FocusV21No1fin

When I was in high
school, my only goal
was normalcy. Like
every adolescent, I just
wanted to fit in. Because
I was in foster care, that
goal was often more
difficult to attain for me
than for my peers. Early
on in my placement,
I wasn’t sure where I’d
be every three months.
I changed foster homes
in the middle of high
school, I lacked accessi-
bility to the same
resources my peers had and being in foster
care created obstacles to experiencing a
“normal” adolescence. Although adoles-
cence isn’t easy for anyone, it remains a
critical time in preparation for early adult-
hood and later self-sufficiency for everyone
and it is significantly more challenging for
youth in out-of-home placement.
Today I sit here as a senior leader of the
same organization that raised me, a college
graduate with both a bachelor’s and a grad-
uate degree. I find myself upset when I’m
reminded how few of my foster brothers
and sisters make an independent life for
themselves and how many end up back
in the system or lost within our society.
We’ve all seen the stats: 430,000 youth in
care, 100,000 waiting for adoption, and
23,000 aging out of foster care every year.
Over 60% will spend time homeless, and
70% will end up incarcerated. Many will
continue the cycle of families in welfare
and social services.
We know income and independence
from public welfare greatly increase with
educational advancement. However, only
45% of foster youth will attain a high
school diploma compared to the national
average of 88%. Of the percentage that
makes it to high school graduation, only
2%–3% will attain a bachelor’s degree
compared to the national average of 32%.
Only 1% will attain a graduate-level degree
compared to 12% nationally. The gap and
disparity are great; with the cost over
$300,000 per youth who ages out and
ends up back in the system, the total cost
to society is $8 billion.
Newsletter of the Foster Family-based Treatment Association
WINTER2015•Volume21/Number1
continued on pg. 2
1
A on
Supporting
Transition-age
Youth in Care
• “Why Me?”
• Editor’s Column: Practices,
Programs and Emerging
Tools for TFC Providers
Serving Youth in Transition
• Supporting Lifelong
Connections for Transition
Age Youth: The True Work
of “Independent Living
Programs”
• Transition to Independence
Process (TIP) Model
• Integration of
Trauma-Focused Treatment
with Transition Age Youth
• Transitional Living Program:
Helping Youth Successfully
Transition to Adulthood
• Training and Supporting
TFC Foster Parents
• Surviving Independence
FOCUS
Why Me?—by Hank Marotske, BSW, MBA

EDITOR’S COLUMN
— by Gretchen Test, MSW
Everything about my past would tell you college wasn’t
possible. I attended 14 schools from kindergarten through
12th grade, most while I lived with my biological mother.
I fell behind academically and received average, at best, aca-
demic marks through high school. I aged out of care with limit-
ed financial resources and in all probability was headed toward
remedial employment and potential homelessness. My family
history is flooded with pover-
ty, suicide, drug and alcohol
addiction, and incarceration.
In fact, no one from the
Marotske or Powell lineage
had attained a college degree.
So, Why Me?
Like many youth who grow
up with hardship and trauma,
I would often ask “why me”
when I was a youth in care.
Conversely, I have recently found myself asking “why me”
about my college education and relatively successful adult life.
What was it about my experience in foster care that helped me
be one of the few to attain a college degree and independence?
What about my experience in foster care was uniquely differ-
ent and helped me to be one of the 2%–3% who earn a four-
year degree and the 1% that attain a graduate-level degree?
At first glance many will say “look in the mirror”; I was deter-
mined, motivated, maybe even stubborn or strong-willed.
Conversely, my foster care experience was no different than
that of my foster brethren. When someone tells me his or her
story, I often hear my own voice. Our stories are often so much
more alike than different.
Upon further analysis I’ve found a few core concepts in my
experience that match best practices and current research.
Because my experience took place over 20 years ago, these
therapeutic components were not always intentional; in many
ways, the stars aligned. One could categorize this list into three
oft-used buzzwords—normalcy, permanency, and well-being:
Permanency
1. One caring adult who believed and spoke about college
2. Placement stability
3. Independent living skills training—long-term vision
Normalcy
4. Teachers who knew my situation
5. Teachers who modified the learning environment to fit my
learning style and ensure engagement
6. Basic school needs met
7. Extracurricular activity opportunities available
Practices, Programs and Emerging Tools for
TFC Providers Serving Youth in Transition
While nationally there are fewer children in
foster care, many communities are witnessing
increases in the percentage of older youth in care.
