Fostering Healthy Futures Kempe Children's Center

Fostering Healthy Futures Kempe Children's Center

Fostering Healthy Futures 19th April 2016 Professor Heather Taussig Dr Alyson Rees & Dr Dolores Davey Agenda 10am- 10.05 Introductions and welcome- Alyson Rees 10.05-10.15 Summary of consultation so far. 10.15-11.15. Presentation by Heather Taussig 11.15-11.30 Questions 11.30-12 Themes emerging from the consultation 12-12.30 Discussion/pairs/groups 12.30-Lunch Background information Discrete part of the Confidence in Care Searches of the literature found that FHF was one of the few evidence based interventions for children in

foster care Had been running for more than 10 years Model provides 9 months of skills groups for young people age 9-11 (2 groups of 8 children- 4 boys + 4 girls) and also provides mentoring by post graduate social work students (and occasional clinical psychology students) Feasibility study Using Bowen and colleagues (2009) framework for feasibility studies we have aimed to: Explore the acceptability of the Fostering Healthy Futures programme with key stake holders in Wales. Investigate the demand and interest for such a programme from key stake holders. Investigate the practicality of transferring the programme to Welsh contexts. This included the fit of the mentoring programme with current professional

training. Consultations so far Initial consultation in June 2015 to a range of stake holder groups

Visit to Denver, Colorado to learn more about the programme and to undertake training in the model. Set up an advisory group which has met on 3 occasions and another one planned Consulted with: Young care experienced people Foster carers HEIs Social Work training providers (pan Wales) Care Council Local authority training officers- South East Wales Placement organiser for clinical psychologists (South Wales) Heads of Childrens Services Foster Care team managers North Wales Foster Care team managers South Wales Individual independent foster care provider Still to do One further childrens group Meeting with independent foster care providers Develop a costing model and case study of what it

might look like if delivered in Wales-where it might draw children from, which social work programmes could provide mentors, which organisation might host it. Complete final report Finalise a proposal based on the above details and other findings for running a pilot. Maeth Dyfodol Iachus Heather Taussig, Ph.D. Cardiff University April 19, 2016 Our childrens future and the worlds future are one. ~ Dr. C. Henry Kempe Development of the

Fostering Healthy Futures Program My early experiences Experiences as a therapist and as a mentor Dissertation; rationale for initial age selection Key Features of Fostering Healthy Futures (FHF) 9-month mentoring and skills group program Randomized controlled trial for 10 years

Enrolled in yearly cohorts; 420 total enrolled Graduate students serve as mentors Time-limited mentoring Children continue to participate if they change placements or reunify It Takes a Village

Denver Department of Human Services Adams County Social Services Department Jefferson County Human Services Arapahoe County Department of Human Services Broomfield County Health and Human Services Colorado Department of Human Services Graduate schools -DU, Newman, CSU, UCD, Metro School districts and schools Mental health centers and therapists Youth Mentoring Collaborative

Department of Pediatrics Kempe Foundation Kempe Center Children and families FHF Core Staff 2002-2015

Sara Culhane, Ph.D. Ann Petrila, LCSW Daniel Hettleman, Ph.D. Becky Gennerman-Schroeder, LPC Patrick Nickoletti, PhD Jill Gjerde, MA Michel Holien, LCSW Dana Morgan, LCSW Robyn Wertheimer, LCSW Jennifer Koch-Zapfel, MSW Tracy Rudhe Dongmei Pan, MA Liz Goetter, BA

Julie Bemski, BA Tabitha Webster, BA Allison Bratsch, LPC

Laura Mann, BA Melody Combs, Ph.D. Tali Raviv, PhD Chris Kelman, LCSW Leslie Fitzpatrick, LCSW Orah Fireman, LCSW, M.Ed Edward Garrido, Ph.D. Christie Petrenko, PhD. Leigh Clasby, BA Michael Knudtson, MA Wendy Gehring, BA John Holmberg, Psy.D. Tara Rhodes, MA Lindsey Weiler, Ph.D. Erin Hambrick, Ph.D. Heather Taussig, Ph.D.

