TOGETHER FACINGTHE CHALLENGE

A Therapeutic Foster CareResource Toolkit

2nd Edition

Train-the-Trainer Manual

DEVELOPED BY:Maureen Murray, LCSWShannon Dorsey, PhD

Elizabeth M.Z. Farmer, PhDBarbara J. Burns, PhD

Kess L. Ballentine, MAT (2nd Edition Editor)COPYRIGHT

Together Facing the Challenge 2

Services Effectiveness Research ProgramDepartment of Psychiatry and

Behavioral SciencesDuke University School of Medicine

Financial support for the development and productionof this toolkit was provided by The Duke Endowment.

2nd Edition Copyright 2015Original Copyright 2007

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INTRODUCTION

Welcome to the Therapeutic Foster Care Resource Toolkit, Together Facing the Challenge! Thistoolkit is intended for Therapeutic Foster Care (TFC) programs looking to incorporate an evidence-based model into their existing structure and to enhance and improve the quality of training, servicedelivery, and outcomes for youth in their care.

This training curriculum was developed at Duke University’s Services Effectiveness ResearchProgram and is the result of 9 years of NIMH-funded studies of TFC programs in ‘real world’practice. Together Facing the Challenge (TFTC) is one of only two Therapeutic Foster CarePrograms in the nation that has received a rating of “Supported by Research Evidence” from theCalifornia Evidence-Based Clearinghouse for Child Welfare.

Utilizing research and data from observational studies of Therapeutic Foster Care in North Carolina,toolkit developers established a series of structured didactic and interactive training sessions for fosterparents and agency staff to provide them with the tools and skills necessary to improve outcomes foryouth in care. Elements of trauma-informed care are imbedded throughout the curriculum tohighlight awareness of past trauma and its impact on current functioning. The intent is not to replacewhat an agency does but rather offer a low-cost approach to improving trauma-informed treatmentpractices and outcomes within the existing structure of the TFC agency.

Two training manuals, a train-the-trainer manual for agency staff and a therapeutic foster parenttraining manual, present core concepts relevant to building relationships, understanding andmanaging behavior, and planning for the child’s future. Additionally, a supplemental staff training isprovided to give additional guidance to the staff who support direct care providers. The TFTCcurriculum builds upon research regarding what practices are most effective in TFC as well as what isalready happening in many agencies. In addition, the goal of these materials is to provide focusedtraining on the most effective treatment elements that are often under-utilized in TFC.

Follow-up consultation with TFTC trainers is a critical component of this comprehensive model. Thestructured session format begins at the close of the initial 3-day train-the-trainer workshop andcontinues for a minimum of 12 months. The goal of this consultation component is to teach, support,and coach agency trainers as they work with their agency staff and treatment families, offering a forumfor ongoing dialogue with agency trainers to process issues around implementation of the variousskills and techniques of TFTC. These regularly-scheduled teleconferences help to prevent potentialimplementation problems from becoming insurmountable barriers. We are confident that the formaltraining based on the toolkit, combined with follow-up consultation, contributes to high qualityimplementation of TFTC. We look forward to supporting your efforts to improve the outcomes foryouth. If you have questions about the resource kit materials or trainers, please contact:

Maureen Murray, MSW, LCSWServices Effectiveness Research Program

Department of Psychiatry and Behavioral SciencesDuke University School of Medicine

Box 3454 DUMCDurham, NC 27710

murra024@mc.duke.edu

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TFTC TOOLKIT COMPONENTS

The TFTC Toolkit includes a number of components to support your implementation of thecurriculum in order to improve outcomes for youth in care. Below is a list of included resources.

Train-the-Trainer Manual

The Train-the-Trainer Manual is the primary resource for the TFTC curriculum. In the initial trainingcompleted by TFTC staff, the Train-the-Trainer Manual will be used as the reference guidethroughout the training. Agency staff will then use this document to guide their instruction when theytrain foster parents in the TFTC model. Agency staff should continue to utilize this manual as areference document throughout the implementation process to guide future in-service trainings andcontinue supporting foster parents in in-home implementation. In addition, the Train-the-TrainerManual includes a number of other resources:

■ Training Preparation Guide - This guide will support trainers in ensuring a smooth training.Using this step-by-step guide, trainers will review content and prepare materials in order to befully familiar with the curriculum prior to training foster parents. This section also includesinformation about how to work with adult learners and be a highly effective instructor.