A closer look at foster care data (2012 Adoption
and Foster Care Analysis and Reporting System)
reveals that most teenagers in child welfare sys-
tems enter care as teenagers and in half of these
entries, a primary reason given for their removal is
child behavior.
Recent research on adolescent development
and trauma are challenging traditional notions of
normal teen behavior, especially for teens who
have experienced trauma such as abuse or neg-
lect, or who represent specific groups including
LGBTQ youth. This research is informing the devel-
opment of evidence based and evidence informed
practices. It’s an exciting time in our field.
What do these trends mean for TFC providers?
Will FFTA members be serving more teens
approaching transition out of foster care (age
18 or 21 in some states)? What are we learning
about how best to serve them? How can FFTA
standards guide development of our work with
older teens? This issue focuses on transition age
youth and offers some points of view, programs
and tools that may be helpful to you and your
colleagues. It begins with a positive story about
what works for teens, Why Me by Hank Marotske
from PATH Administrative Services in North
Dakota, who shares his professional and personal
perspectives. Supporting Lifelong Connections
for Transition Age Youth: The True Work of
Independent Living Programs by Shelby Howard of
Seneca Family of Agencies in California, suggests
a practice approach that’s aligned with Why Me.
For practitioners, of course, an issue of FOCUS
would not be complete without examples of
proven or promising programs and tools.
continued on pg. 3
continued on pg. 3
Why Me? | continued from pg. 1
When someone tells
me his or her story,
I often hear my own
voice. Our stories are
often so much more
alike than different.
2

Well-being
8. Personal safety needs met
9. Mental health needs met
10. Independent living skills training—
interdependence skills, self-care
Permanency
My first placement was in a PATH treatment foster
home. I had no idea what that meant at the time. I had
two social workers, one from the county and one from
PATH. The PATH worker was energetic and engaging
and always made me feel like my best interests came first.
On the other hand, I would get new county workers
seemingly every other month. By the time they were
caught up in my case, a new one would appear. I was in
foster care for eight years before I aged out. During those
eight years I had 8 to 10 county workers and one PATH
worker. My PATH worker was the one caring adult who
remained a constant and was responsible for planting the
seed of “when” I go to college, not “if.”
At some point, when I was about 13 or 14 and after a
few years in foster care, I went to an annual court appear-
ance. During the appearance I told Hennepin County
Judge Allen Oleisky that I wasn’t going to wait another
three months to see if my mother was going to meet court
objectives for reunification. I wanted to be normal; I want-
ed a normal high school experience, and I wanted some
consistency in my future. For some reason he honored that
request, the request of a child. Judge Oleisky’s ruling on
ending the constant three-month cycles of disappointing
reunification efforts also helped shift the focus of my treat-
ment plan to permanent and long-term goals. No longer
were we just looking toward the next three months, and
no longer was there uncertainty about when or to where
I’d change schools again. I could focus on building lifelong
friendships and relationships with my peers and communi-
ty. The unfortunate piece here is that it took three to four
years and a relatively independent and boisterous adoles-
cent to shift the perspective of professionals.
As described earlier, my early life involved instability
and constant moving. My PATH treatment worker recog-
nized this and believed stability and community connec-
tivity were important to my healing and to achieving well-
being. When my placement situation was forced, she
ensured I stayed not only in the same school district but
also in the same community. Although my address
changed, my friends, employment, and social activities
continued without disruption.
Editor’s Column | continued from pg. 2
We begin with Transition to Independence Process
(TIP) Model: An Evidence-Supported Practice for
Improving the Progress and Outcomes of Youth and
Young Adults with Emotional/Behavioral Difficulties
(EBD) by Hewitt B. “Rusty” Clark of the National
Network on Youth Transition. Next, Lauren Capel and
Martin Zayon of Kennedy Krieger Institute discuss
how TIP is one element of their work, in Integration
of Trauma-Focused Treatment with Transition Age
Youth. Finally, Mary Lee describes Youth Villages’
approach to this topic in Youth Villages’ Transitional
Living Program: Helping Youth Successfully Transition
to Adulthood.
Great foster parents who “get” teens are like gold —
they spend more time with teens than just about
anyone else and make a huge impact on a young
person’s healing and successful transition into adult-
hood. Those of you who are foster parents or train
foster parents will enjoy Training and Supporting TFC
Foster Parents to Meet the Needs of Older Youth by
Marianne Werth of Adolescent and Family Growth
Center, Inc.
Finally, Josh Whitkin’s article, Surviving Independence,
provides a glimpse into a new tool for teaching youth
about life skills and positive behaviors that has tested
positively and will undergo evaluation in 2015.
