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THERAPEUTIC FOSTER CARE: A SYSTEMIC APPROACH FOR SERIOUSLY EMOTIONALY DISTURBED FOSTER CHILDREN

Ellen Burkemper

USA, Saint Louis University

Society has an obligation to raise all of its children in a manner that will allow them to reach their full potential. Children in foster care have often experienced multiple extrinsic and intrinsic risk factors. These risk factors may affect the well being of the child as the child reaches maturity. A foster child diagnosed as seriously emotionally disturbed presents additional challenges to the child welfare service system. It is in the best interests of the child and of society that this child is provided a secure growth environment conducive to the remediation of his/her mental health difficulty, thereby reducing the effects of this particularly troubling early childhood risk factor. The setting for this change effort may be a therapeutic foster home environment that provides a professional community support system attentive to the needs of the foster child, the foster parents, and the child's biological family.

Children are in foster care for a number of reasons. Some children cannot live with their parents because of parent behaviors that are aversive to societal child rearing norms. Some parents choose not to live with theirchildren and relegate this responsibility to caretakers, including the state. Some children engage in behavior that is aggressive and are, thus, not suited to living in a usual fashion in their biological home. The reason for the placement in foster care, while important, is just one piece of the puzzle. An additional piece of that puzzle that must be addressed is the needs of a foster child who is seriously emotionally disturbed and requires specialized attention and treatment.

Children in foster care have often suffered some degree of deprivation. The forms of deprivation can be economic, social, psychological, emotional, physical, or academic (Gustavsson & Segal, 1994). The needs of these children go beyond the child welfare view of care taking (Weisz, 1995) to a more comprehensive therapeutic perspective and treatment milieu. The "insults experienced by these children merits intensive intervention" (Stoesz, 2000, p. 8) that will rectify the psychological and social problems exhibited by these children and that inhibits their ability to appropriately interact with others and to become successful members of adult society. Therapeutic foster care Therapeutic foster care is a step beyond traditional custodial foster care and "represents a combination of child welfare and mental health approaches" (Rosen, 1998, p. 25). These children may benefit from an array of services available to them within the community rather than living and receiving services in the more restrictive residential or hospital setting. A less restrictive setting is a specialized therapeutic residential facility providing 24-hour care known as a therapeutic foster home environment (Weisz, 1995). Studies indicate that individualized foster care programs, including therapeutic foster care, result in positive and optimistic results for the foster child. These studiessuggest, though the results are not definitive, that "the children tend to meet their treatment goals, experience positive changes in self-esteem, and move on to less restrictive settings, as compared with children discharged from institutional settings" (Rosen, 1998, p. 28).

The seriously emotionally disturbed child is placed with professional foster parents who receive far more training, ongoing supervision and professional input, and respite care than the traditional foster parent (Rosenfeld, Altaian & Kaufman, 1997). Therapeutic foster parents are carefully selected and screened. The child welfare system professionals have already had some ongoing interaction with these parents when the parents served as traditional foster parents. The specialized and ongoing therapeutic training provides the welfare system professionals with yet another opportunity to screen the foster parents. These parents have to successfully complete each component of the training.

While most seriously emotionally disturbed children may qualify for mis in-home therapeutic approach, some of these children may not qualify. These include children who are severely aggressive and overly violent, predatory sexual offenders, those that engage in serious suicidal gestures or attempts, are chemically dependent, or are fire setters (Missouri Department of Social Services, 1991). Children with these problems may be a danger to themselves or others and should be considered for a more restrictive helping environment. Therapeutic foster care training
The relationship with the foster parent is used as a therapeutic tool and is considered a modeling relationship (Davies & Bland, 1978; Rosenfeld, Altaian & Kaufman, 1997). It is important that the foster parents have training and education modules geared toward:
o knowledge of child development including social, emotional, cognitive, and academic expectations; o behavior management techniques focused in operant conditioning and social learning theory; o communication skills for in-home use as well as for professional interaction with psychiatrists, social workers, parent aides, and caseworkers; o negotiation and conflict management skills; o training in stress management; o education concerning psychopharmacology; o education concerning chemical and substance abuse; o education concerning mental illness; and
o school/academic interventions.