■ Session Materials - A number of TFTC activities require question cards or vignettes. Thesematerials have been created for you and are organized by Session and Activity in the SessionMaterials appendix. Simply copy, cut, and head to your next training!

■ Training Fidelity Forms - This Appendix includes the forms that agency-level trainers can useto observe each other and ensure that TFTC is being presented with fidelity.

■ In-Home Implementation Fidelity Forms - By using the forms in this appendix, case managerscan work with foster parents in the home to work toward full TFTC implementation withfidelity in the most important setting: the home.

■ Recommended Resources - The recommended resources appendix includes recommendedresources, additional activities that can be used in the home or in future in-service trainings,and forms that many of our agencies have found useful to implement or modify for their ownuse.

■ Info-to-Go Sheets - Info-to-Go sheets single page summaries of each session. These sheetsare also included in the Foster Parent Training Manual and can be used by case managers in anumber of ways: as a guide to teach a condensed version of a session to a parent who missesa session, as a reference in the home when re-teaching a concept, or as a way to quickly reviewconcepts in preparation for meetings with parents or youth.

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“Research shows thatwhen therapeutic foster

parents have strongrelationships with youth

and with their casemanagers, youth do

better in TherapeuticFoster Care.”

The participant will:■ Understand what evidence-based practice is

■ Understand the correlation between relationships

and outcomes■ Understand how uncooperative behavior develops

■ Understand the ABC model

■ Understand the key components of tracking a

behavior to assist in development of an action planto address the behavior

MATERIALS

PowerPointTreatment ParentTraining Manuals(copies made byagency)Off-Road ParentingDVDSession 1 ActivityMaterials Pack

Chart PaperIndex CardsSign-in SheetMaterials Baskets(i.e. Post-Its, mark-ers, scrap paper,pens, etc.)DVD Player andProjector/ TVTimerTable tents/nametags

SESSION 1 LEARNING OBJECTIVES

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ACTIVITY 1.C: THE INVISIBLE SUITCASE

■ Provide each participant with 3 index cards and a clear plasticbaggie

■ Instruct participants to record their responses to the followingwith one response on each index card:▪ Write down a statement that a child or youth in care may

hold about themselves.▪ Write down a statement that a child or youth in care may

hold about their caregivers.▪ Write down a statement that a child or youth in care may

hold about the world in general.■ Have participants place their statements into their plastic baggie■ Explain the following in your own words:

▪ Youth in foster care often arrive to our homes with visiblebags of clothes and prized possessions. However, each timethey experience a placement they also bring with them aninvisible suitcase filled with thoughts and beliefs informed bytheir lives in their family of origin and in their time in fostercare. The contents of this invisible suitcase is often notshared in words, but expressed in the actions and attitudes ofyouth in our home. It is important to create a relationshipthat is emotionally and psychologically safe so that we cancreate an environment that is sensitive to the contents of ouryouth’s invisible suitcase.

Source: National Child Traumatic Stress Network

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HOW DOES TRAUMA AFFECT YOUTH INTHERAPEUTIC FOSTER CARE?

Say to participants:

Understanding the contents of our youth’s “invisible suitcase” is criticalto understanding children in care and helping them to overcome theeffects of trauma. Remember that what you wrote on your index cardmay be the kinds of thinking that is in their minds and drives theirfeelings and behaviors.

Generate a discussion regarding how we can help kids in re-packing theirsuitcase. Use the following bullet points.

■ When we protect them from harm, children learn that the world isa safe place.

■ When we nurture children’s strengths and respond to their needschildren and youth feel capable.

■ When we provide affection and love, children develop self-esteemand learn they are loveable and worth loving.

■ When we ask what happened to you versus what’s wrong with you?

■ When we understand what some of our child’s triggers are andrespond accordingly.

Explain the following in your own words:

Children and youth in care frequently re-enact patterns or relationshipsfrom their past in their present interactions with their caregivers. Theyget your attention while keeping you at a safe (physical and emotional)distance to prove that the negative beliefs they hold in their “invisiblesuitcase” are accurate. It is often used as a vehicle to vent their frustra-tion, anger and anxiety and as a means of protecting themselves. Theseare survival skills that have often worked for them in other settings.

■ It is very important for our foster parents not to buy-in to theirchild’s negative beliefs and expectations.

■ It is very important for our foster parents not to react in anger orin the heat of the moment.

■ It is very important for our foster parents not to take the child’sbehavior at face value. What is underlying the behavior?

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