An exploration of the relationship between children in treatment foster care and their foster caregivers

University of Minnesota Ph.D. dissertation. October 2013. Major: Social Work. Advisor: Elizabeth B. Lightfoot. 1 computer file (PDF); ix, 227 pages, appendices A-J.Purpose: This study explored through the perception of foster children and caregivers, the importance, quality, and content of their shared relationship in Treatment Foster Care (TFC). Children at TFC level of care due to emotional/behavioral disturbance (EBD) evidence a persistent and severe degree of EBD and are at risk of placement in a more restrictive setting, i.e. psychiatric hospitalization or residential treatment. TFC seeks to improve child safety, permanency, and well-being outcomes through therapeutic care within the context of normalized family life (Dore & Mullin, 2006). The body of knowledge of the condition of children served within TFC level of care outpaces the body of knowledge of how these children can and need to be effectively cared for. Much is known about the antecedents, their behavioral and emotional presentation, and relationship difficulties, however only a few interventions or outcomes specific to these foster children or foster families have been rigorously studied (Craven & Lee, 2006). No standard of care exists for foster care of EBD children, and theoretical models and treatment methods of TFC vary widely (Farmer, et al, 2002). Although therapeutic relationship has been demonstrated as an instrument of adaptive change for children in other contexts, it is yet to be thoroughly explored within TFC. Methods: This study utilized qualitative research methods in an interpretive description study design. Through purposeful sampling subjects were identified within a statewide TFC program. Data collection included semi-structured interviews with foster parents and children in their care, and agency child case-file document review. Data analysis, informed by attachment theory, resilience, and clinical knowledge, occurred concurrently with data collection. Through the analysis process, themes and patterns were identified among subjective perspectives, while also accounting for variations between individuals, and to led to clinical application implications Results: Analysis yielded descriptive information about the quality, process, and importance of TFC child-caregiver relationships. Relationship process and importance for children centered on being helped, being known, being comfortable, choosing to connect. For TFC parents this centered on providing consistent care, valuing and respecting kids, figuring kids out, modeling parenting/lifestyle. Connectedness to foster family as a whole and connectedness long term (formally and informally) was prevalent. Description of TFC relationship: therapeutic relationship utilizing reflective and responsive parenting as the technique of change. Conclusions/Implications: This research contributes knowledge for direct application to social work practice within TFC and to guide further inquiry regarding this vulnerable, high-risk population. It offers detailed description of adaptive relationship processes and perception through the insight of foster youth and their caregivers