Family Involvement in Treatment Foster Care.

Child mental health policy and practice has increasingly embraced family-driven practice which promotes family involvement in all aspects of planning and service delivery. While evidence for positive outcomes related to family involvement is mounting in traditional residential treatment, there is little information about family involvement in treatment foster care. This study provides data on family involvement in a statewide randomized trial of treatment foster care. The types of family involvement, factors associated with such involvement, and placement outcomes were examined. Nearly eighty percent of youth experienced recent family contact and/or family participation in treatment planning. Implications for research, policy, and practice to increase understanding the role of family involvement are discussed.

Use of Psychotropic Medications among Youth in Treatment Foster Care.

We describe the use of psychotropic medications among youth in treatment foster care (TFC). Data from 240 youth were coded to examine rates of medication use, including polypharmacy and an indicator of "questionable polypharmacy." Fifty-nine percent of youth in TFC had taken a psychotropic medication within the past two months. Of the youth taking psychotropics, 61% took two or more and 22% met criteria for questionable polypharmacy. The majority of youth taking psychotropics also received psychosocial mental health services and were more likely to receive such services than youth not taking medication. Use of psychotropic medication use was not significantly related to demographic factors, maltreatment history, or custody. However, youth with more severe symptoms were more likely to be on medications and to be on multiple medications. Youth with "questionable polypharmacy" were less likely than other youth on multiple medications to have a recent visit to a psychiatrist.

Prior Trauma Exposure for Youth in Treatment Foster Care.

Very little research has focused on rates of trauma exposure for youth in treatment foster care (TFC). Available research has utilized record review for assessing exposure, which presents limitations for the range of trauma types examined, as records are predominantly focused on abuse and neglect. The current study examines exposure rates and association with emotional and behavioral outcomes for 229 youth in 46 TFC agencies. The youth in this study had exceptionally high rates of trauma exposure by foster parent report, similar to youth in traditional foster care, with nearly half of the sample exposed to four or more types of traumatic events. A composite child abuse and neglect exposure variable was associated with child and adolescent emotional and behavioral outcomes. Implications for services provided as part of TFC are discussed.

Enhancing and Adapting Treatment Foster Care: Lessons Learned in Trying to Change Practice.

Evidence-based practices to improve outcomes for children with severe behavioral and emotional problems have received a great deal of attention in children's mental health. Therapeutic Foster Care (TFC), a residential intervention for youth with emotional or behavioral problems, is one of the few community-based programs that is considered to be evidence-based. However, as for most treatment approaches, the vast majority of existing programs do not deliver the evidence-based version. In an attempt to fill this gap and improve practice across a wide range of TFC agencies, we developed an enhanced model of TFC based on input from both practice and research. It includes elements associated with improved outcomes for youth in "usual care" TFC agencies as well as key elements from Chamberlain's evidence-based model. The current manuscript describes this "hybrid" intervention - Together Facing the Challenge - and discusses key issues in implementation. We describe the sample and settings, highlight key implementation strategies, and provide "lessons learned" to help guide others who may wish to change practice in existing agencies.

Enhancing "usual practice" treatment foster care: findings from a randomized trial on improving youths' outcomes.

OBJECTIVES: This article reports the initial findings from a randomized trial to enhance treatment foster care (TFC) in "usual care" agencies. The intervention, Together Facing the Challenge, was built on a combination of practice-based elements from a prior descriptive study of TFC and selected elements from Chamberlain's evidence-based model (multidimensional treatment foster care) to fill conspicuous gaps in usual practice. The study was designed to examine whether additional training and consultation to staff and treatment foster parents improved outcomes for youths. METHODS: The study was conducted with 247 youths in TFC and their treatment parents from 14 TFC agencies in a southeastern state in 2003-2008. Half of the agencies were randomly assigned to the intervention condition and received study-provided training and consultation. Agencies in the control group continued to provide training and treatment as usual. Data for the analyses presented here were from interviews with treatment parents at baseline, six months, and 12 months. RESULTS: Compared with youths in the control group, youths in the intervention group showed improvement on the three focal domains--symptoms, behaviors, and strengths. Effects were significant for all outcomes at six months. Effects for behaviors remained significant by 12 months. CONCLUSIONS: This study employed a hybrid model to improve practice. It built on current practices in existing agencies and infused additional training and consultation to overcome observed deficits. Such an approach has tremendous potential for moving beyond a singular focus on disseminating evidence-based interventions to a broader view of improving practice in a wide range of agencies.

Service system involvement and delinquent offending at system of care entry.

This study examines correlates of delinquent offending among 2,554 youths presenting to community-based treatment in Center for Mental Health Services-funded systems of care. Variables in five key domains, including demographics, family risk, child clinical risk, school, and service system involvement, were examined in relation to severity of offending at treatment entry for early/middle (11-15 years) versus late (16-18 years) adolescents. Significant correlates of offending severity were identified in all domains except family risk for the 11 to 15 year olds and in demographics and child clinical risk for the 16 to 18 year olds. Service system involvement was a unique correlate of delinquency in the younger group. Findings add to other studies showing that correlates of offending appear to differ across stages of adolescence; specifically, school and service system involvement may be less important for older adolescents than for younger adolescents. Service system involvement should be included in longitudinal studies of risk for adolescent offending.