 hours/week for 30 weeks. The groups follow a manualized curriculum that combines cognitive-behavioral strategies with activities designed to help children process experiences related to placement in out-of-home care. For example, topics include: emotion recognition, problem solving, anger management, cultural identity, change and loss, and peer pressure. Multicultural stories and activities are integrated throughout.

Mentoring: Children are paired with graduate student mentors and receive 30 weeks of 1:1 mentoring (2-4 hours per week). Mentors work to: 1) create relationships with children that serve as positive examples for future relationships, 2) advocate for needed services, 3) help children generalize and practice skills learned in group, 4) engage children in educational, social, cultural, and recreational activities, and 5) promote positive future outlooks.

FHF targets risk and protective factors that have been identified as strong predictors of adolescent mental health problems, risk behaviors and associated outcomes.

Program Goals

The goals of Fostering Healthy Futures (FHF) are:

  • Promote healthy relationships with peers and adults.
  • Promote positive attitudes about self and future.
  • Promote skills for regulating behavior and coping adaptively.
  • Prevent or reduce mental health problems, including trauma symptoms, anxiety, and depression.
  • Prevent, or reduce the likelihood of, youth involvement in delinquency, substance use, and risky sexual behavior.
  • Prevent, or reduce the likelihood of, placement instability and restrictive placements.
  • Prevent, or reduce the likelihood of, school failure and dropout.
  • Prevent, or reduce the likelihood of, arrests and incarceration.

Logic Model

View the Logic Model for Fostering Healthy Futures (FHF).

Essential Components

The essential components of Fostering Healthy Futures (FHF) are:

  • Skills Groups
    • Groups are comprised of 8 boys and girls, one group supervisor, one co-leader (typically a graduate student), and one skills group assistant.
    • Groups are comprised of children with diverse mental health and behavioral (both prosocial and deviant) functioning.
    • Groups are 1.5 hours in length (1 hour of skills group and a half hour of supervised meal and socialization time).
    • During the hour of group, children participate in the FHF manualized skills group curriculum.
    • During the half hour following group, children, mentors, and staff share a meal. This provides youth with the opportunity to socialize with other youth with ACEs and child welfare involvement and to practice social skills under the supervision of staff and mentors.
    • Group supervisors receive a 3-day in person training on the FHF model. The group supervisor and skills group co-leaders receive 3 additional hours of training prior to leading the skills groups. They also receive 1-2 hours/week of ongoing training throughout the 9-month intervention period.
  • Mentoring
    • Mentors are graduate students in social work, psychology, and related fields on field placement or internship with the implementing agency.
    • Mentors are selected after a standardized interview, and after careful screening, using guidelines set forth in the FHF Implementation Manual.
    • Mentors each mentor two children.
    • Mentors complete 24 hours of training and orientation before meeting with children.
    • Mentors receive one hour of individual supervision, one hour of group supervision (during their mentees’ skills group), and one hour of didactic seminar per week. Mentors also participate in a team meeting for one hour every other week.
    • Mentors meet 1:1 with each youth they mentor for 2-4 hours/week for 30 weeks and transport their two mentees to and from group each week for 30 weeks.
    • Mentoring activities and advocacy are individually tailored to meet any identified needs and to promote identified strengths of individual children, following the guidelines set forth in the FHF Implementation Manual.
    • Mentors spend 18-20 hours per week on the FHF program, engaged in the following activities: (1) mentoring youth, (2) interfacing with parents, caregivers, and other involved professionals such as teachers, therapists, and caseworkers in order to facilitate communication and advocate on behalf of children’s needs, and (3) attending supervision, trainings, and meetings.

Program Delivery

Child/Adolescent Services

Fostering Healthy Futures (FHF) directly provides services to children/adolescents and addresses the following:

  • Trauma and associated mental and behavioral health problems as a result of adverse childhood experiences and child welfare involvement
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Although FHF is predominantly a child-focused intervention, substitute caregivers, biological parents, and other collateral adults are involved in the following ways: 1) Mentors and program staff regularly communicate with caregivers/parents about the things their children are learning and doing in the preventive intervention. 2) Caregivers/parents and therapists are given monthly letters about what children are learning in skills groups and how to help children practice these skills. 3) Mentors interface with parents/caregivers, therapists, educators, guardians ad litem, and caseworkers in order to share information and coordinate intervention strategies. 4) As appropriate, children’s mentors provide caregivers/parents with support and instrumental aid for problems that caregivers/parents identify.

