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Research Forum: Fostering Healthy Futures for Children in Foster Care Heather Taussig, PhD
National Mentoring Symposium Banff, Alberta November 2, 2016
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“Our children’s future and the world’s future are one.”
~ Dr. C. Henry Kempe 3
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Development of the Fostering Healthy Futures Program
My early experiences Experiences as a therapist and as a mentor Dissertation; rationale for initial age selection Focus groups Meeting with community leaders
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Key Features of Fostering Healthy Futures for Children
Randomized controlled trial for 10 years Enrolled in yearly cohorts; 420 total enrolled Graduate students serve as mentors Time-limited mentoring Children continue to participate if they change placements or reunify Funded primarily by the National Institute of Mental Health (K01 MH01972, R21 MH067618, R01 MH076919, R01 MH S1, R01 MH S1), with supplemental foundation, state, and university funding
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FHF Core Staff 2002-2015 Sara Culhane, Ph.D. Ann Petrila, LCSW
Daniel Hettleman, Ph.D. Becky Gennerman-Schroeder, LPC Patrick Nickoletti, PhD Jill Gjerde, MA Michel Holien, LCSW Dana Morgan, LCSW Robyn Wertheimer, LCSW Jennifer Koch-Zapfel, MSW Tracy Rudhe Dongmei Pan, MA Liz Goetter, BA Julie Bemski, BA Tabitha Webster, BA Allison Bratsch, LPC Laura Mann, BA Melody Combs, Ph.D. Tali Raviv, PhD Chris Kelman, LCSW Leslie Fitzpatrick, LCSW Orah Fireman, LCSW, M.Ed Edward Garrido, Ph.D. Christie Petrenko, PhD. Leigh Clasby, BA Michael Knudtson, MA Wendy Gehring, BA John Holmberg, Psy.D. Tara Rhodes, MA Lindsey Weiler, Ph.D. Erin Hambrick, Ph.D. Heather Taussig, Ph.D.
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Graduate Student Interns
Lorendia Schmidt Phoung Phan Beth Lipschutz Jacquelyn Eisenberg Angela Bierle Lisa Harrison Nicole Henkins Erin Hoglund Kerrie Earley Ashley Moore Justine Stewart Lauren Goldberg Marissa Nasca Amber Wolfe Jennifer Reynolds Krystal Caduff Miranda Learmonth Molly Jenkins Rebekah Koenigbauer Sarah Oakley Lauren Timkovich Sam Murillo Elizabeth Berling Kristin Krietemeyer Jessica Henritze-Hoye Jenna Kelley Diane Kleinschnitz Linda Ladago Rachel Sacco Ani Steele Rachel Bennett Emily Bruce Stephanie Cichocki Emily Frank Senite Sahezghi Ashley Stewart Elizabeth Stitzel Nancy Vargas David Bennett John Pitman Molly Ward Melissa Romero Madeline White Miriam Chavez Elena Hernandez Krystal Gutierrez Frances Saalfield Evalina Kirkpatrick Anna Bullock Rosie O’Connor Jeremy Fuerte Kjell Taysom Megan Pavek Rachel Alpert Katherine Belcher Taylor Collins Renata Heberton Alyse Keilson Blake Konner Emily Lyons Melissa Maurer Regan Linton Nina Modern Jennifer Pitcavage Meredith Schaffer Holly Selepouchin Heidi VanEpps Katherine Ware Melani Dawson-Lear Kristine Wilson Brenna Ellington Lanette Ambers Carrie Oliver Amy Bruner Liz Dinsdale Vashawn Banks Josh Goldman Marisa Duran Amber Cross Thomas Melanie Rodriguez Clover Bone Tiffany Conway Katie Ferguson Katie Melstrom Lisa Meyers Kendra Sasa Carla Scarpone Lewis Smirl Kelsey Wennesland Regina Richards Michelle Brunner Jocelyn Gray Jon Phillips Jennifer Stucka Christina Haskins Tina Francis Sarah Kane Mark Spehn Jennifer Nelsen Mele Cabral Jon Florida Sibyl Graham Beth Hilligoss Tighe Kaysar Alexandria Lewis Sarah Romero Stacy Walsh Jessica Devore Jacquelyn Gabel Jeffrey Hatcher Ryan Holmes Emily Laux Megan Lovingier Sapphire Rosier Cami Wangaard Jessica Barry Rachel Berns Maria Davidsmeier Diana Gonzalez Brandon Hester Nadine Leonard Julia McKinnon Amy Muetterties Heather Price Kristen Schmidt Rachel Stonecipher Ashley Wiggins Lissa Miller Jenna Brown Jane Simon Allison Harris Shane Spears Jolie Rinebarger Diane Bouhall Kelly Fries Erica Brown Shavon Perkins Jess Valsechi Katie Kaser Britta Johnson Renea Nilsson Laura Merten Kyle Steinke
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Over 90,000 hours of field placement experience!
