Therapeutic foster care - Berry Street Childhood Institute

These matching processes have been shown to
enhance placement stability.
12. In TFC the carer is considered to be therapeutic in
their parenting practices, so that therapy is much
more than the domain of the mental health
clinician.
13. Specialist frameworks and skills are needed in the
assessment processes of caregivers in TFC. There
is a need for practice standards in these
assessment processes, not to raise the bar but to
increase the knowledge of workers whose aim is
to understand and support carers.
14. Common to all TFC programs is the emphasis
placed on enhanced training and support for
carers, to provide good outcomes.
15. There are a number of factors which increase the
chances of successful training.
16. Established TFC programs in the U.S. and U.K.
generally promote contact between carers and
biological family, and have therapeutic services
aimed to assist biological family, as this family
involvement has proven to be a critical element in
provided good outcomes for children. Research
has shown that a carer's anxiety about a child's
contact with biological family is associated with
poor child adjustment.
17. Ideas for a practice model of TFC in a Victorian
context might include:
• A comprehensive assessment framework
• A trauma-attachment model within a systemic
framework
• Therapeutic parenting
• Strong care team/collaborative approach,
providing a 'reflective space'
• Attachment focused dyadic or family therapy
• Therapy and case management for the
biological family
• Focus on permanency, either with biological or
foster family
• Supervision, consultation and support for
carers and workers, with a focus on self care
• Creative support and respite options, such as
the 'Mirror Families' initiative
A trauma-attachment
framework
Children with trauma-attachment difficulties present
a significant challenge for all who work with them, in
understanding and responding to their needs. An
integration of trauma and attachment theories offers
a useful framework in understanding children's
difficulties, making sense of their thoughts, emotions
and behaviours and guiding interventions for them.
In examining therapeutic care models, an emphasis
on the importance of developing secure attachments
through therapeutic parenting as well as treatment
which may facilitate this development deserves
considerable attention. “In attachment-focused therapies
the aim is to help children use their carer as a secure base
from which they can explore the unhappy and painful
aspects of their past and of their present” (Golding 2006,
p. 343). For this reason, this literature review adopts a
preference for therapeutic models that utilised a
trauma-attachment approach which emphasised a
relational approach to treatment interventions.
Throughout this document there is reference to a
'trauma and attachment framework'. It is most useful
to integrate the theories developed around both
trauma and attachment when trying to understand
the complex worlds of children who have suffered
abuse and neglect: attachment theory because it
speaks of human relationship development from prebirth
throughout the human life span and trauma
theory because it helps us to understand the
neurobiological and social impact of abuse and
neglect on the human individual (See Appendix 2.)
Mental health problems of
children in care
The interplay of trauma and attachment
Children in care are particularly vulnerable to
developing social, emotional and psychological
difficulties. In entering the care system, children have
often already experienced a multitude of difficulties,
such as abuse and neglect, family histories of mental
illness or drug and alcohol abuse, exposure to
substance abuse and family violence, family
dysfunction and criminality (Schneiderman et al.,
1998). These experiences are often compounded by
the separation that is inextricably created when a
child enters care and the associated loss of family,
culture, community, peers and, frequently, school
environments. Such experiences of loss, trauma and
disruption have a significant impact on children
developing secure attachment relationships as well as
their capacity to later form attachments with a new
carer (Golding, 2006). A secure attachment is
fundamental to a child's development and is
regarded as a key protective factor while an insecure
attachment is a risk factor and is often associated with
children who have experienced abuse and neglect
(Golding, 2006).
Attachment and culture
In light of the over-representation of Aboriginal
children in out of home care and the growing
application of trauma-attachment based models of
interventions with children in care, it is important to
understand the interplay between attachment and
culture. Attachment theory has largely evolved from
6 Therapeutic Foster Care