Trauma Focus Model for Reducing Long-Term Foster Care

Permanency Innovations Initiative- Trauma Focus Model for Reducing Long-Term Foster Care Project

The Trauma Focus Model for Reducing Long-Term Foster Care Project with the Illinois Department of Children and Family Services (DCFS) is implementing a trauma-focused intervention, Trauma Affect Regulation: Guide for Education and Therapy (TARGET) to increase permanency rates for a target population of children identified as being most at risk of long-term foster care.

Study Overview

• Status: Completed
• Conditions: Foster Care
• Intervention / Treatment: Other: Trauma Affect Regulation: Guide for Education and Therapy (TARGET)

Detailed Description

The Illinois Department of Children and Family Services (DCFS) is one of six recipients of the Permanency Innovations Initiative Grant. These funds support the statewide implementation of Trauma Affect Regulation: Guide for Education and Therapy (TARGET) in Illinois. TARGET is a manualized, psycho-educational intervention designed to address complex trauma and difficulties with emotional regulation and relational engagement that occur across a wide range of trauma-related difficulties, including trauma-related and behavioral symptoms. The aim of this intervention is to address the key barriers to permanence for the target population. This population includes youth ages 11-16 who are placed in traditional, relative, and specialized foster homes throughout the state of Illinois, have been in foster care for at least 2 years, and are experiencing mental health challenges and/or at least one placement change. The three key barriers to permanency are: (1) children's need to improve emotional regulation and reduce symptom severity, particularly disruptive behaviors; (2) biological parents' skills in regulating their emotions so they are better able to complete services and address the underlying issues related to their involvement in the child welfare system; (3) foster parents and other placement resources skills in understanding and addressing the needs and disruptive behaviors of the children in their care with trauma histories.

The local evaluation will examine the effectiveness of the TARGET program in increasing permanency rates for foster youth in the target population. The main hypothesis to be tested is that addressing unstable child affect & behavior secondary to trauma using an intervention that improves both youth modulation skills as well as foster parent capacity to respond appropriately to youth will stabilize placements and improve youth ability to engage with potential permanency resources, thus facilitating progress toward permanence. The evaluation involves randomly assigning eligible foster youth to receive TARGET services or receive services as usual. The evaluators collect proximal and distal outcomes from multiple administrative data sources. Additionally, the evaluation includes the collection of key proximal outcomes through the use of interviews with foster youth, their foster parents and biological parents deemed eligible for participation in the project.

• Study Type: Interventional
• Enrollment (Actual): 462
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 11 years to 16 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Youth ages 11-16 who are placed in traditional, relative, and specialized foster homes throughout the state of Illinois who, upon reaching the two-year anniversary of entering care, are experiencing mental health symptoms and/or have had at least one placement change.
• If a youth does not exhibit any mental health symptoms as indicated by the Child and Adolescent Needs and Strength (CANS) tool, they need to have at least 3 placement changes to be eligible for the study.

Exclusion Criteria:

• Youth are ineligible to participate if at the time of eligibility assessment, they are in need of immediate and acute substance abuse treatment, have a Full Scale IQ score below 70, and/or have made recent suicidal threats or plans.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Treatment	Other: Trauma Affect Regulation: Guide for Education and Therapy (TARGET); The intervention is called the Trauma Affect Regulation: Guide for Education and Therapy (TARGET). TARGET is a manualized, psycho-educational intervention delivered in 10 - 12 sessions. TARGET is designed to address complex trauma and difficulties with emotional regulation and relational engagement that occur across a wide range of trauma-related difficulties, including trauma-related and behavioral symptoms. The full TARGET model consists of learning 7 essential core skills. These skills are called the FREEDOM steps: Focus, Recognize triggers, Emotion self-check, Evaluate thoughts, Define goals, Options, and Make a contribution.; Other Names: TARGET
No Intervention: Comparison

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to stable permanence	Measured by administrative data from the Adoption and Foster Care Analysis and Reporting System (AFCARS)	Measured from the date of random assignment to the discharge date or to the end of the study period for cases that did not discharge
Placement stability	Measured by administrative data from the Adoption and Foster Care Analysis and Reporting System (AFCARS)	Measured at initial study enrollment and at the 8, 14, 20, and 26-month mark of enrollment in the study

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Foster parent skills in responding to youth's emotional and behavioral dysregulation	Measured by Parenting Practices Chicago Survey (PPCS) (Gorman-Smith et al., 1996)	completed by study youth at initial study enrollment and at 6 months after baseline data collection

