WSIPP Details Cost-Benefit Analysis of Teaching-Family Model

In July of 2015, the Washington State Institute for Public Policy (WSIPP) released a cost-benefit analysis of Teaching-Family Model group homes in the context of juvenile justice.

Despite the relatively high costs of the Teaching-Family Model’s intensive treatment, as compared to other programs evaluated by WSIPP, the significant societal benefits of the treatment were clear.

The Teaching-Family Model’s significant effects on the participant’s likelihood to graduate from high school as well as the prevention of further crime and victimization, in the context of WSIPP’s analysis, result in a large net societal benefit of $26,009 per participant, as shown above.

Compared to another evidence-based living treatment program, Multidimensional Treatment Foster Care, the Teaching-Family Model group homes were found to have a higher benefit-to-cost ratio of $2.18 compared to $2.11, and a higher probability that benefits will exceed costs – 71 percent versus 65.

Summary Statistics (WSIPP)

Benefit-to-cost ratio $2.18
Benefits minus costs $26,009
Probability of a positive net present value 71%

1999 meta-analysis (Lipsey) of programs used in juvenile justice found Teaching-Family Model group homes to be one of the most consistently effective treatment approaches for delinquents. A 2004 pre-post treatment study summarized:

Teaching-Family Model programs reduced subsequent arrest rates by 33 percent, compared to a 12 percent reduction from the typical delinquency treatment. (Larzelere, et al. 2004)

Looking at behavioral outcomes beyond recidivism, that same 2004 study found that youth undergoing Teaching-Family Model treatment improved from the “clinical or borderline range at intake” to functioning “similar to national norms at a three-month follow-up” on standardized instruments such as the Child Behavior Checklist.

Teaching-Family Model group homes have yielded positive outcomes for juvenile justice populations since its evidence-based origins almost 50 years ago. Teaching-Family Model treatment results in positive outcomes for a variety of different client demographics across a broad range of service deliveries. See our FAQ.

Teaching-Family Association Welcomes New Executive Director
michele-exp.jpg

July 13, 2018—The Teaching-Family Association is proud to announce and welcome Michele Boguslofski as our Executive Director. Michele has served the past four and a half years as Director at Alpine Academy at the Utah Youth Village in Salt Lake City, Utah. Under her direction, Alpine has reached new heights in quality of care, tenure of staff, professionalism, and services offered to and support of students and the team.

Michele began her career as a Teaching Parent over 30 years ago in Vermont and has spent the majority of her career at various TFM sites as a practitioner as well as administrator. Michele has experience as a Chief Operations Officer and an Executive Director at other non-profit businesses and has worked collaboratively with state-level officials, partnered with international organizations, and is a sought-after trainer, presenter and consultant. She has served on TFA’s Board of Directors, Accreditation and Ethics Committee, and is a Trainer of Primary Reviewers for the Association.

Few people working within the Model have such vast experience and expertise and are therefore qualified in the way that Michele is to take on this vital role and lead TFA in the way that she can.

Michele will be responsible for the continued oversight and management of the Association including the Board of Directors, Accreditation and Ethics Committee, and members. Additionally, Michele’s role as a full-time Executive Director will include an emphasis on marketing and expanding TFA and a focus on facilitating and supporting sites with respect to dissemination and development. One of her colleague’s reports, “Michele has the wonderful and unique gift of making everyone she comes in contact with feel special and important”, and her energy and passion, paired with her knowledge and experience, make her an ideal fit for this role.

Michele will move into her role as Executive Director effective Monday, August 6, 2018, working closely with Peggy McElgunn (TFA’s current ED) for several months to ensure a smooth and seamless transition for the Association and its members. Michele and her husband Jeff are moving to South Carolina in August and this will become the new headquarters for the Teaching-Family Association when Michele assumes fully responsibility later this year. We will formally welcome Michele and honor Peggy for her many accomplishments and years of service at our 41st Annual Conference, November 4-7, 2018, in Omaha, Nebraska.

About the Teaching-Family Association

The Teaching-Family Model’s early research began in the late 1960’s and the Teaching-Family Association (TFA) was founded in 1975 to ensure the quality of care provided by professionals who actively pursue the goals of humane, effective, trauma-informed, individualized treatment for children, families, dependent adults, and others using the common framework of the Teaching-Family Model for treatment and support. Programs and services are delivered in schools, day treatment settings, the private homes of families receiving services, treatment foster care homes, small group care homes, campus and community based treatment programs, psychiatric hospitals and communities, and can be implemented with any population.

What is learned in one agency is shared with other agencies within the Association and incorporated into the standards of quality assurance processes within the Association. TFA’s goals are to accredit members, recognize programs, standardize effective training, supervision, and evaluation procedures, support program replication, and provide yearly conferences for sharing new material and program development. The Teaching-Family Association is the only entity in North America that defines and implements standards and review procedures related to the actual performance and quality of treatment and service delivery systems at all organizational levels.

NREPP, APA, and CEBC recognize the Teaching-Family Model as evidence-based. TFA is an international organization with programs in the United States, Canada, New Zealand, Albania, and Australia.

PRESS RELEASE: FOR IMMEDIATE RELEASE

CONTACT: Dr. Steven Morse, (609) 877-4111, ext.208
smorse@gpaschool.org
Download Press Release Here

Compassion Fatigue & the Strengths-Based Workplace – Bob Phillips

Bob Phillips, D.Bh, LMSW, LADAC, of Eastern New Mexico University led an excellent session about Compassion Fatigue, Burnout & the Strengths-Based Workplace at the Teaching-Family Association Mid-Year Meeting in Santa Fe, New Mexico.

This session focused on what burnout and compassion fatigue really look like, how we can measure or track these stressors, and how we might build an organization’s capacity to inoculate employees against these stressors or help them to recover more quickly from them.

