Programs that keep Indian Families together
When looking for programs that keep families together, the two best resources to help identify evidence based programs, are below, Blueprints for Healthy Youth Development and the California Evidence-Based Clearinghouse for Child Welfare. To date, there are no evidence based programs shown to work especially well or specifically for Native Americans families, so further research is necessary. Different programs address different behaviors that may contribute to the breakup of Indian families (e.g., abuse and neglect, drug abuse, domestic violence, sexual abuse, etc.) so they should be selected according to the specific needs of the family.
Blueprints for Healthy Youth Development
“Blueprints for Healthy Youth Development provides a registry of evidence-based positive youth development programs designed to promote the health and well-being of children and teens. Blueprints programs are family, school, and community-based and target all levels of need — from broad prevention programs that promote positive behaviors while decreasing negative behaviors, to highly-targeted programs for children at-risk of placement and troubled teens that get them back on track.
Demand for effective programs to prevent violence, placement and foster healthy youth development continues to grow. Across the country, organizations sponsor a raft of well-intentioned programs. Yet, very few of them have evidence demonstrating their effectiveness, and many are implemented with little consistency or quality control. Unproven programs not only waste scarce resources but also can do harm. Blueprints promotes only those programs with strong scientific evidence of effectiveness.”
“Program providers often ask which programs work best for specific populations of children and youth. Blueprints has identified several surveys that make it easy to match children’s strengths and needs to specific programs”
- Functional Family Therapy (FFT) is a short-term (approximately 30 hours), family-based therapeutic intervention for delinquent youth at risk for institutionalization and their families. FFT is designed to improve family communication and supportiveness while decreasing intense negativity and dysfunctional patterns of behavior. Parenting skills, youth compliance, and the complete range of behaviors (cognitive, emotional, and behavioral) domains are targeted for change based on the specific risk and protective factor profile of each family.
Functional Family Therapy (FFT) is a prevention/intervention program for youth who have demonstrated a range of maladaptive, acting out behaviors and related syndromes. Intervention services consist primarily of direct contact with family members, in person and telephone; however, services may be coupled with supportive system services such as remedial education, job training and placement and school placement. Some youth are also assigned trackers who advocate for these youth for a period of at least three months after release.
- Nurse-Family Partnership begins during pregnancy as early as is possible and continues through the child’s second birthday. Nurses work with low-income pregnant mothers bearing their first child to improve the outcomes of pregnancy, improve infant health and development, and improve the mother’s own personal life-course development through instruction and observation during home visits. These visits generally occur every other week and last 60-90 minutes.
Specific objectives include improving women’s diets; helping women monitor their weight gain and eliminate the use of cigarettes, alcohol, and drugs; teaching parents to identify the signs of pregnancy complication; encouraging regular rest, appropriate exercise, and good personal hygiene related to obstetrical health; and preparing parents for labor, delivery, and early care of the newborn.
Nurse-Family Partnership sends nurses to the homes of pregnant women who are predisposed to infant health and developmental problems (i.e., at risk of preterm delivery and low-birth weight children). The goal is to improve parent and child outcomes. Treatment begins during pregnancy, with 60-90 minute visits about once every other week, and continues to 24 months postpartum. Program content covered in the home visits includes (a) parent education about influences on fetal and infant development; (b) the involvement of family members and friends in the pregnancy, birth, early care of the child, and support of the mother; and (c) the linkage of family members with other formal health and human services. In addition to working with the mothers directly, the nurses promote the goals of the program by engaging other family members and close friends in the program and by assisting families to use other formal health and social services.
- Parent Management Training – Oregon Model (PMTO™) is a group of theory-based parent training interventions that can be implemented in many family contexts including two-parent, single-parent, re-partnered, grandparent, and foster families. It aims to teach effective family management skills in order to reduce antisocial and problematic behavior in children. Populations of focal youngsters have ranged in age from 3 through 16 years with specific clinical problems or at risk for problems, such as antisocial behavior, conduct problems, theft, delinquency, substance abuse, and child neglect and abuse. PMTO is delivered in group and individual formats, in diverse settings (e.g., clinics, homes, schools, community centers, homeless shelters), and over varied lengths of time depending on families’ needs. Typically sessions are one week apart to optimize the opportunity for learning and rehearsing new practices. The number of sessions provided in parent groups ranges from 6 to 14. In clinical samples, the mean number of individual treatment sessions is about 25.
