Good Practice: Kent’s intensive fostering of troubled children

The use of a points system, based on a US model, has improved behaviour and placement stability, finds Camilla Pemberton

“If all carers and children received the support we do, placements wouldn’t break down,” claims Tessa Caruana, a foster carer from Kent. A bold claim, but Caruana is convinced that an innovative fostering programme, devised in the United States, is the key to cutting placement breakdowns among emotionally disturbed adolescents.

In 2004, Kent Council – along with 16 other authorities funded by the Department for Children, Schools and Families – began piloting the multi-dimensional treatment foster care (MTFC) programme.

The worldwide model, based on behavioural principles, is now fully integrated into Kent’s fostering services. It aims to transform challenging behaviour by offering a points-based system of incentives and intensive support. “Our aim is to sustain placements so we target behaviours that cause distress to carers and threaten placement stability,” says Debbie Simmons, programme manager at MTFC Kent.

By accumulating points for good behaviour children move through three “levels”. At level one, independence is restricted and children rarely go out without their foster carers – to allow carers to “really get to know and understand them”, says Simmons. At level three they are ready to leave care, or move on to a mainstream placement.

Children must earn 2,000 points – attending school earns 100 points, for example – to move from level one to level two. Poor behaviour is punished by taking points away, “but children know how to earn them back so it shouldn’t feel too negative,” says Simmons.

Good behaviour is rewarded, with sporting trips, computer games or magazines. “Carers learn what motivates the child. These young people do not always respond to praise alone,” she says.

During each level carers and teachers complete a daily report on the child and difficult behaviour is plotted on to a graph. “There is usually a direct correlation between bad behaviour and times of stress or anxiety. It allows us to pinpoint them and minimise stressful situations,” says Simmons.

Although there are no rigid time limits, children take, on average, between 12 and 18 months to earn enough points to complete the programme. “The measure of success is whether we can move a child to a normal fostering placement, or to a less resource-intensive setting than the one they came from, if they were referred from a secure unit for example,” Simmons says.

Successful young people are called “graduates”. To be accredited by the programme’s US developers, authorities must demonstrate a 66% graduate rate. In March 2010, Kent became the first UK authority to be accredited.

Kent MTFC is still working with small numbers of young people (25 to date) because foster carers are only advised to take on one child at a time and must not have young children of their own still living at home. “We are recruiting from a small pool,” Simmons admits. However, Kent plans to expand its services and the early signs are certainly positive. Only three of the 15 placements completed over the past three years have broken down.

Expert guidance on children in care

Case study: Tessa Caruana, Approved MTFC carer: ‘After a couple of months they respond’

After 12 years of working in mainstream fostering, Tessa Caruana, now an approved MTFC carer, says she feels “more supported and happier than ever”. She notices real changes in the young people she fosters through MTFC.

“When they arrive they are anxious and irritable and usually find it impossible to concentrate or stay calm,” she says. “Most have complex histories, of running away, or of needing to be restrained. But within a couple of months they start to respond to the structure of the programme and are calmer, more respectful and visibly more secure.”

Caruana says the training has helped her to remain calm too. “I’ve learned to ignore certain behaviour, so that young people realise they can’t get a reaction or test me to see if I’ll walk away. That helps them feel safer.

“But I couldn’t have done that without the support. There’s a real partnership between the young person, the carer and everyone involved in the programme.”

Cost benefits

Loughborough University conducted a cost-benefits analysis of MTFC. It found the scheme was cheaper than funding a residential resource – where many of the children are referred from, and where many would otherwise be placed.

The cost of maintaining a MTFC placement over six months was £33,870 compared with £58,908 for an agency residential placement and £80,202 for an in-area residential placement.

When considering children’s outcomes, MTFC was also found to produce savings across youth offending team and child and adolescent mental health budgets.

Scheme facts

The multi-dimensional treatment foster care programme is:

● Recommended for 12- to 16-year-olds with severe emotional and psychological difficulties who have experienced multiple placements or interventions.

● MTFC foster carers train for about three months before first placement and attend weekly meetings throughout placement for training and support.

● The scheme features close mentoring and programme supervision. Advice is available 24 hours a day.

● Children attend weekly therapy sessions.

● Compulsory monthly respite care is available.

● Family therapists work intensively with birth families, where appropriate.

● There is regular contact between treatment team, foster home, school and birth family/guardians.

This article is published in the 13 May issue of Community Care magazine under the heading Kent’s foster care scheme makes its point