Session Slides & Resources

Session Notes

The following are free-form notes, though not an exact accurate transcript, of Bob Phillips’s presentation to accompany the slides. Follow along with the session slides, above.

New Mexico workforce coalition… How are we going to replace an aging workforce, and how are we going to bring people from the bottom up? Sounds like many of you are struggling with those things in your organizations…

Human services organizations in New Mexico have about the same turnover as 7-11 stores. Our data suggests that turnover is even worse among administrators—that they may turnover even more often than direct service staff.

You have some people who come and stay for five minutes, but then you have people who’ve been around forever that maybe should be gone… it’s about filling the middle.

Occupational health stressors drive people out of these jobs and careers—in particular, my work is about understanding the risk and protective factors around compassion fatigue and burnout.

It’s quite shocking to me that these things aren’t addressed more systematically than they are. Firefighters are prepared for danger—and they’re trained to save each other first. The danger is part of what attracts them to that work, in my experience. But how many people in human services come to the work fully understanding that the work has inherent stressors… that these things can be quite distressing… some of the people I’ve interviewed thought they were going to do this forever and save the world, but they find it’s not what they thought it would be.

Why don’t we show them? We’re afraid to run them off… We struggle with mental health stigma…

Stressors may affect people out of the blue in some cases. I hope that people will share this information with their staff and people they care about—and I think we need to measure this consistently.

People can and do recover from these things, and more often than not—when they do recover, they recover stronger than they were before. How we can cultivate in organizations protective factors to inoculate staff or have staff recover more quickly from these things?

Burnout is acquired through consistent contact with emotionally demanding situations. It’s a process, not a lightbulb. Unlike compassion fatigue, it’s a gradual erosion of commitment, etc. It’s acquired over time. But you can see it from people new in the field—in my experience that means they come to the field with something in their lives that’s already burning them out.

Compassion fatigue is an accessible, kind of friendly term for vicarious traumatization or secondary traumatic stress… We see a lot of compassion fatigue in our work, but Interestingly, you’ll actually see this a lot in journalism. In journalism schools they’re talking about this more than we are in social work schools.

The recognition that people can be traumatized directly or indirectly. Traumatic syndromes, by definition, have to have some external reference point where something outside overwhelmed a person’s coping ability. The only people that don’t have to worry about compassion fatigue are people that never cared. That’s unusual in this field—empathy may be a vector for this that’s powerful. A strong emotional connection… you’ve opened up this mainline that’s capable of transmitting whatever they’re feeling to what you’re feeling.

In those with compassion fatigue, particularly what I’ve seen a lot is a sense of foreshortened future—they can’t see tomorrow. They don’t know what life’s going to do next or what it’s going to be. That’s very common in my experience. People doing a job for 15 years and suddenly they feel they can’t do it one more day, and they don’t know what else they can do.

52 percent of us are at HIGH risk for compassion fatigue. And burnout is around 26 percent. These are not rare or even uncommon. Does that seem right in your experience?

How effective we are at developing relationships is a huge factor in helping—in outcomes. And to do that we need empathy—we won’t be helpful unless we create these relationships. But once we’ve done that, we’ve created this mainline from their pain to ours.

Most people have experienced some trauma in their own lives. However, you’ve recovered from that, compartmentalized that—one always has the risk of over-generalizing your experience to the experience of other people. Most people are deeply affected by children’s suffering.

Most of the people who work in this area have these things, but we rarely train for it or supervise around these issues in the field.

In order to cope, we often disengage, which sets off a whole chain of things… troubled and fascinated about disengagement from social relationships, which is massively hazardous to your health.

We spend a ton of time at work. “The great, good place” – the sociology of those “third places” where we find social connections outside of family and work. Number one predictor of longevity of health is the density and quality and nature of social relationships—that study has been generalized to tons of other populations as well. The worst thing you can do is solitary confinements where you disconnect and disengage, it’s the most painful kind of human emotion—loneliness, rejection, same pathways in the brain as physical pain.

If you are strongly socially connected—you reduce your risk of dying of anything by 50 percent. How many people can I call to help me out, who will really be there for me? The density of how many relationships like that you have. How many people could just walk in and have “refrigerator rights.” Who cares about you—who you can count on—the number and quality of those relationships. 1000 weak supports might be as good as 10 really huge supports. But the number and frequency of that kind of thing is huge….

Facebook is somewhat negatively correlated with mental health. There’s two things that happen that produce a depression—making social comparisons, they have that and I don’t… Fear of Missing Out (FOMO) on guard duty all the time. Social media outlets have their place and usefulness, but they do not take the place of real friends.

Disengagement in the workplace, from the work family—is that a sign? Is that too simplistic to say that that’s compassion fatigue? No—I don’t think so, those may be initial symptoms of that compassion fatigue. These things are isomorphic—if it’s happening here, it’s probably happening there. If it’s happening at work, it’s probably also happening at home or in third places. The cost of caring is too high, so they stop caring. Family place or third place to refill that cup… but in general, these things happen across all three places.

Something encouraging—political activism, when people give a damn about what’s happening around them in society—in real life, not on Facebook—those things powerfully connect us to something larger than ourselves… political activism is strongly negatively correlated with compassion fatigue.

What do you do about it? Are there ways to inoculate against it? We’ve identified a lot of the risks, but you may also have a ton of protective factors. Risks are only half of the story. If people are exposed to risk without a lot of protective factors, that’s a danger.

Compassion satisfaction or compassion exhilaration—helper’s high. The more of that you can get in your life, the better. Build in a lot of successes in your work. The measurement and cultivation of HOPE—how you keep hope alive in your work. Resiliency training.

Whatever’s going on for you—if you can make it (1) comprehensible. If it stays senseless, you can’t cope with it. It has to make sense in some way. It has to be (2) manageable, you have to be able to calm down, etc. And you have to be able to go back and make something that happened to you (3) meaningful. Sense of coherence is hugely negatively associated with compassion fatigue.

