“Being able to support children while they are temporarily away from their primary caregivers is a hard, but meaningful calling,” she says.
Now an associate professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine, Murray leads Together Facing the Challenge, an evidence-informed therapeutic foster care training model designed to support child welfare agencies. The goal is to help foster parents build skills to improve outcomes for vulnerable youth.
The Duke Endowment’s support for Together Facing the Challenge has included funding for a second randomized trial focused on coaching, and the Endowment is currently supporting organizations in North Carolina and South Carolina that are recruiting and training foster families using the model.
Murray discusses the program – and the complex field of foster care – in the following interview.
How did Together Facing the Challenge begin?
The work started here at Duke University by Dr. Elizabeth Farmer about 20 years ago. She had been a therapeutic foster parent and had a passion for improving the overall quality of services. Betsy is now associate dean for research and a professor at Virginia Commonwealth University School of Social Work.
What needed improving?
Very few children were getting any kind of treatment related to trauma. Also, many were staying in care for long periods and weren’t developing the skills they needed to move effectively into young adulthood.
Thirdly, lots of reactive parenting was taking place. After a crisis, there’d be a plan. Once the crisis subsided, things return to status quo. There wasn't a focus on what was needed to reduce the number of crises.
With Together Facing the Challenge, what need are you trying to address?
The number of children in foster care increases each year, as does the complexity of their mental health needs. There’s a huge need both for foster parents and for foster parents with a higher level of training.
Rather than watch placements fail and foster parents feel bad about their work, we wanted to offer them intensive training and coaching to support them in their role as frontline treatment providers.
The goal is to give children a place to feel safe, secure, nurtured and loved – a circle of support as they begin to heal.
It stands to reason that if foster parents are better trained, there’s less attrition – and fewer disrupted placements for children. Explain why that’s important.
Every disrupted placement is hard on a child, and the result is cumulative. We know for each move a child makes, the likelihood of having a successful outcome decreases greatly.
Many placements disrupt because the foster parents are simply overwhelmed by the child’s behavior. These are caring and dedicated people, but they don’t always understand the things that can trigger behavioral outbursts.
And that’s why a ‘trauma focus’ is so important?
Children often come into care with an “invisible suitcase” of trauma experiences: physical, emotional and sexual abuse; long periods of neglect; multiple moves among caretakers; or substance abuse among caretakers.
Learning how to make decisions that are informed by the child’s trauma history, and not just their surface behavior, is critical. If caregivers aren’t prepared, and if they don’t have a supportive team environment, that’s when the call gets made to the agency saying ‘I can’t work with this child.’
Does Together Facing the Challenge focus primarily on therapeutic foster care?
A distinction is made nationally between “therapeutic” and “traditional” foster care. It’s based on the complexity of the child’s needs.
But the complexity of needs in “traditional” foster care is growing and foster parents who serve these children need the same training in trauma-informed care that we presently provide to therapeutic foster care agencies.
We believe the same training and coaching techniques are applicable, and we’re starting to work with agencies that offer traditional care.
Why does the field of foster care have so few evidence-based models?
Creating an evidence-based model with the necessary level of control trial research is difficult. Only two organizations have done so, with one of them being us – thanks to funding from the National Institute of Mental Health, The Duke Endowment and the support of Duke University.
You saw significant improvements in your first randomized clinical trial. What measures did you use?
We used standardized measures of child outcomes, such as the Parent Daily Report, the Strengths and Difficulties Questionaire, and the Behavioral and Emotional Rating Scale (BEHRS).
What improvements did you see?
We saw a significant reduction in problem behaviors as reported by the foster parent. We also saw increased use of praise and increased use of privilege removal, and better monitoring and supervision.
The second randomized trial, funded by the Endowment, was focused on the ongoing coaching that agencies provide, right?
Initial training is always helpful, but it’s ongoing practice that really impacts long-term behavior and change. If any of us decides to take up an activity, we know it’s not the initial lesson that makes us good, but the commitment to ongoing practice.
We wanted to see if adding intensive coaching support for TFTC supervisors would help agencies implement the model and make it even more effective.
What did you find?
It was a smaller study, but initial results are promising. Agencies that got extra coaching received more positive feedback from parents about understanding approaches, and there was more interaction between parents and supervisors.
The research continues and we’ll have more findings in late 2018 or early 2019.
Where is Together Facing the Challenge being offered in the Carolinas?
Twenty-six agencies across 70 office sites are using TFTC – and we’re adding more all the time. The model is less expensive than the alternatives, and that’s one reason it’s growing.
How many staff members have been trained in the Carolinas? And foster parents?
TFTC has trained 509 staff members, who have trained nearly 2,000 foster parents.
Are those numbers growing?
Rapidly. Funding from the Endowment is allowing us to continue to work with private agencies offering therapeutic foster care and to expand to agencies working in traditional foster care. We hope to double the numbers of staff and foster parents trained by the end of this next funding cycle.
Is TFTC being offered in other states?
Because of our publications and presentations, we’ve received a lot of national interest. We have trained agencies in more than 20 states.
What is next for Together Facing the Challenge?
Most children in foster care benefit from an ongoing relationship with their biological families. We are adapting TFTC to help foster parents and foster care agencies work with those biological families to help kids make a successful transition back home?
What are the biggest challenges in foster care?
Recruitment and retention. The need for quality caregivers who are able to meet the needs of children coming into care is critical, along with the need for agencies to equip parents with effective tools and resources.
Combined with that, we're seeing more kids coming into therapeutic-level foster care at a time where we're shutting down a lot of the higher-level group homes and residential facilities. We’re trying to serve most, if not all, children in a more family-based setting.
How do you keep from feeling overwhelmed?
I love Arthur Ashe's quote, “Start where you are. Use what you have. Do what you can.”
That's what I've done over the past 15-20 years: Look at where agencies are, what tools they have now, and what they can do. In this time of great need, that’s how we help them reach as many people as possible.