Recommended Intensity:

Children attend skills groups for 1.5 hours per week. Children spend approximately 1 hour per week with their mentors during transportation to and from skills groups. Children spend 2-4 hours per week in 1:1 mentoring activities with their mentors.

Recommended Duration:

30-week program that typically runs concurrently with the academic year, from September through May

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Daily Living Setting
  • Foster / Kinship Care
  • Community-based Agency / Organization / Provider
  • Group or Residential Care
  • Virtual (Online, Telephone, Video, Zoom, etc.)

Homework

Fostering Healthy Futures (FHF) includes a homework component:

The FHF curriculum supports children in creating Lifebooks, which use verbal and non-verbal media to chronicle children’s pasts and document their hopes and plans for the future. The skills group curriculum includes weekly Lifebook activities that encourage youth to practice skills learned in group with their mentors and with others in their home, school, and community environments.

Languages

Fostering Healthy Futures (FHF) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • 1 group room that can accommodate 8 children and 2 adults, access to a white board or easel/with paper, and ability to show DVDs are essential; or equipment needed to hold group online such as computer and streaming software with ability to share screens for provider and electronics capable of receiving a live stream for participants
  • 1 room for 4 mentors and 1 supervisor to conduct group supervision
  • 1 room to accommodate 8 children, 4 mentors, 2 group leaders, 1 skills group assistant and 1 mentor supervisor for a shared meal
  • Licensed or license-eligible mental health professionals to supervise graduate interns who serve as mentors and group co-leaders
  • Licensed or license-eligible mental health professionals to conduct manualized skills groups
  • Graduate student interns to serve as mentors and co-leaders; they are unpaid
  • Staff or volunteers to serve as skills group assistants (to order food, set up the group room, supervise time outs from group, etc.)
  • Food for a shared meal before or after group
  • Funds to reimburse mentors for mileage and for business class automobile insurance when needed. Mentors must use their own cars and must provide their own basic automobile insurance
  • $12/week per child is given to mentors to cover the costs of mentoring activities
  • Criminal and driving record background checks on all staff/interns

Manuals and Training

Prerequisite/Minimum Provider Qualifications

  • Mentors must be enrolled in a university undergraduate-, Master’s-, or Doctorate-level clinical program with a field placement or internship requirement that can be met through participation in the program.
  • Intern and Group supervisors must hold either a Master’s or Doctorate degree in a relevant field (i.e., social work, psychology) and be licensed or license-eligible. They should have prior supervisory experience.
  • Group supervisors must hold either a Master’s or Doctorate degree. They should have significant clinical experience working with high-risk youth, preferably in a group setting.
  • Group co-leaders are typically graduate students in a relevant discipline.
  • Skills group assistant positions can be filled with existing staff at implementing agencies, with volunteers, or with hourly student workers, but must have significant experience working with children and must be able to manage children who have been given a time out from group.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Taussig, H. N., Wertheimer, R., Fireman, O., Raviv, T., & Holmberg, J. (2015). Fostering Healthy Futures implementation manual. University of Denver.

Hettleman, D., Wertheimer, R, & Taussig, H. N. (2005). Fostering Healthy Futures skills group manual. University of Denver.

Available via the program contact.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

In person, via phone, and/or video consultation

Number of days/hours:

Pre-implementation training is a 3-day in-person training.

Ongoing training and consultation during the program year ranges from 1-3 hours/week depending on the staff position in the first year of program implementation.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Fostering Healthy Futures (FHF) as listed below:

There is a FHF Program Readiness Assessment available from the FHF Program Developers.

Formal Support for Implementation

There is formal support available for implementation of Fostering Healthy Futures (FHF) as listed below:

There are implementation manuals, in-person trainings, and weekly ongoing training and coaching throughout the implementation year. Please contact the Program Developers to obtain information about implementation training costs.