FHF Graduate Student Research Assistants and Group Leaders

Brendan Close Tiffany Conway Tracy Rudhe Erika Joye Nicole Lariviere Brian Wolff Jenn Winkelmann Amy Franke Pam Freeman Mia Kim

Jessi Wheatley Danielle Smith Amanda Brown Melani Dawson-Lear Melanie Rodriguez Heather Frey Vyga Kaufmann Riley Spuhler Neta Bargai Walter Heidenreich Julie Bemski David Roberts Jenell Ribble Alexis Karris Martine Lopez Marisa Duran Patrick Nickoletti Alana Henken Kathryn Jargo

Dena Miller Liz Hooks Thea Wessel Jennifer Sackett Tara Buckley Jordan Pock Amy Percosky Andrea Reece Tisha Bean Emily Macdonald Sara Rosenau Natalie Tolejko Jill Gjerde Kristen Simpson Rachel Lund Shari Watters Ann Chu Michelle Brunner

Yael Chatav Lindsay Heath Kristin Nelson Kate Slivka Lindsay Smart Susan Whittle Elizabeth Goetter Julie Lyons Courtney Fiedler Edyta Biegunajtys Claire Heppner Clara Paynter Kelsey McNeill

Jenell Ribble Dena Miller Martine Lopez Thea Wessel Alana Henken Julie Bemski Claire Heppner Amy Percosky Andrea Temple Allison Glover Sarah Morehouse Jennifer DeVault Debra Boeldt Christine Kelley

Denise Onofrey Jennell Ribble Alanna Gangemi Jenny Doft Jenea Jones Kristin Allen Maddie Philley Rachel Shulman Leigh Clasby Sarah Perzow Emily Rotbart Laurel Story Mayla Yang

Tish Wer Claire Stephenson Allison Glover Melissa Toppel Jasmine Crane Christina Hack Olga Leonova Leah Chelist Katie Lange Melena Postolowski Kristen

Mackiewicz Allison Bratsch Kristen Vescera Leah Scandurra Emily Laux Caroline Oppenheimer Tara Rhodes Leah Harrigan Cory Reid-Vanas Erica Ragan Jessica Schnittka Shelby Scott Maria Davidsmeier Shawna HenryLange Anne Eden Rachel Stonecipher Michelle Turner

Liz Healy Lucia Lapaz FHF Graduate Student Research Assistants and Group Leaders (cont.)

Senite Sahlezghi Rachel Bennett Holly Kingsbury Veronica Tunis Kate Stevens Laura Bonkiewicz Amber Sobczak Kaleigh Becker Lauren Forbes Molly Sarubbi Meghan OConnor Meseret Hailu Meghan McKee Samantha Brown Katie Combs

Emily DeFrancia Sheila Kistler FHF Graduate Student Interns (Mentors) 2002-2003 Melani DawsonLear Kristine Wilson Brenna Ellington Lanette Ambers Carrie Oliver 2003-2004 Amy Bruner Liz Dinsdale Vashawn Banks Josh Goldman Marisa Duran Amber Cross Thomas Melanie Rodriguez

Clover Bone 2006-2007 Lorendia Schmidt Phoung Phan Beth Lipschutz Jacquelyn Eisenberg Angela Bierle Lisa Harrison Nicole Henkins Erin Hoglund 2007-2008 Kerrie Earley Ashley Moore Justine Stewart Lauren Goldberg Marissa Nasca Amber Wolfe Jennifer Reynolds

Krystal Caduff Miranda Learmonth Molly Jenkins Rebekah 2004-2005 Tiffany Conway Katie Ferguson Katie Melstrom Lisa Meyers Kendra Sasa Carla Scarpone Lewis Smirl Kelsey Wennesland

Regina Richards 2005-2006 Michelle Brunner Jocelyn Gray Jon Phillips Jennifer Stucka Christina Haskins Tina Francis Sarah Kane 2008-2009 Rachel Alpert Katherine Belcher Taylor Collins

