Specialized foster care: treating seriously emotionally disturbed children - "Transitions," Oregon Social Learning Center program, Eugene, Oregon

Children Today, Jan-Feb, 1990 by Patricia Chamberlain, Mark Weinrott

Specialized Foster Care:

What can be done to help a 9-year-old girl with a lifelong history of severe physical and sexual abuse? Jenna is her name, and she had been removed from and returned to her natural family on several occasions. She had developed violent tendencies toward others, would sometimes injure herself, and could explode at the drop of a hat. She had a speech articulation problem, perhaps due to brain injury, and an attention span that barely covered a T.V. commercial break. Most of the time Jenna acted anxious and withdrawn and had virtually no skills for relating to her peers. Jenna, a ward of the court, was in the state hospital where she had made some progress. Yet she still had difficulty relating to others, threw frequent and long-lasting tantrums, and was way behind in school. Thousands of dollars and hundreds of hours had been devoted to her treatment. She finally seemed to be on the right track, but what would the next chapter reveal? It was so easy to envision her slipping back. She always had.

Enter "Transitions," a Specialized Foster Care program for seriously emotionally disturbed children and youth based at the Oregon Social Learning Center in Eugene, Oregon. OSLC, a private, nonprofit organization focusing on research and treatment to strengthen families, also operates "Monitor," a Specialized Foster Care (SFC) program for chronically delinquent youths. A world apart from traditional foster care, the SFC programs capitalize on both the homelike foster family setting and proven methods of behavior change to work with children and teenagers who are headed into or out of institutions.

Transitions uses behavioral strategies based on social learning principles. These strategies are implemented by foster parents, who are the agents of change and who simultaneously expose the children to normal family life. Transitions recruits parents who engage in very specific and predetermined treatment activities. The parents--who are considered professional foster parents--are carefully screened, given intensive pre-placement training, provided with daily support and consultation, and encouraged to support one another in weekly meetings. They are also compensated at a rate above that normally allotted for foster care, and they are accountable for their performance. Only one child is placed in each

The foster parents are expected to implement a daily treatment plan analogous to a school individual educational plan. In Jenna's case, this meant following a chart that laid out her daily schedule, with specific expectations about self-care, chores, school performance, and social behaviors. The chart showed pictures of these tasks so she could easily understand them. Each time she completed a required activity, she received points that could later be traded for small prized and special privileges. Conversely, she could lose points or earn a time-out for problem behaviors, such as not following through, hitting, or for being rude or defiant.

Jenna also participated in weekly therapy sessions devoted to sexual abuse issues and social skills training. She was enrolled in a special education class in the local school, and her progress was carefully monitored by her foster parents and case manager. Jenna also attended a yoga class to help her relx and learn to sustain attention. Her foster parents took part in weekly meetings with other foster parents and project staff. As Jenna progressed, or when new treatment goals were identified, modifications in her schedule and point system were made.

The foster family's link to the program is the case manager, who is responsible for 10 youths, far fewer than the 40 to 100 families typically carried by caseworkers in public agencies in Oregon. The family receives about three to five hours of direct contact each week by project staff, and foster parents are seen individually at least once a week. Youngsters are also seen once a week individually. Their natural parents or other relatives who might be available to provide aftercare for them are also seen in weekly family therapy. Unlike conventional foster care, virtually all program services provided to the youth and his or her parents are delivered or directly monitored by the case manager, who is available 24 hours a day and who exercises a great deal more autonomy than the typical caseworker.

From the beginning of her placement in Transitions, Jenna adjusted well. She reported that she liked her foster parents, and she began to visibly relax and become comfortable at home. She was also progressing nicely at school. Her teacher organized Jenna's work and schedule to accommodate her short attention span and low level of academic fuctioning. In the individual therapy sessions, her therapist used role play to help her learn and practice new skills, such as how to start a conversation with peers, how to share and take turns while playing, and how to talk about anger rather than act it out.

Not surprisingly, Jenna continued to experience some problems. There were occasional temper tantrums, the ever-present hyperactivity, residual fears, and headaches. The foster parents were charged with observing and tracking these problems, collaborating on the design of specific intervention techniques, and implementing the interventions. Consultation and supervision from the program took place via daily telephone contact between parents and the case manager. Interventions were continuously evaluated and revised.