The central role of the PMTO therapist is to teach and coach parents in the use of effective parenting strategies, namely skill encouragement, setting limits or effective discipline, monitoring, problem solving, and positive involvement. Skill encouragement incorporates ways in which caregivers promote competencies using scaffolding and contingent positive reinforcement (e.g., establishing reasonable goals, breaking goals into achievable steps, use of praise, tokens, and incentive charts). Setting limits or effective discipline involves the establishment of appropriate rules with the application of mild contingent sanctions for rule violations. Monitoring (supervision) involves keeping track of the youngsters’ activities, associates, and whereabouts, as well as arranging for appropriate childcare, transportation, and supervision of youngsters when away from home. Problem solving involves skills that help family members communicate well and negotiate disagreements, establish rules, and specify consequences for following or violating rules. Positive involvement reflects the many ways parents invest time and plan activities with their youngsters. Promoting school success is a factor that is woven into the program through all the components.
- The Treatment Foster Care Oregon (TFCO) Program, formerly Multidimensional Treatment Foster Care, was developed as an alternative to institutional, residential, and group care placement for teenagers with histories of chronic and severe criminal behavior. In most communities, such juveniles are placed in out-of-home care settings prior to being sent to closed custody incarceration. Typically, these settings include some type of group home or cottage on a larger institutional campus where youngsters reside with others who have similar problems and histories of offending. On a continuum of care, TFCO is a relatively non-restrictive community-based placement that can be used in lieu of residential or group care or that can be used for youth transitioning back to the community from such settings. TFCO is less expensive than placement in group, residential care, or institutional settings.
The fundamental philosophy behind the program is reinforcement and encouragement of youth. Prior to placement, the case manager meets with an adolescent in detention to review the program model and program components. TFCO adolescents go through a behavior modification program which is based on a three-level point system by which the youth are provided with structured daily feedback. The youth have the opportunity to earn points throughout the day for expected activities outlined in the treatment, including going to class on school days. They lose points for any type of rule infraction, including attitude. The system emphasizes positive achievements, and point loss is handled matter-of-factly. Once the youth earn a total of 2100 points (this usually takes three weeks), they are able to ascend to a higher level. At each level, the youth are able to benefit from a more extended list of privileges, including home visits. At level three, the youth are even able to be involved in community activities without direct adult supervision. There is a learning emphasis on teaching interpersonal skills and on participation in positive social activities including sports, hobbies, and other forms of recreation.
Once the program begins and an adolescent has been placed with a TFCO family, daily telephone contact is made and behaviors are assessed through the Parent Daily Report (PDR). These calls are brief and are designed to monitor the occurrence of problems during the past 24 hours. Points earned and lost are also tracked along with any incidents that may be affecting treatment. The youth is also assigned to an individual therapist who provides support and assists in teaching skills needed to relate successfully to adults and peers. Meetings with the individual therapist occur on a weekly basis. Family therapy sessions help parents prepare for the youth’s return home and help them become more effective at supervising, encouraging, supporting, and following through with consequences. Parents are then able to practice these skills during home visits once the child has reached level two of the program. They work through a modification of the point level system being used in the TFCO home, which more closely aligns with the TFCO system as time goes on and home visits become longer and more frequent.
Another component of the program is school monitoring. Youth have a school card, which they carry to class, and have teachers sign off on attendance, behavior, and homework completion. The cards are collected daily by the TFCO parents, and the teacher ratings transfer into points on the daily program. Once the program has been completed (typically 6 – 9 months) and the youth have returned home, families continue to receive aftercare support. Case managers remain on-call to families, and the point level system remains in place. Parents can participate in group sessions with other families, where they can continue to learn specific parenting skills, as well as receive feedback and support from other parents. Aftercare services remain in place for as long as the parents want, but typically last about one year.
California Evidence-Based Clearinghouse for Child Welfare (CEBC)
“The mission of the California Evidence-Based Clearinghouse for Child Welfare (CEBC) is to advance the effective implementation of evidence-based practices for children and families involved with the child welfare system.”
“The primary goal of the CEBC Program Registry is to provide a searchable database of programs that can be utilized by professionals that serve children and families involved with the child welfare system. The programs are arranged by topic area. Within each topic area is a definition and clear information on the requirements (e.g., target population and goals) that must be met by each program in order to be included in the specific topic area. The requirements for which outcomes the research evidence on a program must demonstrate in order to be rated within each topic area are also listed. Each individual program description contains easily accessible and vital information, including, at a minimum, a CEBC Scientific Rating, citations and summaries of relevant published peer-reviewed research studies conducted on the program, a brief description of the program, and training and contact information.”