Renata Heberton Alyse Keilson Blake Konner Emily Lyons Melissa Maurer Regan Linton Nina Modern Jennifer Pitcavage Meredith Schaffer

Holly Selepouchin Heidi VanEpps Katherine Ware 2009-2010 Lissa Miller Jenna Brown Jane Simon Allison Harris Shane Spears Koenigbauer

Jolie Sarah Oakley Rinebarger Lauren Timkovich Diane Bouhall Sam Murillo Kelly Fries Elizabeth Berling Erica Brown Kristin Krietemeyer Shavon Perkins Jess Valsechi Katie Kaser

Britta Johnson Renea Nilsson Laura Merten Kyle Steinke 2012-2013 Jessica Henritze2010-2011 Hoye Mele Cabral Jenna Kelley Jon Florida Diane Kleinschnitz

Sibyl Graham Linda Ladago Beth Hilligoss Rachel Sacco Tighe Kaysar Ani Sttele Alexandria Lewis Sarah Romero 2013-2014 Stacy Walsh Rachel Bennett

Jessica Devore Emily Bruce Jacquelyn Gabel Stephanie Jeffrey Hatcher Cichocki Ryan Holmes Emily Frank Emily Laux Senite Sahezghi

Megan Lovingier Ashley Stewart Sapphire Rosier Elizabeth Stitzel Cami Wangaard Nancy Vargas 2011-2012 Jessica Barry Rachel Berns Maria Davidsmeier

Diana Gonzalez Brandon Hester Nadine Leonard Julia McKinnon Amy Muetterties Heather Price Kristen Schmidt Rachel Stonecipher Ashley Wiggins

2015-2016 David Bennett John Pitman Molly Ward Melissa Romero Madeline White Miriam Chavez Elena Hernandez Krystal Gutierrez *Over 80,000 hours of training provided to 130 FHF Enrollment Recruited all 9-11-year-old children in any type of foster care placement in participating counties

Placed in foster care over prior 12 months as result of maltreatment, and were in care at the onset of the intervention Children with significant mental health, cognitive/ academic and behavioral problems (including sexual behavior problems) were not excluded Fostering Healthy Futures (FHF) Program Design 1) Evaluations of Childrens Functioning 2) Therapeutic Skills Groups 3) Mentoring

Screening Evaluations We assessed functioning in the following domains: Cognitive Academic achievement Mental health Social

Behavioral Therapeutic Skills Groups 30 weeks; manualized program 8 children per group, equal females and males Mental health clinicians and graduate trainees facilitate

1 hour group and then dinner with mentors Improve skills, process feelings related to the foster care experience, and reduce stigma Session Content Basic Social Skills Healthy Coping

Feelings Perspective Taking Problem Solving Healthy Communication Anger Management Positive Self-Talk Dealing with Worry Active Coping Strategies

Change and Loss Adolescent Issues Mixed Emotions Abuse and Neglect Healthy Relationships Panel Night

Anatomy and Puberty Dealing with Peer Pressure Resisting Drug/Alcohol Use Healthy Dating Relationships Program Ending Future Orientation Career Shadows Healthy Goodbyes GRADUATION! Mentoring

Graduate students spend 3-4 hours per week of individual time with each child they mentor They work on childs Lifebook, engage in extracurricular activities, help find other adult role models, shadow adults in professions of interest, work on homework, take them to libraries, recreational activities, etc. Focus on engaging them in their communities and teaching them advocacy skills

Mentors interface with other adults in childs life Role of mentor - create a web of support for children, improve social skills, and provide staunch advocacy Mentor Supervision Intensive orientation 1 hour of individual supervision weekly

1.5 hours of group supervision weekly 1 hour seminar on relevant topics weekly Supervisor available by cell phone after hours Special Program Activities Panel Night Cultural Presentations Cultural Presentations

Encourage self-exploration Encourage self-respect and respect for others Supports problem-solving and perspectivetaking skills Celebrate the difference and uniqueness each child brings to group Cultural Areas Explored

