Vol. 8, No. 1• November 2003
Therapeutic Foster Parents: Guarding the Future One Spirit at a Time
by John Newnam
Brandon is a nine-year-old boy. He loves Nintendo and basketball, he loves his family, he doesn’t like broccoli, and he sleeps in Spiderman pajamas. But there is something that sets Brandon apart from his classmates. It sets him apart from most boys his age. Brandon has seen more in his nine years than most of us see in a lifetime.
Brandon is one of thousands of kids who have witnessed domestic violence, been forced to traffic drugs by their parents, been forced to have sex with strangers to help support the family or their family’s drug habit. Brandon has lived in six different homes. He doesn’t feel that he is loved, that he can trust anyone, or that he even belongs in this world.
His behavior is hard to understand unless you spend time with him. He pushes us away from him to maintain his safety. He doesn’t want to attach to anyone because it would hurt too much to lose another person, another friend, another family member. Brandon doesn’t want to sleep because bedrooms to him are scary places. Life is uncertain, and love… love has no meaning.
This was Brandon’s life until he met the family he lives with today. Now Brandon feels safe. His nightmares are only in dreams now, not in reality. His pain is still exhibited through his behavior, but now there are safe arms to hold him until his fears fade. Gentle hands help dry his tears. Soft words nurture him through his darkest moments. He feels loved.
Brandon lives with people who have received special training to help mend his broken spirit, who understand that they may be his only hope of finding permanency in his life. Brandon lives with therapeutic foster parents.
Therapeutic Foster Care
It would be wrong to say that traditional foster care is not therapeutic. Any experienced foster parent can tell you about the behaviors, the sadness, and the rage children bring into their homes. And just like therapeutic foster parents, traditional foster parents are knowledgeable, loving people who devote a portion of their lives to helping children and their families.
The two types of foster care differ, however, in the types of children they serve, in what they require of foster parents, and in the compensation they offer. In general, children in therapeutic foster care have more intense, complex needs than children in traditional foster care. Often they have multiple handicaps, including mental illness, substance abuse, developmental disabilities, and intense behavioral misconduct. Some children in therapeutic foster care suffer from all of these conditions.
To prepare them to care for these children, therapeutic foster parents (TFPs) must attend many hours of training over and above the 30 hours of pre-service training (MAPP/GPS) received by traditional foster care providers. Medication administration, crisis intervention, treatment planning, and intervention implementation are just a few of the topics addressed during this extra training. Like traditional foster parents, TFPs must attend 10 hours of in-service training a year after they are licensed. In addition, they must attend treatment team meetings and IEP (Individual Educational Plan) meetings.
More than Treatment
Some people think of therapeutic foster care as short-term treatment for children with long-term needs. There is limited evidence to support this approach. To say that the family structure, parental interventions, and living in a stable nurturing environment with safe and loving role models do not influence the success of the child is unfounded. Evidence suggests that longer stays in the same home with the same family produce better outcomes for children.
TFPs are compensated at a much higher rate than traditional foster parents. Under the new foster care board rates approved in July 2003, traditional foster parents receive $365 per month for children aged birth through age five, $415 for children aged six through 12, and $465 for children aged 13 through 18. In actuality these monthly amounts are not payments at all, but merely offset expenses parents incur while clothing, feeding, and otherwise providing for the children in their care. TFPs, because of the intensity of the behaviors of the children with whom they work, are paid every month, often at rates two and three times the foster care board rate.
If a family wants to become a therapeutic foster family they should talk to their friends and shop around for the agency that best fits their personality. There are over 30 different agencies that train and support therapeutic foster parents in North Carolina. Some are large, some are small, but their goals are the same: “To provide a safe, nurturing home to children who need help adjusting to life with disabilities and the norms of our society.”
For more on these agencies, consult the NC Division of Social Services’ list of private child-placing agencies at
<http://www.dhhs.state.nc.us/dss/childrensservices/licensing/AgencyLists/cpalistfostercare.pdf>.
Trends and Challenges
Therapeutic foster care in North Carolina has undergone many changes. Initially it was strictly a mental health service. Then it became a service provided by local mental health and local social service agencies. Today it is offered primarily through private nonprofit providers under contract with local agencies.
Therapeutic foster care has faced many challenges and changes in the past few years. Some have been for the best, such as the merging of the NC Division of Facility Services licensure rules and the NC Division of Social Services licensure rules. This has paved the way for more consistent training and licensure standards.
Other changes have made providing care more challenging. Therapeutic foster care providers are held responsible for the care of the child 24 hours a day, seven days a week. To support them, the strategy of therapeutic foster care agencies has been to provide “wraparound services.” However, under mental health reform, agencies not associated with the therapeutic foster home provider will be the ones to determine which therapists, counselors, mentors, community-based services, workers, and other forms of support TFPs receive. Yet when agencies unrelated to the therapeutic foster care provider are allowed to provide services, the integrity of the family and service is compromised. When multiple organizations become involved, the supervision of the services becomes fragmented. This diminishes the value of the foster family and delegates treatment decisions to periodic service providers. The system does not embrace the strength of the family as an integral therapeutic structure.
The biggest challenge therapeutic foster care providers will face in the near future involves a new admission and discharge process that will be run by managed care agents who only know the child through documentation. This new system will base all decisions on the child’s ability to meet treatment goals. It will not take into account issues of attachment, stability in the community, or the damage done to children each time they are moved to another placement. Those making these decisions will not visit the homes or ask children what they want.
In an era of person-centered planning, the foster child’s opinion seems to be the least valued opinion of all. As one foster parent so aptly stated, “It’s like dialysis. You don’t take someone off of dialysis because now they are doing better. You take them off when a permanent solution presents itself.”
If permanency is truly our goal, we need to move children as little as possible. For a few children who suffer from severe trauma, adoption may never be an option. Long-term foster care may be the only realistic answer.
Despite the challenges, the future for therapeutic foster care is promising. Through reform, more and more children will be moving from group homes into therapeutic foster care. As they do, we will need more strong, nurturing families than ever. Therapeutic foster parents and their commitment to our children brings hope to the future. The caring community is the safe house, the loving family the foundation.
John Newnam is a Regional Director for OmniVisions, a private child-placing agency in North Carolina.
Copyright � 2003 Jordan Institute for Families