Fun—what percentage of your life do you consider fun? Whatever that is for you… what percentage of your life would you say is fun? We found a cut score that says—40 percent or more, they’re remarkably protected against these things. Less than 40 percent, not so much. “Cultivated positive emotion.”

Crisis has an element of danger and opportunity in it. Traumatic growth.

The Gallup organization—takes the results of polls and surveys and takes them into the world of management consulting. But they began to recognize based on data from 2 million people! (We have nothing like this in academics.) That shows how some organizations are remarkably resilient… Measuring the strengths of an organization is a huge deal.

All of these things contribute—there’s not a bad one on the list, but some are more important than others… [see Gallup workplace questionnaire]…

With regards to research, community colleges are agile in working with these things—establish some official relationships. You might find people who love to crunch numbers, like me. You never know what kind of partnership you might set up….

Motivational Interviewing was born here in New Mexico. Took thirty years to make it a success. Applications from the success of the Military’s Master Resiliency Training. We can train it. There’s ample evidence there, for that…

When is the last time you asked yourself what you wanted to be? Personal equity evaluation.

You are: your rolodex, your projects, your clients. Business = rolodex, again, social connections. Independent contractor mindset—free agent nation. We should teach social workers how to market themselves, how to develop products, operations, client services, information management, time management, planning—those are skills people need in the modern workplace that people often don’t get trained in. Think about other kinds of things that make people’s work better. If they can do these things better, they are less likely to burn out. To have those satisfying skill sets… Less anxiety about letting people go, they have less anxiety about going because you’ve given them skillsets…

With regards to using the ProQOL to measure potential stressors – probably, formally, use it at least once a year. But you can also use it just to structure an interview.

Being able to assess the cost of burnout or compassion fatigue in an organization—what’s the cost of care?…  Correlation for SRS measurements to estimate the prevalence of high risk for compassion fatigue or burnout, there might be a way to pair those up. To see if the performance outcomes would be different—to extrapolate cost offsets, if you do something to inoculate people to this. The cost off-sets of additional training. There’s a cost related to having a staff member focus on taking care of staff (like at Children’s Bureau), but there’s outcomes there—lower turnover saves money.

Chimera Collective
The Likert Scale Debate: Reliability & Validity
Likert-Scales.jpg

Introduced by Renis Likert in 1932 in his work, “A Technique for the Measurement of Attitudes,” Likert scales are commonly used in questionnaires—from simple surveys to academic research—to collect opinion data. Since 1932, a great deal of debate has surrounded what features and factors might improve the reliability and validity of the scale—attempting to answer the question: how should we design the scale such that respondents provide the answer closest to the actual truth, i.e. their true answer devoid of influence or bias?

Of course, minimizing this potential at the individual level would improve reliability and validity of the data collected by the questionnaire as a whole—that the data would be replicable if surveyed, again, and that the data reflects the true opinions of the population surveyed.

Firstly, should we use more points or less? And perhaps the largest dispute: Should we include a neutral response or not—should the respondent have the ability to offer no opinion at all? Let’s leave the neutral response debate, for now, and look at the number of responses on the scale.

More points or less? (Why do we use 4 or 5 scales, rather than 6 or 7?)

Teaching-Family Model standards require the collection of Likert scale data on either a 4 scale or a 5 scale. These options provide the same descriptiveness of opinion—no complexity in opinion is added beyond the introduction of a neutral response. In other words, if respondents have an opinion, they’d be  dealing with the same four opinionated options.

Very dissatisfied | Dissatisfied | Satisfied | Very satisfied

Very dissatisfied | Dissatisfied | Neutral | Satisfied | Very satisfied

Many researchers have argued for the use of more points to improve reliability and validity—a 7 scale, for example, looks like this:

Extremely | Moderately | Slightly | Neutral | Slightly | Moderately | Extremely
dissatisfied dissatisfied dissatisfied satisfied satisfied satisfied

As we will return to the neutral option question later, let’s interpret the difference between scales of 5 and 7 as equivalent to the difference between scales of 4 and 6. Since Likert introduced and advocated for the use of the 5 point scale, many researchers have argued that 7 points may increase reliability and validity. (Though, it should be noted, this is a hard limit—some researchers have argued that individuals cannot distinguish between more than seven different distinct opinions about a subject, and that reliability is not increased beyond 7 points (Miller, 1956 & Johns, R. 2010, respectively).)

If we were to agree with a growing consensus that 6 or 7 point scales are the most reliable and valid options, why might we continue to use 4 or 5 scales? On one level, researchers have also reported higher reliability for 5 point scales in certain contexts (Jenkins & Taber, 1977; Lissitz & Green, 1975; McKelvie, 1978; Remmers & Ewart, 1941). Furthermore, a number of studies have suggested that five point scales increase response rates and response quality in addition to being less confusing and reducing respondents’ “frustration level” (Babakus and Mangold, 1992; Devlin et al., 1993; Hayes, 1992). One study explained that the 5 point scale is common and thus readily comprehensible to respondents, enabling them to accurately express their views (Marton-Williams, 1986).

The research arguments above provide strong support for the use of 4 or 5 scales in the practical context of Teaching-Family Model implementation for two reasons:

1. Comprehension

Firstly, TFM standards require agencies to collect the opinions of clients, children and other non-experts who might not be able to distinguish the difference in opinion between, for example, slight satisfaction and moderate satisfaction (on a 6 or 7 scale) with regards to the questions being asked.

To illustrate—when asking for feedback on an agency’s Facilitative Administration, can we reasonably assume consumer respondents to have a complex enough understanding and opinion of this system of a Teaching-Family Model agency to provide their accurate opinion—without frustration—with 6 or 7 different options? Using a 5 scale lowers barriers to comprehension and makes it more likely for non-expert respondents to express their true opinion on a subject at a reasonable level of detail.

