Fostering Healthy Futures

We recently published a paper replicating findings from previous research on the mental health impacts of the Fostering Healthy Futures (FHF) program (Taussig, Weiler, Garrido, Rhodes, Boat & Fadell, 2019). The study was a randomized controlled trial with 426 children who were randomly assigned to either FHF or the control condition. Below are a few important takeaways from this research.

Briefly, FHF is a mentoring and skills group program for preadolescent youth (ages 9-11) who have experienced maltreatment and been placed in foster care. The mentors are graduate students in social work and psychology who receive course credit for their mentoring. Each graduate student mentors two children in one-to-one matches over the course of 30 weeks (across the academic year). They also provide transportation for their mentees to and from a weekly skills group.

Important takeaways:

Mentoring can be a highly acceptable and engaging intervention for young people who have experienced substantial adversity and living instability.

• Although children in foster care are a highly mobile group and although there can be tension between child welfare services and families (both biological and substitute), we observed high rates of recruitment and retention – 95% of the children/families who were offered the program began it, 92% of the children completed it, and there was over 85% attendance at both skills groups and mentoring visits (including those who dropped out of the program).
• We designed FHF after conducting numerous focus groups with all stakeholders. Our design reflects their insights regarding what would meet their needs and reduce barriers to participation. We hypothesize (but don’t have data to demonstrate this definitively) that these design elements contribute to high engagement and retention rates:
  1. When children enter foster care they often receive a number of diagnoses and the system focus is on ameliorating problems. In FHF, instead of pathologizing, we focus on building strengths and supporting children in gaining skills that will help them engage successfully in prosocial activities. We think this reduces stigma.
  2. Children are in their skills group with others who have experienced something similar (i.e., foster care), which may also reduce stigma; we are now piloting an expanded version of FHF with children who have experienced ACEs (i.e., adverse childhood experiences) but who are not in foster care.
  3. FHF provides all transportation for skills group and mentoring as well as meals during group; children remain in the program and paired with their mentor even when they change placements or return home.

A mentoring and skills training program can reduce mental health problems and mental health treatment for diverse children.

• The FHF program demonstrated a reduction in internalizing (e.g., depression, anxiety) and trauma symptoms 6-10 months post-intervention. Children, their caregivers and teachers reported on the children’s symptoms, which strengthens the findings.
• Children were less likely to be receiving mental health treatment at follow-up, which might suggest a cost savings of the program.
• There were no systematic differences in FHF program outcomes as a function of race, ethnicity, IQ, placement type, or baseline mental health problems, suggesting the FHF program can benefit diverse children.

Time-limited mentoring can be effective for children who have experienced trauma.

• When we started the FHF program, we were constantly asked this question: How can you ethically end a mentoring relationship for children who have experienced significant trauma? In the same vein, people thought the 9-month program was too short to yield any benefits.
• The focus groups we conducted with young people as we were designing the program suggested a few key things in regards to time-limited mentoring:
  1. Children in foster care often had been paired with intended long-term mentors who stopped showing up when they had significant mental health or behavioral problems or when they changed placements.
  2. Children reporting having positive relationships with teachers who they did not see after the school year ended and reported having enduring effects from these relationships.
  3. Children reported having many unplanned and negative endings with adults in their lives.
• For these reasons, as well as pragmatic concerns (described next), we decided to run the FHF program for the duration of the school year and work very hard to ensure that children could stay in the program if they changed placements or reunified.
• Importantly, we wanted all children to have a healthy and planful goodbye. To normalize saying goodbye, we celebrate the end of FHF through a program graduation and both group and mentoring visits end at the same time. Qualitative interviews conducted post-program with children and their caregivers suggested that the program length worked well and that while the mentoring endings were sad, they were expected and not traumatic.
• Pragmatic considerations including funding, the mentors’ (graduate students’) schedules and risk management issues also drove our decision to make FHF a 30-week program.

The use of students as mentors may be an effective strategy to recruit, train, and retain mentors.

• In developing FHF, we spoke with numerous executive directors of major mentoring programs and consistently heard the challenges of recruiting, training and retaining mentors. Because we were working with such a vulnerable population who had often experienced traumatic endings, we felt it necessary to ensure that mentors would receive significant training and supervision and that the likelihood of them leaving during the program year was highly unlikely.
• FHF provides 24 hours of training to mentors pre-match and then throughout the 9-month program each mentor receives (weekly) 1.5 hours of didactic training, 1 hour of individual supervision and 1 hour of group supervision. Our mentor retention rate is close to 100%.
• In addition, training graduate students in methods for working with children and families who have experienced great adversity turns out to be a great thing for both the mentors and our field!
• We recently completed a population review entitled, Mentoring for Youth in Foster Care and found that most of the formal mentoring programs for this population which have been evaluated have used students or agency staff mentors as mentors, perhaps because of the need for more expertise and/or ongoing training.

Despite the fact that we had many naysayers when we started our program, our replication study gives us greater confidence that FHF is having a positive impact on diverse children. Knowing the population with which you want to work and gaining their input on program design can help you develop a contextually-sensitive and engaging program which can yield important benefits. We are continuing to conduct research examining other program outcomes as well as testing an adaptation of the FHF program for teens. Stay tuned as we learn more about what works and for whom!