Each of these modules provide the child welfare staff with an opportunity to screen foster parents for the therapeutic role they will play in the change efforts for seriously emotionally disturbed children and at the same time address most of the concerns of rearing a seriously emotionally disturbed child.

Therapeutic foster parent education and training requires a committed, organized, and funded response from the child welfare system, and may sometimes be viewed as a shift in mission for child care organizations. Therapeutic foster care is a systemic, multi-professional response the focus of which should result in the successful behavioral, emotional, social, cognitive, and academic success for the child (Rosenfeld, Altaian & Kaufman, 1997). Therapeutic foster care requires ongoing attention to the needs of the child, and where possible, to and with the biological parents, caretakers, or extended family. This programming is expensive, though the extra stipend paid to these parents is less than the cost ofhospitalization or residential care (Rosen, 1998).

Тherapeutic and support services.

The reasons for placement and the training provided to therapeutic foster parents are starting points for composing a therapeutic milieu. Further services for therapeutic foster parents and for the child can include (Gregory & Phillips, 1997): o individual child counseling and psychiatric services; o in-home family therapy for the child and the foster family, and/or the child and biological family; o a foster parent support group; o 24-hour crisis intervention; o daily telephone consultations; o once monthly meetings with the caseworkers or consultants; o multifamily retreats; and o planned and unplanned respite care.

These services provide support for the therapeutic foster parent and are offered to help the parent carry through on the therapeutic plan, as well as to reduce the likelihood of the foster home failure.

The biological parents, caretakers, and extended family are also members of the team. They are encouraged to become a part of their child's individualized services by taking part in any or all of the training modules and professional meetings or appointments that concern their child. They are considered an integral member of the team that plans the placement, the treatment and the return home (Davies & Bland, 1978). This empowerment perspective is used in an effort to help the biological parents bring change to their views and methods of child rearing and to ultimately return the child to his/her parents. Conclusion.

The child welfare system should respond to the needs of seriously emotionally disturbed foster children. These children have mental health difficulties that command more attention from caretakers but whose care is not necessarily suited to institutionalization in a residential setting or hospital. One option for an in-home-not-institution-response is therapeutic foster care. Therapeutic foster care is a comprehensive approach that attends to the mental health needs of the child, the foster parent, and the biological parent system. The foster parents are carefully selected and trained, the child welfare system is attentive to the needs of the child in interaction with the therapeutic foster parents, and the biological parents are considered integral members of the planning and treatment team. This systemic framework empowers the community of interested parties to work toward the best interests of the seriously emotionally disturbed foster child.
References Davies, L. J. & Bland, D. C. (1978). The use of foster parents as role models for parents.Child Welfare, 57(6), 380-386.Gregory, S. D. & Phillips, F. B. (1997). "Of mind, body, and spirit": therapeutic foster care-an innovative approach to healing from an NTU perspective. Child Welfare, 76(1), 127-142. Gustavsson, N. S. & Segal, E. A. (1994). Critical issues in child welfare. Thousand Oaks, CA.: Sage Publications.

Missouri Department of Social Services, Division of Family Services, Area II (1991). Behavioral foster care procedure for Area II. Fulton, Missouri: Author.
Rosen, M. (1998). Treating children in out-of-home placements. New York: The
Haworth Press. Rosenfeld, A. A., Altaian, R., & Kaufman, I. (1997). Foster care. In R. K. Schreter, S. S. Sharfstein, & C. A. Schreter (Eds.). Managing care, not dollars the continuum of mental health services, (pp. 125-13 8). London, England: American Psychiatric Press, Inc.
Stoesz, D. (2000). A theory of children's services: reflections on Epstein's indictment. Children and Youth Services Review, 22(1), 1-11.

Weisz, V. G. (1995). Children and adolescents in need a legal primer for the helping
professional. Thousand Oaks, CA: Sage Publishers.