2. Response Rates

Secondly, the Consumer Satisfaction standard requires a relatively high response rate compared to what might be considered an acceptable sample size for research or opinion polling—for two important reasons: all relevant parties should be offered a regular opportunity to provide formal feedback and comment on the work of the agency, and the agency should collect as much specific information and feedback as possible, rather than work with only the basic response data of a representative sample.

While it might be possible to achieve high response rates on a survey of clients regardless of the number of points on the scale—if these responses are collected in person or conducted by interview, for example—standards also require the administration of external consumer surveys which are far more difficult to administer with such a comprehensive response rate. (Note, if feedback is collected by interview, some research has also suggested that it is much simpler for an interviewer to read out the complete list of scale descriptors with a 5 point scale, thus improving the reliability and validity of responses (Dawes J.G., 2008).)

So, while research might prefer a more descriptive scale, in the practical implementation of the Teaching-Family Model there are strong arguments for the continued use of a 4 or 5 point scale. As the purpose of the data collected is continuous quality improvement or accreditation review—we might also ask the expert opinion of reviewers and administrators—does the 4 or 5 point scale provide enough information to guide TFM implementation?

The Neutral Response Option (Why would an agency choose a 4 scale over a 5 or vice versa?)

The choice to use a 4 or 5 scale is up to individual Teaching-Family Association accredited agencies. It should be noted, however, that the decision should be consistent for the sake of comparability across surveys—the choice will affect response data and make data between a survey utilizing a 4 scale and one using a 5 scale not reliably comparable, though it may seem so.

An important consideration in this debate is that TFM standards require the same high level of criteria regardless of whether or not a neutral option is included. On a 4 scale, that’s a score of 3— describing that everyone is, on average, satisfied—and on a 5 scale, that’s a score of 4—describing the same. One might assume that a neutral option would throw off averages to be slightly lower than would be equivalent on a 4 scale, as there is one more option below criteria than otherwise, but the opposite might also be true—it may be that the neutral option would skew responses towards neutrality from negativity, raising the average score. Let’s see how this plays out in research debate.

A scale without a neutral option is often criticized for “forcing” the respondent to make a decision whether or not something is positive or negative, which may reduce reliability and validity where respondents’ truly have no opinion or are neutral. As Likert himself advocated for the use of the neutral option—his research found the neutral option and 5 choice scale to create the statistically expected standard deviation or “bell curve” distribution when used—it must be said that a strong majority of research literature supports the use of the neutral option or simply only considers the differences between scales which use a neutral option. In fact, a scale without a neutral option might not be considered a Likert scale by some resources.

However, the arguments for doing away with the neutral response are also compelling. Respondents have a tendency to avoid the cognitive effort required to pick an opinionated answer when reporting their opinion (Krosnick, et al., 2002)—in other words, neutrality is the path of least resistance, and a neutral option may inaccurately skew results towards neutrality. But that’s not all, respondents’ may also choose a neutral option due to ambivalence (Bishop, 1987)—respondents may choose a neutral answer to avoid the negative feelings associated with their conflicted views on an issue. Cognitive effort may be required for individuals to choose between their positive and negative feelings, which a neutral option would make less likely to occur (Nowlis et al., 2008).

For these reasons and others, some researchers suggest doing away with the neutral option on Likert scales (Garland, 1991; Krosnick et al., 2002; Kalton et al., 1980)—the central argument being that removing the neutral option forces respondents to exert cognitive effort whether simply tending towards neutrality or strongly ambivalent about a topic. This requires individuals to use what they perceive to be the most important point of an argument to make a decision (Weijters et al., 2010; Nowlis et al., 2002). I would speculate, from these points, that removing the neutral option might also make respondents more likely to provide specific comment on why they chose one way or the other, which makes feedback more valuable to Teaching-Family Model agencies.

I believe the key consideration in the debate between using a 4 or a 5 scale centers around the relevancy of the questions to the respondents. When asking for opinion data among a large sample of individuals about which you may know little, it follows that a neutral option should be used to allow for a truly neutral opinion towards some of the questions asked by the survey or questionnaire. However, if we can reasonably assume that all questions asked in a survey—carefully selected questions about TFM implementation asked to stakeholders and consumers of those services, for example—are highly relevant to the respondents selected, we might lean towards the elimination of the neutral option, “forcing” respondents to employ appropriate cognitive effort and provide the most accurate and useful feedback to Teaching-Family Model agencies.

One potentially compelling argument for the use of a 5 scale is that many other organizations may also use 5 scales in similar ways. In that case, collecting satisfaction data with a neutral option would allow a TFM agency to benchmark data against other non-TFM organizations. I say non-TFM, as it appears most common among Teaching-Family Association agencies to utilize a 4 scale for consumer feedback based upon review data.

Other considerations

The reliability and validity of opinionated data will continue to be a topic of debate for some time—it is particularly difficult to parse the many factors which influence, behaviorally, the responses of individuals. Interestingly, the decision of whether or not to label each individual option or simply the extreme options, like this—

1 | 2 | 3 | 4 | 5
Very dissatisfied Very satisfied

—also has a significant and somewhat ambiguous effect on individuals’ responses—labeling only the extremes leads to more extreme responses, but labeling all options may lead to responses that are more neutral than may be perfectly accurate. Due to the complexity of the behavioral issues that relate to the self-report of opinion, it may be advisable to simply work with what is standard—such that new results can reliably be compared with previous results.

It should also be remembered that while this numerical data provides a valuable indicator to Teaching-Family Model agencies, the value and usefulness of specific, detailed and written feedback cannot be understated, and all consumer feedback surveys should include prompting questions to regularly elicit this feedback.

Chimera Collective
Member approaches to ethics standard 507: informed consent

How do you handle the situation when a child understands what he is being asked to sign but refuses to sign?