Clinical Training 144 interns Over 90,000 hours of field placement experience!
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Research Assistants and Group Co-Leaders
Graduate Student Research Assistants and Group Co-Leaders Brendan Close Erika Joye Nicole Lariviere Amy Franke Mia Kim Jessi Wheatley Melani Dawson-Lear Melanie Rodriguez Riley Spuhler Walter Heidenreich David Roberts Alexis Karris Marisa Duran Patrick Nickoletti Dena Miller Thea Wessel Jennifer Sackett Amy Percosky Tisha Bean Emily Macdonald Jill Gjerde Rachel Lund Ann Chu Yael Chatav Tiffany Conway Tracy Rudhe Brian Wolff Jenn Winkelmann Pam Freeman Danielle Smith Amanda Brown Heather Frey Vyga Kaufmann Neta Bargai Julie Bemski Jenell Ribble Martine Lopez Alana Henken Kathryn Jargo Liz Hooks Tara Buckley Jordan Pock Andrea Reece Sara Rosenau Natalie Tolejko Kristen Simpson Shari Watters Michelle Brunner Lindsay Heath Kristin Nelson Kate Slivka Lindsay Smart Susan Whittle Elizabeth Goetter Julie Lyons Courtney Fiedler Edyta Biegunajtys Claire Heppner Clara Paynter Kelsey McNeill Jenell Ribble Dena Miller Martine Lopez Thea Wessel Alana Henken Julie Bemski Amy Percosky Andrea Temple Allison Glover Sarah Morehouse Jennifer DeVault Debra Boeldt Christine Kelley Denise Onofrey Jennell Ribble Alanna Gangemi Jenny Doft Jenea Jones Kristin Allen Maddie Philley Rachel Shulman Leigh Clasby Sarah Perzow Emily Rotbart Laurel Story Mayla Yang Tish Wer Claire Stephenson Allison Glover Melissa Toppel Jasmine Crane Christina Hack Olga Leonova Leah Chelist Katie Lange Melena Postolowski Kristen Mackiewicz Allison Bratsch Kristen Vescera Leah Scandurra Emily Laux Caroline Oppenheimer Tara Rhodes Leah Harrigan Cory Reid-Vanas Erica Ragan Jessica Schnittka Shelby Scott Maria Davidsmeier Shawna Henry-Lange Anne Eden Rachel Stonecipher Michelle Turner Liz Healy Lucia Lapaz Rachel Levine Aleja Parsons Meagan Rohde Laura Sullivan
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Research Assistants and Group Leaders (cont.)
FHF Graduate Student Research Assistants and Group Leaders (cont.) Senite Sahlezghi Rachel Bennett Holly Kingsbury Veronica Tunis Kate Stevens Laura Bonkiewicz Amber Sobczak Kaleigh Becker Lauren Forbes Molly Sarubbi Meghan O’Connor Meseret Hailu Meghan McKee Samantha Brown Katie Combs Emily DeFrancia Sheila Kistler Kelsey Barton Sarah Ballard Macie Dominique Darian Finley-Garcia Josh Francia Hillary Haspel Molly Ward Victoria Baltzell Kayla Bell Samantha Key Allison McVey Faryn Scarlett Anika Sjoholm Heng Amy Black Chelsey Elgas Chloe DeMarsh Anna Melillo 154 students from 8 disciplines trained in clinical research
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It Takes a Village Denver Department of Human Services
Adams County Social Services Department Jefferson County Human Services Arapahoe County Department of Human Services Broomfield County Health and Human Services Colorado Department of Human Services Graduate schools: DU, Newman, CSU, UCD, Metro School districts and schools Mental health centers and therapists Multiple non-profit organizations Children and families David Olds Sara Culhane Ann Petrila Daniel Hettleman Volunteers Kempe Center Kempe Foundation Youth Mentoring Collaborative Department of Pediatrics, University of Colorado Developmental Psychobiology Research Group Sue
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Fostering Healthy Futures Preteen Program
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FHF Enrollment Recruited all 9-11-year-old children in any type of out-of-home placement in participating counties Placed in court-ordered out-of-home care over prior 12 months as result of maltreatment, and were in out-of-home care at the onset of the intervention Children with significant mental health, cognitive/academic and behavioral problems (including sexual behavior problems) were not excluded Youth continued to participate in the program even if they changed placements or reunified with parents.
