Trauma Systems Therapy–Foster Care (TST-FC)

Resource and birth parents of youth aged birth-21and child welfare casework staff who work with those youth

For parents/caregivers of children ages: 0 - 21

TST-FC is a 4-module group-based training for resource parents and birth parents of youth in foster care. It is designed to provide training on definitions and impact of trauma, as well as specific approaches and interventions to parent more effectively, including a focus on parental self-care. TST-FC provides a trauma-informed approach based on the Trauma Systems Therapy (TST) model. Staff within a foster care agency are identified and trained to be TST-FC trainers. TST-FC can be used as a stand-alone model, or in conjunction with full TST implementation.

Adam Brown, PsyD

• Agency/Affiliation: Child Study Center at NYU Langone, Hassenfeld Children's Hospital, Dept. of Child and Adolescent Psychiatry
• Email: adam.brown2@nyumc.org
• Phone: (646) 754-5103

The goals of Trauma Systems Therapy – Foster Care (TST-FC) are:

• Increase awareness of trauma-specific concepts for resource parents providing care to foster youth in order to improve quality of care and to decrease placement disruptions
• Increase awareness of trauma-specific concepts for birth families of youth in foster care, to increase understanding and prepare for reunification
• Provide specific strategies and interventions to resource parents to improve quality of care and to decrease placement disruptions
• Provide specific strategies and interventions to birth families of youth in foster care to improve the quality of interactions and prepare for reunification
• Increase awareness of trauma-specific concepts for casework staff in foster care agencies that have not implemented Trauma Systems Therapy (TST) to improve the quality of support provided to youth and caregivers

The essential components of Trauma Systems Therapy – Foster Care (TST-FC) include:

• Places the focus on the intersection of the traumatized child’s emotional functioning and behavioral functioning as well as that child’s environment, relationships, and psycho-social supports.
• Organizational model that helps to embed trauma-informed concepts and practices within the organizational structure and culture of a child welfare agency as part of the implementation of TST-FC into the agency if TST is not already implemented.
• Manualized, highly interactive group training for caregivers (foster parents, birth parents, and kinship foster parents) of youth in foster care and the child welfare caseworker staff if TST is not already implemented into the agency
• Designed to be provided in groups, which can range in size from small to large. If a large group, the facilitator will divide into smaller break out subgroups for discussion and activities
• Composed of 4 modules which can be provided flexibly depending on the needs of the setting (i.e., 4 sessions of 2-hour groups, 2 sessions of 4-hour groups, 1 8-hour group session)
• Fully manualized, including a facilitator’s guide, as well as participant handouts and activities
• Utilizes language, concepts, and tools from the Trauma Systems Therapy model
• Can be used either as a stand-alone model for agencies that want to incorporate trauma specific principles and tools, or in conjunction with full TST implementation
• Helps caregivers understand the importance of their role as part of the treatment team helping a foster child cope with the impact of their traumatic experiences
• Provides casework and clinical staff in a foster care setting with the concepts, language, and tools they need to effectively understand and meet the trauma specific needs of the youth and caregivers they are supporting as part of the implementation of TST-FC into the agency if TST is not already implemented

Parent/Caregiver Services

Trauma Systems Therapy–Foster Care (TST-FC) directly provides services to parents/caregivers and addresses the following:

• Caregivers (foster parent, birth parents, or kinship care providers) of children with internalizing and externalizing behaviors and, exposure to trauma; caregivers may also lack communication, nurturing, and self-care skills.

Recommended Intensity

Four 2-hour group modules delivered to caregivers (foster/birth families) in a variety of configurations and ongoing intervention provided by child welfare professionals to the caregivers they oversee

Recommended Duration

The caregivers participate in the entire group curriculum, which is 8 hours in total and can last one day to 4 weeks, but the language, tools, and strategy taught caregivers is used by the caseworkers throughout the child’s involvement with child welfare services.

Delivery Settings

This program is typically conducted in a(n):

• Birth Family Home
• Community-based Agency / Organization / Provider
• Foster / Kinship Care
• Public Child Welfare Agency (Dept. of Social Services, etc.)

Homework

Caregivers are provided with tools and handouts to complete and to use with the youth in their care.