Our population all has intellectual disability so in a sense they are adult-children. Many have been assigned conservators who can make consent decisions for them but still we seek to have the individual understanding and cooperation of those we serve. The difficulty we deal with, regardless of conservator or not, is a refusal to take prescribed meds or a refusal to bathe, do household chores, go to school etc. With the meds, we report it as a medication error and try to address the issue with behavior modification if it persists. Under no circumstance can we force or coerce compliance.

  • We document. The document is fully explained to the client, any questions are answered, if and as appropriate changes are made (unless it is a standard licensing or admissions form), and if they refuse to sign we ask they sign to the side and make note that they received it, but don’t agree/want to/whatever, or we make a notation based on their specific reason, sign and date it.

  • Document the refusal. This could look differently depending on the situation. For example, maybe you gave the client a copy of a hand book and they refused to sign that they received it. Then you may just list that the client was given a copy of the hand book and refused to sign, with the date, staff signature, etc. next to this notation. And if the client is under 18, I’m assuming the guardian would be signing paperwork as well so you may have the guardian and staff/witness both sign next to the documentation re: the refusal.

  • While the child would not like to sign, the legal consent for treatment, training, research participation is with the person who has legal standing to do so. If the youth has a legal standing to refuse we would honor their request.

  • In our case, we would have the legal guardian sign for them and note that the child refused to sign. In Alberta, consent is only recognized for kids 12 years and up, but a guardian can still sign for them up to the age of 18. This is basically just the “consent for treatment” that I’m referring to. If we did research we would likely only do it with consent from the child (if they are at the age where they can legally consent). Hope that makes sense.

  • We separate out these issues and in regard to research you should not combine research consent with any other consents and the client always has the right to opt out. Additionally lack of consent to research should not be used as a criteria for anything regarding treatment and should be guided by the organizational IRB board. Regarding consent to treatment with kids: this is always difficult as a good chunk of our kids don’t want the treatment initially. Much of the youth consent to treatment came out of child welfare and best practice guidelines regarding having youth involved in treatment decisions. I think there are some very practical reasons why organizations may not require consent forms from the youth. 1/3 of our kids are court ordered to Boys Town, many others would be homeless or in dangerous living situations that they would prefer to be in but it is not in their best interests. However I think organizations have the responsibility to find other mechanisms for youth to be an active participant in their treatment even though they may not want the treatment. Regarding training of youth I am not sure what this would be. Most of our training that impacts youth would be handled through our schools and again, many of the kids would not provide consent regarding learning activities but they still need to attend the learning activities.

  • The legal guardians have to sign off on our form. Youths and legal guardians also sign off on the Informed Consent/Client Rights form that states we reviewed the information contained in the form with them. The Publication Consent form that we use for non-identifying information about clients requires the youth to sign off if they are 12 or older. Consent on this form is often not given. What that means for us is that we can’t use that particular youth’s story in any of our publication/media efforts in a general non-identifying description of the youth. We get a specific identifying consent form for any youth we feature in any media efforts before engaging the youth in the interview process. If we did a specific research project that involved our youth, we would have to get consent from both youth and legal guardian. If consent was not given, that youth could not participate in the research project. We typically have not done academic-type research that focuses on a certain group of our youth (i.e. having a control group where no changes to program are made and having a test group where we do things differently in program with them).

SAMPLE CONSENT FOR RELEASE »

SAMPLE INFORMED CONSENT »

SAMPLE PUBLICATION CONSENT »

Chimera Collective
TFA Newsletter Companion: Self-Compassion

In the Spring edition of the TFA Newsletter, we feature an article by guest writer Deirdre Staton, MSW, LCSW entitled “The Cost of Caring and How You Can Avoid Compassion Fatigue.”

Staton has been a Licensed Clinical Social Worker in Virginia since 1998, serving the Richmond, Charlottesville and Harrisonburg communities.

You can learn more about Staton and her work on her website, deirdrestaton.com.

In this newsletter companion, we feature additional content—including a self-assessment quiz and a slide deck from one of Staton’s recent presentations:

 

Resilience Against Compassion Fatigue Through Self-Compassion

This slide deck includes more content, like some self-compassion exercises to try, further resources and references for the benefits of self-compassion listed in the TFA Newsletter article.

ACCESS THE SLIDES »

Quiz: Test How Self-Compassionate You Are!

Get scores—immediately—to see how self-compassionate you are on several different scales.

TAKE THE QUIZ »

 

TEDx Talk: The Space Between Self-Esteem and Self-Compassion by Dr. Kristin Neff

 
 
TFA Newsletter Companion: Mindfulness

Mentioned by:
A Mindful Way Through…

 
 

Mentioned by:
Mindful Moments

6 Breathing Exercises to Relax in 10 Minutes or Less

Abdominal Breathing Technique

How it’s done: With one hand on the chest and the other on the belly, take a deep breath in through the nose, ensuring the diaphragm (not the chest) inflates with enough air to create a stretch in the lungs. The goal: Six to 10 deep, slow breaths per minute for 10 minutes each day to experience immediate reductions to heart rate and blood pressure, McConnell says. Keep at it for six to eight weeks, and those benefits might stick around even longer.

When it works best: Before an exam or any stressful event. But keep in mind, “Those who operate in a stressed state all the time might be a little shocked how hard it is to control the breath,” Pacheco says. To help train the breath, consider biofeedback tools such as McConnell’s Breathe Strong app, which can help users pace their breathing wherever they are.