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Fostering Healthy Futures (FHF) Program Design
1) Evaluations of Children’s Functioning 2) Therapeutic Skills Groups 3) Mentoring
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Screening Evaluations
We assessed functioning in the following domains: Cognitive Academic achievement Mental health Social Behavioral
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Skills Groups 30 weeks Manualized curriculum 8 children per group
Mental health clinicians & graduate trainees facilitate 1 hour group and then dinner with mentors Improve skills, process feelings related to the foster care experience, and reduce stigma
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Session Content Basic Social Skills Healthy Coping Change and Loss
Feelings Perspective Taking Problem Solving Healthy Communication Healthy Coping Anger Management Positive Self-Talk Dealing with Worry Active Coping Strategies Change and Loss Mixed Emotions Abuse and Neglect Healthy Relationships Panel Night Adolescent Issues Anatomy and Puberty Dealing with Peer Pressure Resisting Drug/Alcohol Use Healthy Dating Relationships Program Ending Future Orientation Career Shadows Healthy Goodbyes GRADUATION!
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Mentoring Graduate students spend 3-4 hours per week of individual time with each child they mentor They help them generalize the skills learned in skills groups, engage in extracurricular activities, identify adult role models in their communities, engage in recreational activities, etc. Focus on engaging them in their communities and teaching them advocacy skills Mentors interface with other adults in child’s life Role of mentor - create a web of support for children, improve social skills, and provide staunch advocacy
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Mentor Supervision Intensive orientation
1 hour of individual supervision weekly 1.5 hours of group supervision weekly 1 hour seminar on relevant topics weekly Supervisor available by cell phone after hours
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Special Program Activities
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Panel Night
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Cultural Presentations
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Cultural Presentations
Encourage self-exploration Encourage self-respect and respect for others Supports problem-solving and perspective-taking skills Celebrate the difference and uniqueness each child brings to group
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Cultural Areas Explored
Race/Ethnicity Country of origin Language Family role/Family composition Traditions Being in out-of-home care Gender Religion Neighborhood School and peers
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Career Shadows
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Field Day
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So What?
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Won’t Work Children are too old Children are “too disturbed”
Children have sexual behavior problems Children are in diverse placements Children reunify Children didn’t sign up
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Won’t Work Graduate students can’t be mentors
Interns can’t drive children Program is too short Can’t end a mentoring program Mismatches between mentor/mentee Need a parent training component Can’t get consent Can’t do rigorous research
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Recruitment and Retention Rates
92% of eligible youth were recruited for this voluntary program 93% of those randomized to the intervention began the intervention 92% of those who began the intervention completed it; youth who dropped out were included in intent-to-treat analyses 92% completed the Time 2 interview 93% completed the Time 3 interview Over 90% of caregivers and teachers were interviewed at each timepoint
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Program Uptake Mentors met with youth an average of 27 of 30 times
Children attended an average of 25 of the 30 skills group sessions An average of 96% of the 108 discrete skills group activities were completed These numbers include 5 children who withdrew from the program
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Mental Health Outcomes
Fewer mental health problems on a multi-informant index Fewer trauma symptoms Fewer symptoms of dissociation Less mental health treatment Better quality of life Taussig, H.N., & Culhane, S.E. (2010). Impact of a mentoring and skills group program on mental health outcomes for maltreated children in foster care. Archives of Pediatrics and Adolescent Medicine, 164,
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Placement and Permanency Outcomes
71% reduction in residential placements 44% fewer placement changes for children who started in foster care 5 times greater permanency for children who started in foster care 3 times more adoptions 2 times as many reunifications Taussig, H.N., Culhane, S.E., Garrido, E., & Knudtson, M.D. (2012). RCT of a mentoring and skills group program: Placement and permanency outcomes for foster youth. Pediatrics, 130:e33-e39.