Fidelity Measures

There are fidelity measures for Fostering Healthy Futures (FHF) as listed below:

Fidelity measures currently being tracked include:

  • Attendance, program completion, and other measures of program uptake (e.g. time spent on mentoring visits)
  • Skills group content delivery
  • Mentor training curriculum delivery
  • Mentor and group co-leader supervision
  • Program satisfaction

Fidelity Measure Requirements:

Please contact the program representative for more information.

Implementation Guides or Manuals

There are implementation guides or manuals for Fostering Healthy Futures (FHF) as listed below:

There is a manual that specifies all the components of the program.

Implementation Cost

There have been studies of the costs of implementing Fostering Healthy Futures (FHF) which are listed below:

Winokur, M., & Crawford, G. (2014). Fostering Healthy Futures child welfare cost study. Prepared for the Colorado Department of Human Services.

Research on How to Implement the Program

Research has not been conducted on how to implement Fostering Healthy Futures (FHF).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcomes: Permanency and Child/Family Well-Being

Taussig, H. N., & Culhane, S. E. (2010). Impact of a mentoring and skills group program on mental health outcomes for maltreated children in foster care. Archives of Pediatrics and Adolescent Medicine, 164, 739-746. https://doi.org/10.1001/archpediatrics.2010.124

Type of Study: Randomized controlled trial
Number of Participants: 156

Population:

  • Age — 9-11 years
  • Race/Ethnicity — 50% Hispanic, 43% Caucasian, and 29% African American
  • Gender — 51% Male and 49% Female
  • Status — Participants were children who were maltreated and placed in foster care.

Location/Institution: Denver, CO

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to evaluate the efficacy of the Fostering Healthy Futures (FHF) program in reducing mental health and associated problems. Participants were randomized to either FHF or a control group. Measures utilized include the Trauma Symptom Checklist for Children, the Child Behavior Checklist, the Teacher Report Form, the Life Events and Coping Inventory, the Self-Perception Profile for Children, and the People in My Life. Results indicate that the FHF group had fewer mental health problems on a multi-informant factor at T3, reported fewer symptoms of dissociation at T3, and there was a trend suggesting that they were less likely to report symptoms of posttraumatic stress and reported better quality of life at T2. Fewer intervention youth had received recent mental health therapy at T3, according to youth report. Limitations include differences between the two groups at baseline despite randomization, lower IQs and more mental health problems in the subjects lost to follow-up, and changes in respondents over time due to foster placement changes.

Length of postintervention follow-up: 6 months.

Taussig, H. N., Culhane, S. E., Garrido, E., & Knudtson, M. D. (2012). RCT of a mentoring and skill group program: Placement and permanency outcomes for foster youth. Pediatrics, 130(1), 33-39. https://doi.org/10.1542/peds.2011-3447

Type of Study: Randomized controlled trial
Number of Participants: 110

Population:

  • Age — 9-11 years
  • Race/Ethnicity — 54.3% Caucasian, 46.1% Hispanic, and 34.6% African American
  • Gender — 51.8% Male and 48.2% Female
  • Status — Participants were children in foster care.

Location/Institution: Two Colorado counties, United States

Summary: (To include basic study design, measures, results, and notable limitations)
This study uses the same sample as Taussig & Culhane (2010). This study examined the impact of Fostering Healthy Futures (FHF). Youth were randomized to FHF or a no-treatment control group. Measures utilized include the Child Behavior Checklist (CBCL) and child welfare administrative records. FHF youth were 71% less likely to be placed in residential treatment. Results indicate that among children living in nonrelative foster care at baseline, FHF youth had 44% fewer placement changes, were 82% less likely to be placed in a residential treatment center, and were 5 times more likely to have attained permanency. Significantly more FHF youth had reunified 1-year postintervention. Limitations include a lack of information on reasons for placement change.

Length of postintervention follow-up: 12 months.

Taussig, H. N., Culhane, S. E., Garrido, E., Knudtson, M. D., & Petrenko, C. M. (2013). Does severity of physical neglect moderate the impact of an efficacious preventive intervention for maltreated children in foster care? Child Maltreatment, 18(1), 56-64. https://doi.org/10.1177/1077559512461397

Type of Study: Randomized controlled trial
Number of Participants: 144

Population:

  • Age — 9-11 years
  • Race/Ethnicity — 45.8% Hispanic, 47.2 Caucasian, and 29.9% African American
  • Gender — 50.7% Female
  • Status — Participants were children who were maltreated and placed in foster care.