Level of difficulty: Beginner

TFA Newsletter Companion: Session Slides

Spirituality as a Coping Resource

Duane Horstman and Vivian Burdine, Indiana United Methodist Children’s Home

Trauma-Informed Consultation

Emily Shields, Methodist Family Health

Joining Behavioral Approaches with Therapeutic Needs

Huti Cooper, Garfield Park Academy; Amanda Rossi, Garfield Park Academy

Examining Effects of an In-Home Family Services Program Based on the Teaching-Family Model: Preliminary Findings from a Randomized Trial

Kristin Duppong Hurley, PhD and Matthew Lambert, PhD, University of Nebraska—Lincoln;

Ron W. Thompson, PhD, Boys Town National Research Institute

Advocating for the Teaching-Family Model as a Trauma-Informed Approach

Michele Boguslofski, Utah Youth Village, Alpine Academy; Karen Olivier, Closer to Home Community Services



Advocacy Updates: “Family First” Act changed, revived, but removed again—unlikely to pass.

FFPSA, Changed, but gone again.

Only days ago, the Chronicle of Social Change suggested that the Family First Prevention Services Act was amended and revived with a “real shot to pass.”

Today, it’s gone again, and unlikely to pass during this congress.

What happened? Provisions from the Family First Act, which we’ve covered at length (below), were attached to a large bi-partisan “omnibus” bill, the 21st Century Cures Act, which is moving quickly through congress this week.

Representatives and Senators just as quickly raised objections—and child welfare provisions were removed.

Proponents of the legislation have clearly tried to pass the bill under-the-radar, and negotiations have continued behind closed doors since we last discussed them, but as more and more legislators become aware of what the bill means for their states, more and more objections are raised.

New York and California pushed the opposition to the original bill, but reports suggest North Carolina spoke out against its inclusion in the omnibus.

Rep. Virginia Foxx (R-NC) even spoke out directly in favor of congregate care, reports the Chronicle of Social Change“I am well aware of the work these facilities do,” said Foxx. “I did a lot of volunteer work with one of them. I know how hard they work to get foster homes established.”

After the original Family First Prevention Services Act passed its fiscal year deadline for funding, it looked like one of the only ways for the bill to pass—without fuss and in this congress—was if it were attached to a large “omnibus” legislation.

Now, that avenue has failed as well, making it even more unlikely to pass during this lame duck session.

The latest changes… For those following along with particular permutations of the Family First legislation, it is interesting to note that the latest iteration had even more concessions for congregate care providers, including a vague exception for “a setting providing high-quality residential care and supportive services and youth who have been found to be, or are at risk of becoming, sex trafficking victims.”

Both italicized portions would have been up for interpretation by the Department of Health and Human Services, a division of which has argued that children in child welfare “are all at high risk of being trafficked.”

And that’s not all—if you’re interested in the latest congregate care concessions, check out this article from the Chronicle of Social Change, or the bill text that included Family First Act (search for Division D). Note, again, the entire division D has been removed from the bill moving forward.

Examining “Family-Like” Care

By Kurt Jensen, Communications Director, Teaching-Family Association

The actual evidence suggests that foster care could be just as risky as residential care, but we have this dualism that people don’t recognize there. We have the idea, then, of the family being natural, and residential care is unnatural, and obviously – the idea of the homely versus the institutional. So we have these dualisms, I think, which run through, in a sense, some of the ideology around residential child care which we need to unpick.

Andrew Kendrick

Is foster care necessarily more “home-like” than residential care? This was an assumption made by the Chapin Hall policy brief we previously summarized – and it’s an assumption Teaching-Family Model agencies constantly have to overcome in marketing and advocacy efforts. What does it mean – and, how do we explain – that the Teaching-Family Model is “family-style” care?

But it’s also a question that’s highly relevant inside the Teaching-Family Association. How does being “family-style” relate to youth perceptions and outcomes? Does using shift staff necessarily preclude a Teaching-Family Model agency from providing “family-style” care?

Back in July of 2015, Virginia Home for Boys and Girls shared a panorama on Facebook of one of their homes, captioned: “What do you think of when you hear the words ‘group home’? Our homes are built exactly like your home! Our youth have dinner with their teaching parents around the kitchen table, they watch TV in the living room, and they even (reluctantly) do chores to help keep the house clean!“

 
Virginia Home for Boys and Girls Home
 

I loved this post when I saw it, because as much as I love words – and as much as you Teaching-Family Model practitioners are experienced in giving detailed, specific descriptions – a picture really does say a thousand words. And for youth, a home-like environment like this one really does make a difference.

Across the pond, a professor of residential child care at the University of Strathclyde, Glasgow School of Social Work, Andrew Kendrick, gave a presentation in 2009 examining “the family metaphor” as it relates to perceptions of residential care as well as children’s perceptions of relationships and relatedness.

His presentation – which you can listen to and follow along with, below – addresses from several angles how children in care often describe residential staff members “like family” in a positive way, and how and why these positive relationships, and a family-like environment, contribute to quality care.

Relationships are a key standard of Teaching-Family Model care for a reason – strengths-based, positive relationships are vital to the provision of quality care, and so argues Kendrick. Citing Berridge (2002), Kendrick quotes, “Several of the studies of residential homes explained successful residential care according to the quality of the interaction between young people and adults. Terms used include: empathy; approachability; persistence; willingness to listen and reliability.”

Over time, a deeper understanding of attachment theory and resilience theory have simply highlighted the centrality of these relationships in quality care, Kendrick argues. But you know that – it’s a huge part of what Teaching-Family Model agencies do everyday.

But what, exactly, characterizes these positive relationships in care? Citing “Working in Children’s Homes: Challenges and Complexities” by Whittaker, Archer and Hicks (1998), Kendrick lists:

  • Being ready to listen, both to the evidently momentous and to the apparently mundane

  • Being sensitive to a young person’s readiness, or not, to talk and to share feelings and experiences

  • Combining non-verbal or symbolic forms of caring with verbal, explicit ones

  • Noticing good or admirable behaviour and crediting a young person for it

  • Marking special occasions in a young person’s life with a celebration.