Note: Thanks to Becky Connell for serving as Editorial
Committee chair over the last two years (and support-
ing me as I take on this new role). Alexander Walker,
our new Editorial Committee Vice-Chair, and I look for-
ward to working with committee members and staff.
But most of all, thanks to our many authors who step
up to volunteer their time and writing skills, and FFTA
staff who make each and every issue a success. Do you
have ideas for FOCUS? Please contact me (Gretchen
Test, gtest@aecf.org) or the FFTA staff any time!
References
U.S. Department of Health and Human Services, Administration
for Children and Families, Administration on Children,
Youth and Families, Children’s Bureau, www.acf.hhs.gov/
programs/cb Preliminary Estimates for FY 2012 as of
November 2013 (20)
Gretchen Test, MSW, is a Senior Associate at the Annie E. Casey Foundation,
located in Baltimore, MD. She serves on the FFTA Board of Directors and is
the Chair of the Editorial Committee.
continued on pg. 4
3

So between the consistency of my PATH treatment worker,
a decision made by the judge to shift from quarterly reunifica-
tion efforts to a long-term aging out plan, and a decision by
my PATH treatment worker to ensure I remained in the same
school district and community despite the need to change
foster homes, I had the permanency component covered.
Normalcy
I still remember ninth grade. Two
teachers in particular took time to get
to know my situation and modify my
learning environment to my pace. I
chose a video production class because
the course description made it seem
fun and easy, and it met the communi-
cations requirements for graduation.
At the same time, I struggled in math
and science. Some teachers were bet-
ter than others, but for the most part
they ignored me and treated me like
other “burnouts.”
One science teacher, Mr. Fred
Dressler, leveraged my love for video
production to engage me in his sci-
ence class. Because I couldn’t sit still
and often disrupted his class, he had
me videotape and edit his lectures for
future classes in case he needed a
substitute. Needless to say my grade
significantly improved.
Mr. Mike Horton, the video pro-
duction teacher, embraced me early
on, even hiring me at the school’s TV
studio. Both of these teachers worked
together throughout my high school
career to ensure that modifications in
the classroom increased my engage-
ment and my academic performance.
They made attending school important for me.
My treatment social worker and foster parents also strongly
encouraged and supported extracurricular activities. Eventually
I traded extreme therapeutic activities that reminded me every
day I was a foster kid for normal, adolescent extracurricular
activities—church, Boy Scouts, cross-country, track, theater,
and newspaper. I firmly believe these experiences helped my
healing and maturation more than any of the previous tradi-
tional therapeutic interventions. To this day some of my
closest friends came from those adolescent experiences.
My basic school needs were met—I had school lunch tickets,
I could get participation fees waived if I filled out the appropriate
forms on time, basic school supplies were always available. Hard
obstacles to participating “normally” in high school didn’t exist.
There were struggles, nevertheless. I had anxiety around
resources and milestones that my friends took for granted—
getting yearbooks, school pictures, and spirit apparel; attend-
ing school events; knowing how I’d
get home after an event; and the like.
Each of these seemingly normal inflec-
tion points created anxiety and
reminded me I was a foster child.
Interestingly, after an article about
my foster care experience was posted
in the local newspaper, I learned that
many of my social media connections
who had known me as an adolescent
had no clue I was in foster care. I was
surprised how many “friends” had no
idea I grew up in foster care. I guess I
did a good job of faking “normalcy.”
Well-being
My first 11 years were spent in
impoverished areas of South Minneapolis
and a trailer park in a suburb. I was
surrounded by drugs and crime. I think
one of the best things for me was to
be removed from these environmental
influencers and placed into a quieter
and safer community. Although I dealt
with the normal bullying, and there
was definitely substance use going on
around me, the pressure and preva-
lence weren’t as great as they were
when I was younger.
I believe that some of the early
intensive therapeutic interventions
were helpful and stabilized my emotional well-being.
However, I also believe that getting engaged in “normal” ado-
lescent activities did more for my therapeutic healing than did
counseling. I did have one therapist I met with one to two
times a month in high school who was also a consistent adult
through this experience. Seeing him periodically was very
helpful. Our meetings didn’t intrude on my “normal” activities,
but they allowed a healthy and safe check-in for my foster
care experience. He was my advocate in both biological and
foster family relations.
4
continued on pg. 5
Eventually I traded extreme
therapeutic activities that
reminded me every day I was a
foster kid for normal, adolescent
extracurricular activities—church,
Boy Scouts, cross-country, track,
theater, and newspaper.