Race/Ethnicity Country of origin Language Family role/Family composition Traditions Being in foster care Gender Religion

Neighborhood School and peers Career Shadows Field Day Program Ending What Can a Well-Structured Goodbye Provide for Youth? .reflect on growth, strengths, gifts, & accomplishments E ITY H

T UN RT O P OP TO .experienc e a sense of control in the goodbye process .experienc e a nontraumatic loss experience connection even

when the mentoring relationship has ended So What? Wont Work Children are too old Children are too disturbed Children have sexual behavior problems

Children are in diverse placements Children reunify Children didnt sign up Wont Work

Graduate students cant be mentors Graduate students cant drive children Program is too short/long Cant end a mentoring program Mismatches between mentor/mentee Need a parent training component Cant get consent Cant do rigorous research Qualitative Outcomes Qualitative Quotes Youth quotes about the program

It was good cause I got to be with people that were also in foster care and you dont get that a lotso, its easier to cope with people when they have the same feelings as you. Not being alonesometimes I dont have a lot of people to talk to. Talked about what we could do instead of making negative choices, like growing up to get a college degree We would talk about what our goals were in life. We had a real close relationship She was somebody I could share my feelings with because not most people I can share my feelings with It taught me that I wasnt alone. Helped me get along with life. Qualitative Quotes Caregiver Quotes about the Program You could not ask for a better program to participate infor [child], having that bond experience and having someone he really got to develop a relationship with and also have peers that were in the same position, that was a huge positive.

They had a trust going and she reached him on a level that no one yet has really been able to reach him. I think its one of the things that got him through it. He had somewhere to go to be able to talk about it and #1, didnt have to be embarrassed or ashamed, and #2, felt understood and accepted by his peers. When dealing with this kind of thing, youre always like people are gonna look at you as the bad parent because he was removed from my home because of my anger, because of my mistakethey made you feel more comfortable with itits a great, great program. Qualitative Quotes Mentor Quotes about their Training Experience on FHF My time at FHF taught me what a powerful relationship is able to accomplish. As I work with students daily, I remind myself that I can be a positive part of their day. Every interaction that I have either

strengthens or weakens the relationship we have with one another. FHF prepared me to not only work with, but enlist the powerful help of the families who stand behind my students. The program assisted in the development of providing meaningful and purposeful therapeutic interventions that were individualized and directed towards the individuals specific and immediate needs. FHF reinforced the importance of engaging with systems when working with children and families. I learned about the importance of taking the perspective of other

people and realizing that people are doing their very best at that moment in time even if we (the professionals) do not think the client is up to par. I learned how to meet families and youth right where they are. Quantitative Outcomes Quantitative Evaluation Model Assessment + Prevention group receives intervention for 9 months.

Eligible youth evaluated. Report sent to worker. Randomly assign youth to Assessment only and Assessment + Prevention groups. Both groups reevaluated 12 months postbaseline.

BASELINE Both groups re-evaluated 18 months post-baseline. Evaluate biannually, funding permitting, to examine long-term effects. POST-INTERVENTION Assessment Only group does not receive

intervention. Recruitment and Retention Rates 92% of eligible youth were recruited for this voluntary program 93% of those randomized to the intervention began the intervention 92% of those who began the intervention completed it; youth who dropped out were included in intent-to-treat analyses

92% completed the Time 2 interview 93% completed the Time 3 interview Over 90% of caregivers and teachers were interviewed at each timepoint Program Uptake Mentors met with youth an average of 27 of 30 times

Children attended an average of 25 of the 30 skills group sessions An average of 96% of the 108 discrete skills group activities were completed These numbers include 5 children who withdrew from the program Mental Health Outcomes

Lower Mental Health Composite Score Fewer Trauma Symptoms Fewer Symptoms of Dissociation Less Anxiety Less Current Mental Health Treatment

Fewer Psychotropic Medications (trend) Greater Perceived Social Support Higher Quality of Life Placement and Permanency Outcomes One Year Post-Intervention, FHF youth experienced: 71% reduction in placement in residential treatment