These elements of relationships create the perception of “relatedness” for children and youth, Kendrick argues, and this perception is a large part of what Jim Anglin described as a “sense of normality,” vital to the youth’s sense of well-being:

I’m not saying that the relationships with care staff take the place of relationships with family members… but what I’m arguing is we need to be looking at how children and young people see these relationships with staff in the context of the complexity of relationships that they have within families. Jim Anglin talks about a sense of normality – “It would appear that creating a ‘sense of normality’ for the residents without attempting to pretend that a group home setting is either ‘normal’ or ‘normative’ is vital for their sense of well-being.” In a sense, that sense of normality is about relatedness and relationships and how children and young people conceptualize those.


Central to Kendrick’s argument, as it relates to the dualism in popular perceptions of residential and foster care, is that residential care – even assuming shift staff – and positive, “family-like” relationships are not mutually exclusive.

Beyond relationships, he lists environmental factors creating the same sense of relatedness and normality:

  • Routines, rhythms and rituals of daily living

  • Sharing of food

  • [Staff] involvement in cultural and leisure activities

  • The living space and the environment

These are essential elements of what it means for the Teaching-Family Model to be “family-style,” and all of these elements can be achieved by the Model – regardless of setting or staffing particulars.

In fact, data from Betsy Farmer’s study of Teaching-Family Model group homes found a negligible difference in youth outcomes between shift staff and Teaching Parent couples. Why? I’ll speculate – because the Model’s systems foster accountability and facilitate smooth transitions in care between shifts, and perhaps because the Teaching-Family Model provides family-style care, no matter how you slice it.

Kendrick’s presentation was particularly interesting to me for two reasons:

  1. It reminds us that “family-style” care is related to positive outcomes and client perceptions, and it gives us specifics to observe and measure what it means to provide “family-style” care.

  2. It gives us a new paradigm to explain how the Teaching-Family Model provides “family-style” care.

Maybe Kendrick’s work here could help TFA and TFA agencies in future advocacy or marketing efforts – and though a picture might say a thousand words, it still could use some evidence behind it.

What do you think? Leave a comment below!

ADDITIONAL RESOURCES

Kendrick also quotes several studies supporting residential care, generally, in his presentation:

  • A recent review and meta-analysis of research on residential child care concludes that children and young people, on average, improve in their psychosocial functioning (Knorth et al, 2008).

  • The limited research on residential child care also found that generally children did better following time in residential care than they were doing beforehand (Forrester, 2008).

  • When the nature of the aims of placements is taken into account, foster placements and residential placements were equally successful in achieving their specific aims (Kendrick, 1995).

  • If one takes account of behaviour, age and age at entry, children’s homes are not significantly ‘less successful’ than other placements (Sinclair et al., 2007).

Chimera Collective
New Policy Brief: “Safe and Effective Reduction of Congregate Care”

In January, the Chadwick Center for Children at Rady’s Children Hospital and Chapin Hall at the University of Chicago released a collaborative policy brief entitled “Using evidence to accelerate the safe and effective reduction of congregate care for youth involved with child welfare.”

Drawing on data from the Multistate Foster Care Data Archive, the National Survey of Child & Adolescent Well-Being, and the California Evidence-Based Clearinghouse for Child Welfare, the brief presented key findings on the variation in use of congregate care between states and outlined recommendations for customizing safe and effective strategies to decrease reliance on congregate care at the state level in response to legislative and administrative pressure to do so, such as the proposed Family First Act.

Notably, the brief cites the Ainsworth & Hansen (2005) cautionary report of results from Australia’s elimination of congregate care in its summary, arguing for capacity to be built rapidly and effectively in various areas to account for a planned reduction in congregate care:

In principle, any effort to reduce the use of and support for congregate care must be paired with steps to establish the infrastructure to meet the needs of children now in group placements who will be served in more home-like settings. Failure to do so may result in a host of unintended consequences including the increased disruption of foster and kin placements, higher demands on hospital emergency rooms and psychiatric hospitals, and increased use of far more restrictive juvenile justice settings.

ALTERNATIVES TO CONGREGATE CARE

According to the brief’s findings on populations in congregate care, the necessary capacity to be built includes (1) less restrictive, home-like, or home-based disruptive behavior treatments to reduce long-term use of congregate care and  (2) placement stabilization programs to reduce short-term reliance on congregate care as emergency shelters.

The brief cites evidence-based programs rated “well supported” in these two areas by the California Evidence-Based Clearinghouse (CEBC). Treatment Foster Care Oregon – Adolescents appears in both lists. Though not mentioned by the brief, Utah Youth Village’s adaptation of the Teaching-Family Model in an in-home context, Families First, is rated a “promising” Disruptive Behavior Treatment by the CEBC.

The brief’s first recommended action is for state policy makers and agencies to work collaboratively with treatment providers to create customized strategies for reducing congregate care. As we have previously discussed in advocacy updates, this kind of collaborative planning could facilitate conversations surrounding the redefinition of Teaching-Family Model group care with live-in teaching parents as treatment foster care, as it would likely become expedient for states to revisit definitions when looking to quickly build capacity in alternatives.

FOR TEACHING-FAMILY MODEL AGENCIES

Teaching-Family Model agencies could/should become influential voices at the state level, representing a deep knowledge base of Teaching-Family Model systems that can (1) build capacity with proven implementation science and (2) offer evidence-based services across the continuum.

In terms of the brief’s language and argument, there are a number of things to respond to in further depth. We will provide evidence-supported responses and other updates on the latest research and advocacy developments here, in our members-only blogs section of the website.

KEY FINDINGS

  • The overall use of congregate care has decreased by 20% since 2009, but there is substantial variation among states even in this trend (suggesting detailed analysis is needed to understand local trends).

  • Some states rely heavily on congregate care as a first placement (suggesting capacity building for foster homes is needed).

  • Youth placed in congregate care and therapeutic foster homes have significantly higher levels of internalizing and externalizing behaviors than those placed in traditional foster care (suggesting that increased access to services that effectively address internalizing and externalizing behaviors are essential to safely reducing the use of congregate care).