Resources Needed to Run Program

The typical resources for implementing the program are:

TST-FC is provided within a foster care/child welfare agency by the child welfare professionals who are already employed by the agency. No additional personnel are required. Rather, existing staff members are trained to provide the group modules, and the ongoing interventions and supports. The group trainings are typically provided in an agency, but can be provided in community spaces as well (a community center, church/synagogue, YMCA, etc.). The TST-FC tools and interventions are provided as an integrated component of the ongoing work. There are PowerPoint slides to be used in the group presentations. Ideally, these would be projected, requiring a computer, a projector, and a screen or blank wall. If this is not possible, the slides can be printed and reviewed as hardcopy materials during the group sessions.

Prerequisite/Minimum Provider Qualifications

TST-FC is designed to be provided by a foster care agency using their existing child welfare personnel. A minimum of a bachelor’s degree is required.

Manual Information

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

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Training is typically provided onsite. Specific training needs will be discussed and arranged to meet the needs of the agency.

Number of days/hours:

Training will be tailored to meet the needs of the agency, though it typically consists of two days of onsite training. Ongoing technical assistance is also available for any agency that is interested, to be arranged on an individual basis. If interested, please contact the training contact above.

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Trauma Systems Therapy–Foster Care.

Formal Support for Implementation

There is no formal support available for implementation of Trauma Systems Therapy–Foster Care.

Fidelity Measures

There are no fidelity measures for Trauma Systems Therapy–Foster Care.

Established Psychometrics

There are no established psychometrics for Trauma Systems Therapy–Foster Care.

Fidelity Measures Required

No fidelity measures are required for Trauma Systems Therapy–Foster Care.

Implementation Guides or Manuals

There are no implementation guides or manuals for Trauma Systems Therapy–Foster Care.

Implementation Cost

There are no studies of the costs of Trauma Systems Therapy–Foster Care.

Research on How to Implement the Program

Research has not been conducted on how to implement Trauma Systems Therapy–Foster Care.

Child Welfare Outcome: Permanency

• Bartlett, J. D., & Rushovich, B. (2018). Implementation of Trauma Systems Therapy-Foster Care in child welfare. Children and Youth Services Review, 91, 30–38. https://doi.org/10.1016/j.childyouth.2018.05.021

  Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)

  Number of participants: 250 (123 Child Welfare Staff, 21 Mental Health Providers, and 111 Resource Parents)

  Population:

  • Age — Not specified
  • Race/Ethnicity — Child Welfare Staff: 91 Non Hispanic White, 9 Non Hispanic Black, and 3 Other; Mental Health Providers: 13 Non Hispanic White, 4 Non Hispanic Black, and 2 Other; Resource Parents: 96 Non Hispanic White, 7 Non Hispanic Black, and 6 Other
  • Gender — Child Welfare Staff: 89 Female; Mental Health Providers: 15 Female; Resource Parents: 69 Female
  • Status — Participants were child welfare staff, mental health providers, and resource parents from two state child welfare agencies.

  Location/Institution: Child welfare agencies in a Mid-Atlantic and a Mid-Western state

  Summary:

  The purpose of the study was to evaluate the implementation of Trauma-Systems Therapy-Foster Care (TST-FC) in two state child welfare agencies that included training for staff and resource parents. Participants were from a Mid-Atlantic state that is partially state-supervised and partially child  welfare agency administered (Agency A) that was compared to a second agency located in a Mid-Western state that is county-administered (Agency B). Measures utilized include the Trauma Informed Systems Change Instrument (TISCI), the Resource Parent Knowledge and Beliefs Survey-Version 4 (RPKBS), and child welfare administrative data on resource home retention. Results indicate that training participants had positive perceptions of TST-FC and found it useful. TST-FC was associated with significant increases in trauma-informed parenting and tolerance of children’s misbehavior by resource parents, as well as more trauma-informed policies and practices in the child welfare agencies. Training participants reported that TST-FC provided useful tools and a common language about trauma that enhanced their capacity to collaborate with one another and manage children’s difficult behavior. An exploratory study of resource home retention and children’s placement stability revealed fewer foster home closures and placement disruptions when resource parents were trained in TST-FC compared to homes not trained in the model. Limitations include that some individuals who became TST-FC trainers through this process did not feel adequately prepared to train resource parents, some also reported not having enough time to learn how to teach the curriculum, and most participants reported that additional guidance and support for the staff training is needed.

  Length of controlled postintervention follow-up: None.

• Murphy, K., Moore, K., Redd, Z., & Malm, K. (2017). Trauma-informed child welfare systems and children's well-being: A longitudinal evaluation of KVC's bridging the way home initiative. Children and Youth Services Review, 75, 23-34. doi:10.1016/j.childyouth.2017.02.008