Programs shown to reduce Higher Levels of Placement
Child Welfare uses foster placement as a service to ensure the protection of children and youth who must be removed from the home of their parents or guardians because of the occurrence of abuse and neglect. Law and practice dictate that children be placed in the “least restrictive setting.” The least restrictive placement for a child is in the home of their parent or guardian. The range of foster placements outside of the parents’ or guardians’ homes, from least to most, are the following: relative or non-related extended family member, foster family home, foster family agency home, group home, residential treatment center, and community treatment facility.
For over twenty years, child welfare has been concerned about the effects of higher level placements. It has been observed and documented that children and youth who are placed in higher levels of care can become “institutionalized” and therefore unable to return to normal family home environments. While therapeutic treatment is provided in higher levels of care, it does not always prepare children and youth to become accustomed to the intimacy of family life. Therefore, it is often a self-perpetuating intervention that results in children and youth become habituated to living in institutional environments and unable to return to either their own families or to be placed successfully in other family environments. Child welfare invests tremendous financial resources in these placements and then cannot find alternative placements once the mental health treatment has been successfully completed-children and youth become unable to leave the institutional environment despite having addressed the mental health issues that brought them there. Children and youth who have become institutionalized by this intervention often then move from one institutional placement to another until they leave the foster care system, thereby resulting in the child welfare agency’s performing very poorly in the measure of placement stability. It is believed that alternative placement milieus such as Therapeutic Foster Care, which bring therapeutic interventions to a family environment, can be as successful as higher level placements in addressing the mental health needs of children and youth while avoiding the problem of institutionalization and the concomitant placement instability.
The programs listed below have been reviewed by the CEBC and, if appropriate, been rated using the Scientific Rating Scale. In order to be rated: There must be research evidence (as specified by Scientific Rating Scale) that examines 1) child welfare outcomes such as reductions in the use of higher levels of placement or placement disruptions, 2) changes in placement staff attitudes and behavior such as reduction in use of seclusion or restraint, and/or 3) behavior-related outcomes for youth/children such as changes in behavior, symptom levels, and/or functioning. The following programs are rated as Programs with a Well-Supported by Research Evidence or Programs Supported by Research Evidence:
- A) Multidimensional Treatment Foster Care – Adolescents (MTFC-A)
MTFC-A is a model of foster care treatment for children 12-18 years old with severe emotional and behavioral disorders and/or severe delinquency. These youth were in need of out-of-home placement and could not be adequately served in lower levels of care. MTFC-A aims to create opportunities for youths to successfully live in families rather than in group or institutional settings, and to simultaneously prepare their parents (or other long-term placement) to provide them with effective parenting. Four key elements of treatment are (1) providing youths with a consistent reinforcing environment where he or she is mentored and encouraged to develop academic and positive living skills, (2) providing daily structure with clear expectations and limits, with well-specified consequences delivered in a teaching-oriented manner, (3) providing close supervision of youths’ whereabouts, and (4) helping youth to avoid deviant peer associations while providing them with the support and assistance needed to establish pro-social peer relationships. MTFC-A also has versions for preschoolers and children. MTFC-P (for preschoolers) is rated separately. MTFC-C (for children) has not been tested separately, but has the same elements as MTFC-A except it includes materials more developmentally appropriate for younger children.
- B) Multidimensional Treatment Foster Care for Preschoolers (MTFC-P)
MTFC-P is a foster care treatment model specifically tailored to the needs of 3 to 6-year-old foster children who exhibit a high level of disruptive and anti-social behavior which cannot be maintained in regular foster care or who may be considered for residential treatment. MTFC-P is effective at promoting secure attachments in foster care and facilitating successful permanent placements. MTFC-P is delivered through a treatment team approach in which foster parents receive training and ongoing consultation and support. Children receive individual skills training and participate in a therapeutic playgroup, and birth parents (or other permanent placement caregivers) receive family therapy. MTFC-P emphasizes the use of concrete encouragement for pro-social behavior; consistent, non-abusive limit-setting to address disruptive behavior; and close supervision of the child. In addition, the MTFC-P intervention employs a developmental framework in which the challenges of foster preschoolers are viewed from the perspective of delayed maturation.
- C) Positive Peer Culture (PPC)
PPC is a peer-helping model designed to improve social competence and cultivate strengths in troubled and troubling youth, ages: 12 – 17. “Care and concern” for others (or “social interest”) is the defining element of PPC. Rather than demanding obedience to authority or peers, PPC demands responsibility, empowering youth to discover their greatness. Caring is made fashionable and any hurting behavior totally unacceptable. PPC assumes that as group members learn to trust, respect, and take responsibility for the actions of others, norms can be established. These norms not only extinguish antisocial conduct, but more importantly reinforce pro-social attitudes, beliefs, and behaviors. Positive values and behavioral change are achieved through the peer-helping process. Helping others increases self-worth. As one becomes more committed to caring for others, s/he abandons hurtful behaviors.