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Biological parent ability to regulate their own emotions and behaviors and experience of trauma-related symptoms	Measured by Abbreviated Dysregulation Inventory (ADI) (Mezzich et al., 2001)	completed by biological parents of study youth at initial study enrollment and at 6 months after baseline data collection
Biological parent service completion	Measured by administrative data from the Administrative Case Review (ACR)	Measured at initial study enrollment and at the 8, 14, 20, and 26-month mark of enrollment in the study
Biological parent contact with youth	Measured by Parent Contact with Youth (PCY) Instrument (questions modified from the Illinois Adult Connections Study)	completed by study youth at initial study enrollment and at 6 months after baseline data collection
Change in Youth trauma-related and mental health symptoms	Measured by: 1) administrative data from the Child and Adolescent Needs and Strength (CANS) tool and 2) the Trauma Symptoms Checklist for Children (TSCC) (Briere, 1996)	1) Measured at initial study enrollment and at the 8, 14, 20, and 26-month mark of enrollment in the study and 2) completed by study youth at initial study enrollment and at 6 months after baseline data collection
Youth capacity to form and maintain relationships.	Measured by: 1) administrative data from the Child and Adolescent Needs and Strength (CANS) tool and 2) Youth Social Support Instrument (YSS) (LONGSCAN, 1998)	Measured 1) at initial study enrollment and at the 8, 14, 20, and 26-month mark of enrollment in the study and 2) completed by study youth at initial study enrollment and at 6 months after baseline data collection
Youth capacity to regulate their emotions and behavior	Measured by: 1) administrative data from the Child and Adolescent Needs and Strength (CANS) tool and 2) the Abbreviated Dysregulation Inventory (ADI) (Mezzich et al., 2001)	Measured 1) at initial study enrollment and at the 8, 14, 20, and 26-month mark of enrollment in the study and 2) completed by both study youth and their current caregiver at initial study enrollment and at 6 months after baseline data collection
Change in support for biological and foster parents	Measured by Social Provisions Scale (SPS) (Russell & Cutrona, 1984) completed by both biological and foster parents of study youth	Measured at initial study enrollment and at 6 months after baseline data collection
Change in Youth traumatic events	Measured by administrative data from the Child and Adolescent Needs and Strength (CANS) tool	Measured at initial study enrollment and at the 8, 14, 20, and 26-month mark of enrollment in the study
Youth emotional permanency	Measured by Youth Emotional Permanency (YEP) Instrument (questions from the current Illinois Adult Connections Study and the Supportive Connections Inventory developed for the Arizona PII evaluation) completed by youth	Measured at initial study enrollment and at 6 months after baseline data collection
Frequencies of change in direction of youth permanency	Measured by administrative data from the Integrated Database (IDB)	collected at 6, 12, 18, and 24 months
Permanency rates	Measured by administrative data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) collected every 6 months throughout the study duration.	collected at 6, 12, 18, and 24 months
Timely permanence	Measured by administrative data from the Adoption and Foster Care Analysis and Reporting System (AFCARS)	collected at 6, 12, 18, and 24 months
Placement stability after legal permanency	Measured by administrative data from the Adoption and Foster Care Analysis and Reporting System (AFCARS)	collected at 6, 12, 18, and 24 months
Repeat maltreatment following legal permanence	Measured by administrative data from the Adoption and Foster Care Analysis and Reporting System (AFCARS)	collected at 6, 12, 18, and 24 months

Collaborators and Investigators

• Sponsor: Westat
• Collaborators: Children's Bureau - Administration for Children and Families; Illinois Department of Children and Family Services.

Study record dates

Study Major Dates

• Study Start: September 1, 2014
• Primary Completion (Actual): May 1, 2016
• Study Completion (Actual): May 1, 2016

Study Registration Dates

• First Submitted: July 9, 2014
• First Submitted That Met QC Criteria: July 15, 2014
• First Posted (Estimate): July 17, 2014

Study Record Updates

• Last Update Posted (Actual): March 26, 2019
• Last Update Submitted That Met QC Criteria: March 22, 2019
• Last Verified: March 1, 2019

More Information

Terms related to this study

• Keywords: trauma; child abuse and neglect; Long term foster care
• Additional Relevant MeSH Terms: Wounds and Injuries
• Other Study ID Numbers: 8977 3