Threefold increase in adoption for eligible children 44% fewer placement changes 5 times more likely to have achieved permanency Twice as likely to have reunified with their biological parents Fostering Healthy Futures - Phase II

FHF Dissemination Long-term Follow-up Interviews Fostering Healthy Futures for Teens Presentations and Publications Dissemination/Implementation

First Implementation Developed a model of: Initial and ongoing training Fidelity monitoring Data collection procedures for both process and outcome data Outcomes: 94% of the children participated for the full year 92% of skills groups, on average, were attended

99% of core FHF skills group content was delivered 47% of children reunified with their families or achieved permanency No children in the program were hospitalized nor sent to residential programs First Implementation Childrens Evaluations: 87% of children reported FHF has helped me manage my feelings,

such as worry and anger 93% of children reported that they liked getting to know other children in out-of-home care a lot 100% of children reported FHF has helped me better understand what out-of-home care has meant for me 100% of children reported that they feel their mentor accepts them a lot

100% of children at program-end reported they were glad they chose to participate in FHF this year First Implementation Caregiver Feedback: The FHF program helped my son grow emotionally. Our childs mentor is wonderful. Shes so easy to work with. She does a lot with my child and has a lot of patience. The skills group is very good for my child. It helps her with stuff in school. My child loves group. Its important for her emotional well-being. Her mentor has been receptive to everything. I tell her whats going on and

she comes up with ideas about how to deal with everything. What we liked about the program was the consistency. The kids can depend on it and look forward to it. It was great to get him out of the home and to be with other kids in group so that he could see its not just him in foster care. Video Questions? Contact Information: Heather Taussig, PhD Professor and Associate Dean for Research University of Denver

303-871-2937 [email protected] Interim findings Acceptability Sits well in a Welsh context New SSWBA (2014) Strengths based and preventative fits with UNCRC, Charter for Looked After Children (Wales 2016)- Rights could be made more explicit Aspirational - forward looking Young people like coming together Like idea of having a mentor Acceptability continued Mentor needs to be reliable and committed (rigorously assessed- Voices) Need to be post-graduate (less attrition)

Foster carers require regular communication and feedback-pivotal The content of the skills groups map well to a UK context with some adaptation needed Need to map outcomes to our frameworks Acceptability continued Suitable for a level 2 student practice learning opportunity Applying knowledge, skills and values in social work practice (or year 3 elective psychology) Role maps to NOS/CoPP (social work) Model provides additional specialist teaching and supervision in line with Care Council rules and requirements Need additional work and experience of being in an agency/organisation Questions How about endings between the LAC involved and

mentors and skills group leaders Continued support Could social workers, foster carers (blurring of role) or care experienced young people be mentors? Demand and interest Sufficient number of children in South Wales (e.g. a snap shot of statistics from one LA indicated in 2015 there were 51 boys and 46 girls aged 9-11 Sufficient numbers of post grad social work students on programmes based in in South Wales Little similar activity going on with this age group combined mentoring and skills Could help reduce placement break down and in turn out of county placements It is a preventative programme that increases resilience and reduces mental health issues/CAMHs

Demand and interest continued Responds to demand for practice learning opportunities in South Wales Responds to demand for opportunities for students to work intensively with children as this has often seen to be lacking (Lefevere et al. 2016) Move away from case managing Practicalities 16 children travelling no more than 35 minutes- not enough children and students in North Wales for this model to be practical Would need to be situated in a more urban areagroups could be at 2 sites (e.g. Neath & Pontypridd) The student/mentor placement would need to be long and thin 26 weeks January July, rather than block. Students need experience of organisation/agency context

Case study/costing Need an independent agency or consortium of agencies who could host/manage the project Have experience of working with children in foster care and their biological and foster families. The organisation would need to have strong working relationships with local authority childrens services. The organisation would need to have experience of supervising student social work placements. Need to be able to accommodate 8 students Next Steps Apply to Big Lottery for funding to run a pilot Questions for discussion What are your views?

Are there things we havent considered that might be important?

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