  • Compared to youth whose clinical needs are met through therapeutic foster care, youth placed in congregate care are more likely have externalizing problems (suggesting that strategies for serving these youth in home-based setting should focus on preparing those homes to respond by de-escalating difficult behaviors).

  • The California Evidence Based Clearinghouse for Child Welfare (CEBC) contains tested strategies for disruptive behavior problems, however, many of them have not been tested for use with the child welfare population (suggesting that support is needed for implementation and evaluation of interventions that may stabilize foster care placements).

Chimera Collective
Doesn’t group care result in negative outcomes?

40 years of research on the Teaching-Family Model suggest that high-quality residential programs have high levels of youth and family engagement and consistently demonstrate positive outcomes.

Most arguments against residential care do not differentiate between poor-quality and high-quality residential care, or even recognize the possibility of quality residential care.

One oft-cited consensus statement argues, “In addition to compromises in virtually every domain of development, including structural and functional brain abnormalities (Nelson, Bos, Funnar & Sonuga-Barke, 2011), young children raised in group settings are especially vulnerable to disturbances of attachment (Nelson, Fox, Zeanah, 2014; Zeanah, 2000).” It should be noted that all three citations studied Romanian orphanages where the “group setting” was characterized by “profound sensory, cognitive, linguistic, and psychosocial deprivation” (Nelson, Bos, Funnar, & Sonuga-Barke, 2011), which obviously does not reflect high-quality residential care like that offered by Teaching-Family Model agencies.

Isn’t group care a waste of resources?

Failing just one high-risk youth can cost society $3.75 million dollars (Cohen, Piquero, 2009).

Boys Town’s analysis suggests that every $1 dollar spent on residential services has the potential to save $198 – $340 dollars in long-term societal costs.

In addition, Teaching-Family Model agencies are often community-based and take advantage of services already offered in the community in order to use resources as efficiently as possible.

Critics argue that “In a majority of cases, these problems can be safely and effectively treated in the community” (Dozier, et al. 2014), through prevention programs.

This is likely true, and many Teaching-Family Model agencies offer in-home services and parent training, adapted from Model systems and proven effective, to avoid the removal of children from the home.

But we also believe it is naïve to expect that these prevention programs will completely eliminate the need for the foster care system, or that those who do enter the system will have their needs met in foster care.

Residential providers offer children 77 hours per week of care at a rate of $28 dollars per hour, which is difficult to provide in the community alone. It is our view that quality residential care will continue to be a necessary part of the foster care system to ensure that children’s needs are met and costs to society are minimized.

Doesn’t group care traumatize kids? Isn’t it a last resort?

Trauma-informed care and group care are not mutually exclusive.

In fact, the original standards of the Teaching-Family Model align closely with the principles of trauma-informed care.

The Teaching-Family Association has also added a trauma-informed standard that overlaps with many other standards to emphasize its importance in agency reviews.

Often, children who are on a trajectory towards residential care can be identified early based on average daily incidents with foster parents. These incidents lead to repeated removal from care in the foster care system, which increases the traumatic damage of the system.

The belief that residential care should be a last resort means many of these children are continually placed in and removed from settings where they are likely to be removed and traumatized again by that removal. In quality residential care like Teaching-Family Model agencies, these incidents do not result in removal.

We also know that trauma damages the hippocampus, and that caring relationships can reverse this process of damage, but the reconstruction and healing process can take 90 days to even begin, and these connections need to continue to be strengthened past 90 days. The value of residential care is the sustained, durable relationships kids can receive in a stable setting.

American Psychological Association Recognizes the Teaching-Family Model as evidence-based

The American Psychological Association, the leading organization representing psychology professionals, recently identified the Teaching-Family Model as an evidenced-based practice.  On the APA “Psychology Matters” website, the APA noted the Teaching-Family Model “is on e of the few evidence-based residential treatment programs for troubled children”.

It was noted that the Model’s success is based on the view that children’s behavior problems stem from their lack of interpersonal relationships and skills.  It is through using empirically validated methods that the Model is able to teach clients how to build these relationships and gain important skills for social success.

The APA determination is not the first national recognition accorded to the Teaching-Family Model.  With over 30 years of studies and results, the Teaching-Family Model is one of the strongest and most studied evidence-based programs available for treatment.  The Office of Juvenile Justice Delinquency Prevention and the Surgeon General’s Office have both recognized the Model as a strong, evidenced-based solution for treatment programming, as well.

The Teaching-Family Model is available in not only residential treatment programs but has also been used successfully in treatment foster care, home-based treatment, psychiatric institutions and schools.  The Teaching-Family Association offers accreditation to agencies in using the Teaching-Family Model.  This accreditation validates quality of the program in its use of the Model and integrity of the Model, its delivery systems and elements.  Accreditation also ensures quality replication enabling the Model to be implemented on a large scale across many different treatment environments with many different client populations.

The Teaching-Family Association is the only entity in North America that defines and implements standards and review procedures related to the actual performance an quality of treatment and service delivery systems at all organizational levels.  Accredited Sponsor Agency is the highest recognition through accreditation and entitles agencies carrying this designation to support other agencies interested in developing using the Teaching-Family Model.  Accredited Agency designation, as with the Accredited Sponsor recognition, indicates all delivery systems and elements are being met effectively. Accredited Agencies cannot sponsor other agencies, however.

The Teaching-Family Model standards and development information is available through the Teaching-Family Association.  Agencies interested in pursuing the Teaching-Family Model can also contact an Accredited Sponsor Agency for assistance and information.  The Teaching-Family Model is implemented through a mentoring process and any agency interested in using this valuable treatment modality must affiliate with an Accredited Sponsor Agency for support and guidance.


Michele BoguslofskiAPA, Reserach