Interventions for Abusive Behavior
Interventions for Abusive Behavior are defined by the CEBC as programs that address a parent’s or caregiver’s abusive treatment of a child or adolescent. The abusive behavior may be one or more of the following types as defined by the CEBC for this topic area:
- Physical abuse: Nonaccidental physical injury (ranging from minor bruises to severe fractures or death) as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or otherwise harming a child or adolescent
- Sexual abuse: Activities perpetrated on a child or adolescent such as fondling his/her genitals, penetration, incest, rape, sodomy, indecent exposure, and exploitation through prostitution or the production of pornographic materials
- Emotional /Psychological abuse: A pattern of behavior that impairs a child’s or adolescent’s emotional development or sense of self-worth, such as constant criticism, threats, or rejection, as well as withholding love, support, or guidance
Intervening with child abuse is one of the central functions of the child welfare system. Child welfare professionals need help identifying effective interventions that stop the abusive behavior by adults and prevent re-abuse. Interventions included in this topic area aim to minimize the risk that could lead to future child abuse, equip families with the skills and resources they need to ensure that children are safe in the home, and decrease the effects of abuse on children of all ages.
This topic area is focused on interventions to stop the abusive behavior and prevent re-abuse. The following link gives more information on this topic area as it is defined by the U.S. government: http://www.childwelfare.gov/pubs/factsheets/whatiscan.cfm. In order to be included the program must specifically target stopping child or adolescent abuse and preventing recurrence as a measurable goal.
The programs listed below have been reviewed by the CEBC and, if appropriate, been rated using the Scientific Rating Scale. In order to be rated there must be research evidence (as specified by Scientific Rating Scale) that examines abuse-related outcomes such as reductions of recurrence of maltreatment or outcomes for parents or caregivers such as changes in abusive behavior and related parenting practices (e.g., harsh parenting). The following programs are rated as Programs with a Well-Supported by Research Evidence or Programs Supported by Research Evidence:
- A) Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB)
Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) has been rated by the CEBC in the areas of: Sexual Behavior Problems in Adolescents, Treatment of and Interventions for Abusive Behavior.
Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) is a clinical adaptation of Multisystemic Therapy (MST) that has been specifically designed and developed to treat youth (and their families) for problematic sexual behavior. The offending youth must be between 10 and 17.5 years of age. Many of these youth will have been seen by the courts, although this is not an inclusionary requirement. Building upon the research and dissemination foundation of standard MST, the MST-PSB model represents a practice uniquely developed to address the multiple determinants underlying problematic juvenile sexual behavior.
MST-PSB is delivered in the community, occurs with a high level of intensity and frequency, incorporates treatment interventions from MST, and places a high premium on approaching each client and family as unique entities. Treatment incorporates intensive family therapy, parent training, cognitive-behavioral therapy, skills building, school and other community system interventions, and clarification work. Ensuring client, victim, and community safety is a paramount mission of the model.
Each youth/family has uniquely and collaboratively designed individual treatment plans, and each treatment site is encouraged to conjointly develop locally defined outcomes that suit community needs.
- B) Multisystemic Therapy for Child Abuse and Neglect (MST-CAN)
MST-CAN is for families with serious clinical needs who have come to the attention of child protective services (CPS) due to physical abuse and/or neglect of a child in the family between the ages of 6 and 17; where the child is still living with them or is in foster care with the intent of reunifying with the parent(s). MST-CAN clinicians work on a team of 3 therapists, a crisis caseworker, a part-time psychiatrist who can treat children and adults, and a full-time supervisor. Each therapist carries a maximum caseload of 4 families. Treatment is provided to all adults and children in the family. Services are provided in the family’s home or other convenient places. Extensive safety protocols are geared towards preventing re-abuse and placement of children and the team works to foster a close working relationship between CPS and the family. Empirically-based treatments are used when needed and include functional analysis of the use of force, family communication and problem solving, Cognitive Behavioral Therapy for anger management and posttraumatic stress disorder (PTSD), clarification of the abuse or neglect, and Reinforcement Based Therapy for adult substance abuse.
- C) SafeCare®
SafeCare® targets parents who are at-risk for child neglect and/or abuse and parents with a history of child neglect and/or abuse with children ages 0 – 5. SafeCare® is an in-home parenting program that targets risk factors for child neglect and physical abuse in which parents are taught (1) how to interact in a positive manner with their children, to plan activities, and respond appropriately to challenging child behaviors; (2) to recognize hazards in the home in order to improve the home environment; and (3) to recognize and respond to symptoms of illness and injury, in addition to keeping good health records.