Location/Institution: Denver, CO

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the moderating impact of neglect on the efficacy of Fostering Healthy Futures (FHF) among children with more severe physical neglect. Measures utilized include the Posttraumatic Stress and Dissociation Scales of the Trauma Symptom Checklist for Children, the Child Behavior Checklist, Life Satisfaction Survey, the Coping Inventory (TCI), the Self-Perception Profile for Children (SPC), and the People in My Life Measure (PML). Results indicate that after controlling for the severity of abuse, no evidence was found to suggest that program effects were moderated by physical neglect severity. The intervention (FHF) had a strong effect on the T3 mental health composite score, such that intervention (FHF) youth, relative to control youth, had fewer mental health problems, as reported by themselves, their parents/caregivers, and teacher. Limitations include lack of follow-up and measure of physical neglect severity may not be comprehensive.

Length of postintervention follow-up: None.

Taussig, H. N., Weiler, L. M., Garrido, E. F., Rhodes, T., Boat, A., & Fadell, M. (2019). A positive youth development approach to improving mental health outcomes for maltreated children in foster care: Replication and extension of an RCT of the Fostering Healthy Futures Program. American Journal of Community Psychology, 64(3-4), 405-417. https://doi.org/10.1002/ajcp.12385

Type of Study: Randomized controlled trial
Number of Participants: 426

Population:

  • Age — 9-11 years old
  • Race/Ethnicity — 51.5% Hispanic, 50.6% Caucasian, and 28.4% African American
  • Gender — 51.9% Male
  • Status — Participants were children in the child welfare system who were recently placed in out-of-home care.

Location/Institution: Denver, Colorado

Summary: (To include basic study design, measures, results, and notable limitations)
This purpose of this study was to test the efficacy of Fostering Healthy Futures (FHF) program for preadolescent maltreated children in foster care. Participants were randomized to FHF or control conditions. Measures utilized include the Kaufman Brief Intelligence Test (KBIT and K-BIT-2), Adverse Childhood Experiences (ACEs), the Life Satisfaction Scale, the Trauma Symptom Checklist for Children (TSCC), the Child Behavior Checklist (CBCL), and the Teacher Report Form (TRF). Results indicate the FHF program demonstrated significant impact in reducing mental health symptomatology, especially trauma symptoms, and mental health service utilization. Limitations include interview attrition, study was conducted by the program developers and there has not been an independent replication of program effects, and the study did not examine (a) the impact of mentor/mentee match characteristics, (b) the impact of nesting children within mentors or in skills groups, (c) the impact of events that occurred (e.g., placement changes, loss of a loved one, parental incarceration) during the intervention, (d) the impact of prior or concurrent mental health treatment or diagnoses, (e) dose–response intervention effects, or (f) cost-benefit.

Length of postintervention follow-up: 6-10 months.

Weiler, L. M., & Taussig, H. N. (2019). The moderating effect of risk exposure on an efficacious intervention for maltreated children. Journal of Clinical Child & Adolescent Psychology, 48(sup1), S194-S201. https://doi.org/10.1080/15374416.2017.1295379

Type of Study: Randomized controlled trial
Number of Participants: 156

Population:

  • Age — 9-11 years (M=10.38 years)
  • Race/Ethnicity — 47.2% Caucasian, 45.8% Hispanic, 29.9% African American, 7.6% Native American, 1.4% Asian American, 1.4% Pacific Islander, and 1.4% Other
  • Gender — 51% Male and 49% Female
  • Status — Participants were children who were maltreated and placed in foster care.

