Evaluation of a Trauma Intervention Adapted for Youth in Foster Care

Background and Purpose: The Illinois Department of Children and Family Services (DCFS) implemented a trauma-focused intervention, Trauma Affect Regulation: Guide for Education and Therapy (TARGET), with the goal of increasing timely and stable permanence for youth identified as being most at risk of long-term foster care. TARGET aims to ameliorate a prominent barrier to permanence identified in previous studies, emotional-behavioral difficulties frequently related to histories of complex trauma in maltreated youth.

Methods: Youth eligible for the study included foster youth ages 11 to 16 placed in traditional, relative, and specialized foster homes throughout the state who, upon reaching the two-year anniversary of entering care, were experiencing mental health symptoms and had at least two or more placement changes. Focus youth, their foster parents, and biological parents received a baseline (Time 1) assessment and an additional assessment at the completion of the TARGET intervention for those in the intervention group, or at 6 months for those in the comparison group (Time 2). Data necessary for computing distal outcomes were drawn from AFCARS. Additionally, Illinois provided data for all measures derived from the CANS and all information about number of TARGET sessions and focus youth or sibling designation.

Results: The main effects of the impact of TARGET on the seven different proximal outcomes and on timely and stable permanence were mixed. Assignment to TARGET had a direct impact by increasing in-person monthly visits with fathers and other types of monthly parental contact, and in reducing the number of reports of subsequent trauma.  All these results were in the expected direction and are consistent with the proposed hypotheses. On the other hand, the majority of significant findings were in the opposite of the hypothesized direction. Compared to the comparison group, assignment to TARGET was associated with increased symptoms of behavioral and emotional/affective dysregulation, heightened symptoms of trauma such as anxiety, depression, dissociation, and post-traumatic stress, and delayed transitions to timely and stable permanence.  

Conclusions and Implications: The summative evaluation of the TARGET intervention in Illinois identified some expected effects regarding increased visits with fathers, other types of parental contact, and reduced incidents of trauma. The majority of TARGET effects on proximal and distal permanency outcomes, however, were negligible or opposite to the direction expected. Longer tracking of the current youth may be necessary to determine if the path of improvement follows a curvilinear development path so that the TARGET intervention results in a positive sustained impact for youth and their families in the long run. On the other hand, if assignment to the TARGET intervention is associated in the long term with increased behavioral dysregulation, heightened trauma symptoms, and delayed transitions to timely and stable permanence, the appropriateness of the intervention for the target population of youth in care will need to be re-examined.