Adaptation and Implementation of Trauma Systems Therapy-Foster Care in a Public Child Welfare Setting

Background/Purpose: State child welfare systems are charged with supporting children in foster care, maintaining stable placements, and working toward permanency. Many children in foster care have been exposed to trauma, and their resulting disruptive behaviors can cause difficulties for foster parents and lead to placement instability (Agosti et al., 2013). Child welfare agencies must train and maintain staff and foster parents who can identify trauma symptoms and support trauma-exposed children. System-wide adoption of a trauma-informed approach is critical to successful intervention (Groves, 2013). Trauma Systems Therapy-Foster Care (TST-FC) is an adaptation of an evidence-informed treatment model designed for implementation in the child welfare system. Results of an initial implementation evaluation of TST-FC in two public child welfare agencies suggest that it is a promising model for placement stability and reducing disruptive behaviors. 

Methods: The study used a mixed method, multi-informant approach. Research questions included: (1) What was the level and degree of fidelity of implementation in each county? (2) Was there an increase in knowledge and skill of staff and foster parents regarding the impact of trauma on child behavior and functioning? and (3) Were there improvements in child well-being, placement stability, and permanency. 

The sample included TST-FC trained: child welfare staff (n=117), mental health providers (n=21); foster parents (n=111); and children placed in TST-FC trained foster homes (n=27), including a subset (n=8), who received TST-clinical services. Researchers administered surveys with standardized measures, including the Resource Parent Knowledge and Beliefs Survey [Sullivan et al., 2014] and the Trauma Informed System Change Instrument [Richardson  et al., 2010], at three time points (pre-training; post-training; one month follow-up) with staff and foster parents, analyzed clinical fidelity checklists, observed and reviewed notes from team meetings, conducted focus groups and interviews with each group, and reviewed foster parent recruitment and retention data.

Results: Agencies successfully implemented TST-FC with fidelity to the model, though the process was more complex and lengthy than staff and leaders had anticipated. Both agencies trained most staff, and mental health providers in TST-FC. Results indicated significant improvement from pre-training to follow up in agency policies, t(31)=-4, p=0.001; agency practices, t(31)=-4, p=0.001; and individual trauma-informed practices, t(31)=-5, p=0.000.

Foster parents’ knowledge and beliefs about parenting a child with trauma improved directly from pre- training to post-training on the following outcomes: trauma-informed parenting, t(58)=-10.67; p=0.000; tolerance of misbehavior, t(73)=-5.04, p=0.000; and parenting efficacy, t(70)=-6.05, p=0.000. Foster parents’ knowledge decreased slightly by follow-up, but demonstrated a net gain on all three constructs. Administrative data findings suggested increased placement stability for children and improved retention of foster homes.

Conclusions: Results of this implementation evaluation suggest TST-FC is a promising intervention for improving public child welfare service delivery by developing a trauma-informed system. It is associated with significant gains in knowledge in trauma-informed care systemically and among child welfare staff and foster parents; however, implementation requires support and takes time. Additional research is needed to investigate the association between TST-FC and positive child outcomes. Implications for foster parent trauma training in child welfare will be discussed.