Location/Institution: Denver, CO

Summary: (To include basic study design, measures, results, and notable limitations)
This study utilized the same sample as Taussig & Culhane (2010). The purpose of the current study was to examine whether the effect of Fostering Healthy Futures (FHF) is moderated by children’s baseline risk exposure (i.e., number of adverse childhood experiences). Participants were randomized to intervention or control conditions. Measures utilized include the Trauma Symptom Checklist for Children, the Child Behavior Checklist, the Teacher Report Form, the Life Events and Coping Inventory, the Self-Perception Profile for Children, and the People in My Life. Results indicate among children with low to moderate levels of risk, intervention participants evidenced fewer symptoms, whereas intervention participants with high levels of risk did not differ from the control group. Of the nine dependent variables examined, children’s baseline risk moderated the impact of the FHF program on two of them—symptoms of posttraumatic stress and dissociation. That is, children in the intervention group exposed to fewer risks reported fewer symptoms of posttraumatic stress and dissociation than their counterparts in the control group, whereas group differences were not observed among children exposed to relatively more risks. Limitations include findings cannot be generalized to nonmaltreated samples or different geographical locations, the highest risk children in the control group received more mental health services than those in the FHF intervention, and small sample size.

Length of postintervention follow-up: 6 months.

Taussig, H. N., Dmitrieva, J., Garrido, E. F., Cooley, J. L., & Crites, E. (2021). Fostering Healthy Futures preventive intervention for children in foster care: Long-term delinquency outcomes from a randomized controlled trial. Prevention Science. Advance online publication. https://doi.org/10.1007/s11121-021-01235-6

Type of Study: Randomized controlled trial
Number of Participants: 426

Population:

  • Age — 9–11 years (Mean=10.38 years)
  • Race/Ethnicity — 47.2% Caucasian, 45.8% Hispanic, 29.9% African American, 7.6% Native American, 1.4% Asian American, 1.4% Pacific Islander, and 1.4% Other
  • Gender — 51% Male and 49% Female
  • Status — Participants were children recently placed in out-of-home care.

Location/Institution: Denver, Colorado, and three additional metro-area counties

Summary: (To include basic study design, measures, results, and notable limitations)
This study utilized the same sample as Taussig et al. (2019). The purpose of this study was to examine the long-term impact of the Fostering Healthy Futures (FHF) program for preadolescent maltreated children in foster care. Participants were randomized to intervention (FHF) or control conditions. Measures included the Adolescent Risk Behavior Survey (ARBS), administrative data from the Child Protection Services’ intake reports and court records of dependency and neglect, and a 6-item measure developed for children in foster care that measures adverse childhood experiences (ACEs). Results indicate the intervention group (FHF) self-reported 30-82% less total and nonviolent delinquency than the control group between ages 14-18. Court charges for total and violent delinquency in midadolescence were also 15-30% lower for the intervention group. Limitations include children and families were not masked to condition and the impact of adjunct services or baseline placement type were not examined, moderating and mediating effects were not examined, and youth may have been arrested but never had a case filed, or had a case filed that was ultimately dismissed or expunged. Additionally, the sentence (e.g., diversion, probation, or detention/incarceration) a youth received if found guilty was not included.

Length of postintervention follow-up: 6 months and 12 months; 7 years (court records of delinquency charges only).

Additional References

Taussig, H. N., Culhane, S. E., & Hettleman, D. (2007). Fostering Healthy Futures: An innovative preventive intervention for preadolescent youth in out-of-home care. Child Welfare, 86, 113-131. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613856/

Taussig, H. N., Culhane, S. E., Garrido, E., Knudtson, M. D., & Petrenko, C. (2013). Does severity of physical neglect moderate the impact of an efficacious intervention for maltreated children in foster care? Child Maltreatment, 18(1), 56–64. https://doi.org/10.1177/1077559512461397

Taussig, H. N., Culhane, S. E., Raviv, T., Schnoll Fitzpatrick, L. E., & Wertheimer, R. W. (2010). Mentoring children in foster care: Impact on graduate student mentors. Educational Horizons, 89, 17–32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022595/

Contact Information

Heather Taussig, PhD
Title: Professor and Associate Dean for Research
Agency/Affiliation: University of Denver
Department: Graduate School of Social Work
Website: www.fosteringhealthyfutures.org
Email:
Phone: (303) 871-2937

Date Research Evidence Last Reviewed by CEBC: April 2021

Date Program Content Last Reviewed by Program Staff: April 2021

Date Program Originally Loaded onto CEBC: April 2012