A preventative intervention for preadolescent youth recently placed in foster care due to child maltreatment, with an overall goal of improving child well-being. The program is rated Promising. Evaluation results suggest that the program significantly reduced mental health problems, and measures of dissociation. In addition, treatment group youths living in nonrelative foster homes at baseline were more likely to achieve permanency and experience fewer placements.
This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.
Program Goals/Target Population
The Fostering Healthy Futures (FHF) program is a preventative intervention for youth ages 9 to 11 recently placed in out-of-home care due to child maltreatment. The program is designed to identify and address mental health issues, prevent risky behaviors, and promote competence, with the overall goal of increasing child well-being.
Fostering Healthy Futures is a 9-month intervention that is composed of two major components: manualized skills groups and one-to-one mentoring with social work and psychology graduate students. The FHF manualized skills groups meet for 90 minutes per week for 30 weeks during the academic year. The groups consist of 8 children, two licensed clinicians who function as group facilitators, and graduate student trainees. The skills group sessions are structured around a standardized program curriculum that includes cognitive behavioral skill-building activities and process-oriented activities. Curriculum units generally follow the same routine, during which children 1) are given an opportunity to process current feelings and events, 2) review the previous week’s lesson, 3) are taught a new lesson, and 4) participate in an activity such as role play, drawing, game, or small group activity units that are designed to help them practice new skills. Moreover, the group curriculum is tailored to meet the needs of children placed in out-of-home care by incorporating units on coping with change and loss, dealing with worry, and establishing healthy relationships.
Alongside the manualized skills group curriculum, FHF also includes a 30-week, one-on-one mentoring component. Mentors are graduate students in social work and psychology, who receive course credit for their time. Mentors are paired with two children with whom they spend 2 to 4 hours of individual time each week. Mentors are tasked with 1) creating empowering relationships with children that serve as a positive examples for future relationships; 2) ensuring that children receive the appropriate services across various systems, and serving as a support for children as they face challenges in these systems; 3) assist children in using the skills learned in the skills group component in the real world; 4) engaging children in extracurricular, educational, cultural, social, and recreational activities; and 5) promoting a positive outlook for the future. Individualized mentoring activities were chosen based on children’s problem behavior, strengths, interests, and family placement characteristics. Mentors also transport children to skills group activities and other mentoring activities.
Fostering Healthy Futures is based on factors associated with adaptive functioning among high-risk youths. This model posits that child maltreatment and placement in foster care situations can negatively affect psychological, social, and behavioral functioning; often contributing to mental health problems, risky behaviors, lower levels of competence, and poor quality of life (Milan and Pinderhughes 2000; Schofield and Beek 2005). Using this research as its foundation, the Fostering Healthy Futures program seeks to create a supportive environment for children in foster care to come and learn from one another, while also reducing stigma. Further, in an effort to promote adaptive functioning, the program matches each child with a mentor who serves as an additional role model and advocate.
Taussig and Culhane’s (2010) intent-to-treat analyses showed that Fostering Healthy Futures (FHF) significantly increased child well-being, in terms of mental health problems and dissociation, and but there was no significant impact on measures of quality of life or posttraumatic stress among the treatment group.
Mental Health Factor Score
At the 6-month follow up, FHF youths reported significantly fewer mental health symptoms than their control group counterparts.
At the 6-month follow up, FHF youths reported lower levels of posttraumatic stress symptoms than control group youths. However, the difference between the groups was not significant.
FHF youths reported significantly fewer symptoms of dissociation than control group youths at the 6-month follow up.
Quality of Life
FHF youths also reported greater quality of life than their control group counterparts, with a mean difference of .11 immediately postintervention. However, at the 6-month follow-up, there was no significant difference between the groups on quality of life.
Any Placement Changes
When examining the total sample, Taussig and colleagues (2012) found that there was no significant difference between the FHF treatment group and the control group in the number of placement changes over the 18-month study period. However, when examining only youths living in nonrelative foster homes at baseline, youths who went through the FHF intervention experienced significantly fewer placement changes (about 44 percent) than control youths.
Placement in Residential Treatment Center (RTC)
When examining the total sample of youths, the intervention group was significantly (71 percent) less likely than the control group to experience a new RTC placement throughout the 18-month study period. In addition, treatment group youths living in nonrelative foster homes at baseline were also significantly (82 percent) less likely to experience a new RTC placement compared with the control group youths living in nonrelative foster homes at baseline.
When looking at the total sample, there was no significant difference between the FHF treatment group and control group in the number of youths who achieved permanency over the 18-month study period. However, when looking only at youths living in nonrelative foster homes at baseline, youths who went through the FHF intervention were 5 times more likely to achieve permanency compared with the control group youth (a significant difference).