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Moderating effects Found largest benefit on placement changes for children who had the highest level of baseline externalizing problems Found largest benefit on posttraumatic stress symptoms for children who had fewer adverse childhood experiences (ACEs) Thinking about the appropriateness of different mentoring models for children at varying levels of risk
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FHF Dissemination
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We didn’t want our program to be one of the 86%
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People start calling…
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Initial Training Group
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First Implementation 2013-2015
Community-Based Mental Health Center 2 groups; 16 children per year 4 Counties using Core Service Dollars Outcomes 94% of the children participated for the full year 92% of skills groups, on average, were attended 90% of the mentoring visits were attended 99% of core FHF skills group content was delivered 47% of children reunified with their families or achieved permanency No children in the program were hospitalized nor sent to residential programs 5 children returned to biological parents and remained in the program
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National Institute of Justice Grant
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Participants 200 young adults Ages 18-22
Previously enrolled in the FHF randomized controlled trial during summers of 5th wave of interviews Interviews are conducted 6-8 years after the intervention, and approximately 4.5 years since their last interviews
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Measures Living situation and history Substance Use
Neighborhood safety Educational history Employment history Independent living Career goals Finances Cultural identity Social support Self-esteem Religious involvement Civic/Political involvement Mental and Physical health Mental /physical health services Psychotropic meds & diagnoses Sexual risk behaviors Delinquent /criminal behaviors Other violence/victimization Legal involvement Witnessing community violence Maltreatment history Family history Contact with family Life satisfaction Dating violence
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Fostering Healthy Futures for Teens Program
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Fostering Healthy Futures for Teens FHF-T
Do you have any programs for teens? Grew out of similar PYD model guiding FHF Enrolling maltreated teens in 8th and 9th grades with open child welfare cases Skills training provided by mentors; no formal group component, although have workshops
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Core FHF-T Components Guided self-assessments
Goal setting and tracking Skills training Texting/ ing/calling for reinforcement Community engagement/Resource acquisition Teen workshops Career shadowing Youth-Initiated Mentoring
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R RELATIONSHIPS E EDUCATION A ACTIVITIES C CAREER H HEALTH
SELF-ASSESSMENTS & GOAL SETTING R RELATIONSHIPS E EDUCATION A ACTIVITIES C CAREER H HEALTH
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Health Assessment Mental and Behavioral Health
Behavioral and Emotional Screening System Physical Health Health Discussion Cards
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Visioning and Goal Setting
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Core Skills Communication (e.g. assertiveness, perspective taking, refusal skills) Problem Solving (e.g. decision making, slowing down) Emotion Regulation (e.g. anger management, stress management) Academic and Organizational Skills (e.g. study skills, planning) Healthy Behaviors (e.g. good nutrition, exercise, sleep)
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Methods for Skills Training
Skill education and training Gathering information together/researching Role plays Practicing in real life (in-vivo) Providing feedback to youth Encouraging teen to do self-reflection on their progress related to developing or practicing skill
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Post-Program Evaluation
Teens’ Reports 88% said that frequency of mentor visits was “just right” 76% said they found themselves being more hopeful about their future 82% said they found themselves being more focused about their future 63% said the program length was “just right” 100% said that it was somewhat or very helpful to set goals 100% said mentor listens to them and supports them “a lot” Average rating of program was a 9 (on a scale of 1-10)
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Post-Program Evaluation
Teens’ Quotes “It was helpful to set goals with my mentor because once I set them, I achieved more.” “I think it was a good program. It is helpful using your resources and seeing how to connect with them and having someone to help you out.” “I grew a lot from it- I wasn’t paying attention while it was happening but looking back I got what I wanted from it.” “I think the program was great - nothing needs improvements.” “I really liked learning from each other- she gave me a lot of helpful advice and that was good. She kept pushing me towards my goals.”
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Future Plans Continued dissemination of pre-teen FHF program nationally and internationally Continued testing of FHF-T (teen) program in Colorado; exploring Youth Initiated Mentoring as adjunct component Exploring and piloting adapted versions of FHF & FHF-T for other populations Researching for whom our programs work best Researching other outcomes
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Lessons Learned in Mentoring Children in Foster Care
Mentoring is highly acceptable to children/families Mentoring can meet the needs of many stakeholders Planful endings to mentoring relationship are critical Can work with children with a wide range of functioning, but intensive supervision is necessary This work is highly rewarding and evidence suggests it is beneficial for children in foster care, even if they didn’t sign up for a mentoring program
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Questions? Contact Information: Heather Taussig, PhD Professor and Associate Dean for Research Graduate School of Social Work University of Denver
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