A foster mom in New York City cared for an 11-year-old boy. The child refused to follow her directions, and when they rode the city bus, he’d often touch the other passengers. These behaviors distressed the foster mom. She couldn’t persuade him to stop. She wanted to tell the foster agency that she could no longer keep the child.
It’s a common scenario playing out in foster homes across the country. About half of all children placed in foster care exhibit behavioral problems.
“A lot of these kids have experienced trauma, abuse, or neglect, which makes them vulnerable to behavioral and mental health problems,” explains Patti Chamberlain, science director at Oregon Social Learning Center in Eugene, Ore.
Kids with behavioral or mental health problems are far more likely to be shuffled between foster homes. Home-life instability can lead to more bad outcomes, including educational problems, involvement with the juvenile justice system, substance misuse, and other risky health behaviors.
In 1996, Chamberlain began to develop an intervention to increase stability and permanency for foster children. The evidence-based model, now called Keeping Foster and Kin Parents Supported and Trained (KEEP), empowers foster parents by helping them cultivate the skills to take control of difficult behaviors.
The New York City Administration for Children’s Services initiated the first large-scale implementation of KEEP in the United States in 2012. More recently, the state of Tennessee has begun implementing KEEP across foster agencies in seven regions. Chamberlain and others share what they’ve learned about implementation through the process of scaling up the evidence-based model.
Creating Community and Constructive Solutions
KEEP is an evidence-based support and education program for foster and kinship parents. The program concentrates on foster care kids ages 5 through 12. (A sister program called KEEP SAFE homes in on teen issues.)
Groups of 7 to 10 foster or kinship parents attend weekly meetings for 16 weeks. Trained facilitators lead the 90-minute sessions. Facilitators use role play and other interactive approaches to provide practical, research-based parenting techniques.
The techniques emphasize positive parenting—redirecting attention from negative behaviors by offering practical and constructive solutions. For instance, a foster parent dealing with troublesome bed-wetting behavior might reward a child for having a dry night rather than scolding him when he has an accident.
Fostering can be an isolating experience, explains Alexandria Munoz, special projects manager at Coalition for Hispanic Family Services of New York. Relatives and friends may not understand the struggles and challenges of being a foster parent. KEEP groups provide foster parents a genuine community where they can share experiences and learn from one another. “They feel validated and truly supported in the small group setting,” says Munoz.
Bringing KEEP to NYC
The New York City Administration for Children’s Services contacted Patti Chamberlain in 2012. They wanted help changing their foster care system. They chose KEEP.
New York City had 30 foster care agencies at the time. The city initially chose five agencies, including Munoz’s Coalition for Hispanic Family Services, to pilot the evidence-based program.
Case workers would take a more active role in the implementation of evidence-based parenting skills by learning to facilitate KEEP groups.
This was a big change that redefined the relationship between case worker and foster parent, says Chamberlain.
Redefining the Case Worker’s Role
Before KEEP, case workers would refer struggling foster parents to outside parenting classes for extra help. These classes weren’t necessarily tailored to the specific needs of foster parents, and there really was no way to assess whether the intervention was helping.
This created a critical disconnect between the case worker and the foster parent.
In the KEEP model, the case worker is the one providing those services to the foster parent.
“This big change helped us to get to know and understand our foster parents more deeply,” says Munoz. “And that’s ultimately enabled us to make better foster placements.”
Chamberlain faced a daunting task in helping set up KEEP in New York City. The city wanted all case workers trained in the evidence-based program, even if they would not be leading KEEP groups.
The five agencies chosen for the pilot oversaw services for about 2,000 foster kids each year. In rapid order, Chamberlain needed to train roughly 350 case workers.
Case workers must go through a rigorous, 5-day, hands-on training program before they can lead a KEEP group. Chamberlain says there was some resistance at first. Not all case workers welcomed the changes or felt the lessons were relevant to their roles.
Incentivizing Foster Parent Attendance
Once the case workers were trained, another major challenge was getting foster parents to actually show up to group meetings.
“Initially it was like pulling teeth convincing them to come in once a week,” says Munoz. Kinship parents—blood relatives of the child—were especially difficult to persuade. Many of them felt that because of their familial relationship to the child, additional training wasn’t necessary, she says.
New York City took actions to encourage attendance by providing financial incentive for foster parents. A foster parent receives $25 for each KEEP meeting he or she attends. Foster parents who attend at least 80 percent of the weekly meetings get a $100 bonus at the end of the program.
The agencies also worked to break down barriers to attendance by providing childcare and a snack or meal at each meeting.
Over time, says Munoz, foster parent attitudes toward the program began to shift. “They now ask for the services,” she says. “They see it as a good thing that’s going to help them.”
Improving Program Saturation
The five agencies currently implementing KEEP in New York City have made big improvements to their foster care programs over the past 5 years, but some still struggle with low foster parent participation.
The saturation rate for KEEP hovers around 50 percent. That means roughly half of all foster parents at the participating agencies take part in the evidence-based program.
“The goal is to get that number to 80 percent,” says Chamberlain. Some agencies already are there. The Coalition for Hispanic Family Services of New York—Munoz’s agency—has nearly 90 percent participation with their families.
In 2017, the city began tracking saturation, providing quarterly reports to each agency. Agencies are now setting incremental goals and working on new strategies for family engagement, says Chamberlain.
Adapting KEEP Across Cultures
For KEEP to become self-sustaining in New York City, Chamberlain knew they’d need to adapt the model. KEEP was initially developed in a suburban Oregon center. The needs of foster families in New York City were much different.
“We looked for ways to adapt the program to the local culture without adapting away the evidence-based parenting skills,” explains Chamberlain.
The developers worked with agencies to create a manual in Spanish and to reimagine some of the manual’s role-play scenarios for an urban audience. The scenes needed to include things such as public transportation and apartment living. “It needed to feel realistic for our families,” explains Munoz.
Tracking Success in NYC
Alexandria Munoz says that at her agency more than 300 foster parents have gone through KEEP in the past 4 years.
Lateral moves—shuffling kids between foster homes—are down. So is foster parent stress, which the agency assesses weekly, says Munoz. The agency uses a data tracking system to measure success.
As for the 11-year-old boy who wouldn’t follow directions and touched people on the city bus? He’s now 14 and has been living for more than 3 years with the same foster mom—the one who thought she’d have to give him up. KEEP helped her develop constructive techniques for dealing with the difficult behaviors. She’s in the process of adopting the boy permanently.
Scaling Up in Tennessee
KEEP developers are now scaling up the evidence-based model for Tennessee. The program is available in agencies across seven regions of the state.
“We’ve incorporated some of the lessons we learned in New York City as we’ve gone along,” says Chamberlain.
For instance, the developers now operate a shorter 3-day “foundational” training course for case workers. The goal of the short course is to expose all case workers to the program’s goals and evidence-based practices but not necessarily equip all case workers to lead a KEEP group.
Select case workers then undergo additional training to become group leaders.
Tennessee also is experimenting with new systems to incentivize foster parent participation. Foster parents who complete KEEP receive an increased daily board rate from the state. That differs from the program in New York City for which the financial incentive ends with the completion of the program.
Chamberlain believes this new incentive system may offer a better way to increase saturation rates. “The incentive has more value to the parents if they can receive a higher pay rate in the long term,” she says.