Taussig and Culhane (2010) conducted a randomized controlled trial using data from five cohorts of children from two participating Colorado counties in the Denver metro area. The groups comprised children ages 9–11 who had been placed in foster care between July 2002 and January 2009. Children were deemed eligible if 1) they had been placed in foster care by a court order due to maltreatment within the preceding year, 2) resided in a foster care that was within a 35-minute drive to the skills group sites, 3) had lived with their caregivers for at least 3 weeks, and 4) were adequately proficient in English. The final sample included a total of 156 children, with 77 in the control group and 79 in the treatment group. The treatment group received a baseline assessment of their mental health, cognitive, and educational functioning and the 9-month Fostering Healthy Futures (FHF) intervention that consisted of manualized “skill groups” and one-on-one mentoring with social work graduate students. The control group received the same baseline assessment as the treatment group, but continued receiving social services “as usual.” To assess the intervention’s impact, researchers compared treatment and control groups, using statistical techniques to adjust for baseline differences.
Eligible children and their caregivers were assessed at the following 3 time points: 1) baseline (2–3 months prior to the start of the intervention); 2) time 2 (T2), immediately postintervention (11–13 months postbaseline); and 3) time 3 (T3), 6 months postintervention (17–20 most postbaseline). Teachers of participating children were interviewed at 10 months postbaseline, (T2), and 1 year later (T3). Questionnaires measured child well-being, in terms of mental health problems, posttraumatic stress, dissociation, and overall quality of life. Specifically, posttraumatic and dissociation symptoms were measured by the child’s self-report on the posttraumatic stress and dissociation scales of the Trauma Symptom Checklist for Children (TSCC). The overall mental health index was computed based on these TSCC scores, in addition to internalizing scales from both the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF), which were completed by caregivers and teachers. To measure quality of life, children completed the Life Satisfaction Survey, which examined life satisfaction in several domains.
Taussig and colleagues (2012) conducted a follow up of a randomized controlled trial that began in July 2002 and was first evaluated in 2009. The 2012 study is based on data from July 2002 through November 2010. The sample included five cohorts of children ages 9–11, who had been maltreated and placed in foster care from two participating counties in Denver, Colorado. Children were recruited if they 1) had been placed in foster care by a court order as a result of maltreatment within the preceding year, 2) resided in a foster care within a 35-minute drive to the skills group sites, 3) had lived with their caregiver for at least 3 weeks, and 4) were not monolingual Spanish speakers.
Participants were stratified by gender and county before randomizing children in treatment and control groups. The final sample included a total of 110 children, with 54 in the control group and 56 in the treatment group. The treatment group received a baseline assessment of their mental health, cognitive, and educational functioning; and the 9-month FHF preventive intervention that consisted of manualized “skill groups” and one-on-one mentoring with social work graduate students. The control group received the same baseline assessment as the treatment group, but received social services as usual.
Data was obtained from baseline interviews with children and their caregivers, social histories completed by caseworkers at intake, legal petitions filed in the dependency and neglect court, and administrative and placement records. There were no missing records. The primary outcome measures were 1) number of placement changes over the 18-month study period, 2) whether the child had experienced a new placement in a residential treatment center, and 3) whether a child had attained permanency by 1-year postintervention. Intervention effects on the count of placement changes were estimated by using generalized linear models with negative binomial error assumptions. Intervention effects on the dichotomous variables indexing residential treatment center (RTC) placement and permanency were estimated by using logistic linear models. In all cases, the core statistical models included the 2-level treatment factor (treatment versus control) and were tested both with and without 4 covariates (the number of foster care placements prior to the intervention; whether the child had ever been placed in residential treatment; the type of baseline placement (i.e., with nonrelative, relative, or residential treatment); and externalizing problem behaviors as measured by the CBCL).
Visit the Fostering Healthy Futures (FHF) Web site for information about costs: www.fosteringhealthyfutures.org
The Fostering Healthy Futures (FHF) program is being disseminated through community-based agencies. There are manuals and implementation training available; please contact the Program Developer for more information or visit the FHF Web site: http://www.ucdenver.edu/academics/colleges/medicalschool/departments/pediatrics/subs/can/FHF/Pages/default.aspx
Evidence-Base (Studies Reviewed)
These sources were used in the development of the program profile:Study 1Taussig, Heather N., and Sara E. Culhane. “Impact of a Mentoring and Skills Group Program on Mental Health Outcomes for Maltreated Children in Foster Care.” 2010. Archives of Pediatrics and Adolescent Medicine 164(8): 739–46.http://archpedi.jamanetwork.com/article.aspx?articleid=383583Study 2
Taussig, Heather N., Sara E. Culhane, Edward Garrido, and Michael D. Knudtson. “RCT of a Mentoring and Skills Group Program: Placement and Permanency Outcomes for Foster Youth.” 2012. Pediatrics
These sources were used in the development of the program profile:
California Evidence-Based Clearinghouse for Child Welfare. “Fostering Healthy Futures (FHF)”. 2014. San Diego, Calif. California Department of Social Services, Office of Child Abuse Prevention. Accessed April 20, 2015. http://www.cebc4cw.org/program/fostering-healthy-futures-fhf/detailed
Milan, Stephanie E., and Ellen E. Pinderhughes. "Factors Influencing Maltreated Children's Early Adjustment in Foster Care." 2000. Development and Psychopathology
Taussig, Heather N., Sara E. Culhane, and Daniel Hettleman. “Fostering Healthy Futures: An Innovative Preventive Intervention for Preadolescent Youth in Out-of-Home Care.” 2007. Child Welfare