An Exploration of Relationship For Children in Treatment Foster Care and Their Caregivers

Purpose: This study explored through the perception of foster children and caregivers, the importance and mechanism of their shared relationship for change in Treatment Foster Care (TFC).  Children at TFC level of care due to emotional/behavioral disturbance (EBD) evidence a persistent and severe degree of EBD and are at risk of placement in a more restrictive setting, i.e. psychiatric hospitalization or residential treatment.  TFC seeks to improve child safety, permanency, and well-being outcomes through therapeutic care within the context of normalized family life (Dore & Mullin, 2006). 

The body of knowledge of the condition of children served within TFC level of care outpaces the body of knowledge of how these children can and need to be effectively cared for.  Much is known about the antecedents, their behavioral and emotional presentation, and relationship difficulties, however only a few interventions or outcomes specific to these foster children or foster families have been rigorously studied (Craven, & Lee, 2006).  No standard of care exists for foster care of EBD children, and theoretical models and treatment methods of TFC vary widely, leading to difficulty assessing intervention effectiveness (Farmer, et al, 2002).  James and Meezan (2002), identify that the further TFC intervention research moves away from the immediate context of the child’s life, the less we know about the factors influencing their experience and outcomes.  Research that provides rich descriptive data on these children, their family context, and their unique outcomes is needed.  Although therapeutic relationship has been demonstrated as an instrument of adaptive change for children in other contexts, it is yet to be explored within TFC.

Methods: This study utilized qualitative research methods within a multiple (10) case study design.  Each case was comprised of a treatment foster family.  Through maximal purposeful sampling subjects were identified within a statewide TFC program.  Data collection included semi-structured interviews with foster parents and children in their care, Trusting Relationship Questionnaire completion, observation at parent training/support meetings, and case-file document review.   Analysis of data occurred concurrently with data collection.  Coding and themes were developed both within and between cases, and case descriptions were developed utilizing all available data. 

Results:  Analysis yielded descriptive information about the process and importance of TFC child-caregiver relationships.  For parents and children, trust/connection was similarly perceived, yet more positively by parents.  Relationship process and importance for children centered on being helped, being known, being comfortable, choosing to connect.  For TFC parents this centered on providing consistent care, valuing and respecting kids, figuring kids out, modeling parenting/lifestyle.  Connectedness to foster family as a whole and connectedness long term (formally and informally) was prevalent.  Mechanism of TFC relationship: therapeutic relationship utilizing parenting as technique of change.

Conclusions/Implications: This research contributes knowledge for direct application to social work practice within TFC and to guide further inquiry regarding this vulnerable, high-risk population. It offers detailed description of adaptive relationship processes and perception through the voice and insight of foster youth and their caregivers, and is at its core concerned with the well-being of foster children