5
Independent living and job training programs were required.
These programs were always incentivized with payments and
experiential learning. At the time, they were more focused on
the traditional linear track of getting a high school diploma
or GED for career placement. I learned critical interview,
application, and work ethic skills that were later successfully
transferred professionally.
One thing lacking in my treatment plan was a specific focus
on education preparation. Grades and school progress were
discussed at my quarterly treatment meetings, but learning
proper study skills and college preparation were not highlight-
ed in my experience. My focus was on staying in school,
getting “good” grades, taking classes I thought I could pass,
and focusing on the social experiences of high school. There
was relatively little preparation for or education about what
the college experience would look like.
Thankfully I had access to a small college that saw poten-
tial, saw drive, and turned that desire for “normalcy” into an
opportunity for me to attend college. You see, early on, my
only reason for attending college was because that’s “what
everyone did.” I had no academic aspirations; I didn’t fully
understand the implication of what that degree would do for
me. I just knew “normal” people went to college and had
good jobs. I wanted to be “normal.”
What’s Next?
Many of the “accidental” components of my experience are
becoming more prevalent in treatment plans today. You often
see the terms permanency, normalcy, and well-being. In qual-
ity Treatment Foster Care programs, treatment workers often
ensure minimal numbers of placements and emphasize suc-
cessful lifelong connections.
Often the prospect of aging out feels like standing on the
edge of a cliff to foster youth. Your bed will most likely be
taken by another foster kid in need of a home, your familial
connections are weak at best when there is a bond, and finan-
cial resources are often minimal. It’s literally a cliff you’re
going to jump off when you are discharged from care.
Most youth, though anxious about pending adulthood, know
they have a safety net and social scaffolding to assist them as
they launch into societal interdependence. They know if they
stumble there will be some basic supports in place. Research
demonstrates that 25% of young adults won’t move out of their
parents’ home until age 22 and that 40% will end up moving
back home between the ages of 22 and 26. These trends are only
increasing with the rising cost of education and bleak employ-
ment outlooks even for college-educated individuals. Additionally
research has suggested that humans aren’t behaviorally, emotion-
ally, or cognitively mature until we are in our late 20s.
So while traditional families provide a safety net and social
scaffolding to assist young adults, many foster youth who age
out of care lose most structural supports when they are 18.
Recent trends in extending foster care are encouraging. Health
care is now available until age 26, and many states are increas-
ing foster care services into the early 20s. I believe the more we
talk in terms of guaranteeing supports after high school, the
more invested foster youth will be in their high school experi-
ence and the less hopeless they will feel. Expanding support
will give them some hope for and control over their future.
We need to adapt independent living skills programs to
include college and postsecondary preparation, regardless of
current academic performance. Currently, showing foster
youth how to get to college is a weakness in our system.
Collaboration and transparent communication with education
systems coupled with innovative college prep programs would
fill much of the current void.
Although the current trends are positive, we need to chal-
lenge even the most progressive states to do more, to model
programs on the “normal” experiences of today’s young adults.
Financial aid has increased but remains piecemeal and difficult
to navigate. Foster youth need better college preparation and
increased financial aid assistance that’s easier to navigate.
They need a place to stay during holidays and school breaks,
removal of financial barriers and stressors, and transportation.
They need continued mental and physical health services,
continued connection to communities, and trusted adult
relationships that continue through their early20s.
So when I’ve asked “Why me,” and I hear the responses that
it was “all you” or “you’re resilient” I don’t doubt there’s owner-
ship on my behalf. I do believe that, indirectly, and in some
ways unintentionally, the trends and recommendations I men-
tioned above were all part of my successful aging out experi-
ence. I also know through conversations with other foster alum
that have aged out and successfully achieved normal adult-
hood, they also had the scaffolding and structural supports to
help them. Modeling programs and policy around these experi-
ences and practices can only increase the successful transition
of today’s youth facing the aging out process. The investment
in these programs would be immeasurably positive from a soci-
etal impact perspective. The cost of social welfare, homeless-
ness, and incarceration would decrease while the contributions
of interdependent citizens in our community would increase.
Simply put, the investment would yield immeasurable returns.
Hank Marotske, BSW, MBA, is the Director of Corporate Communications and
Development at PATH Administrative Services, located in Fargo, ND. He serves
on the FFTA Editorial Committee.
I wanted to be “normal.”

6
continued on pg. 7
Supporting Lifelong Connections for Transition Age Youth:
The True Work of “Independent” Living Programs
The age of adolescence is described
by professor and author Daniel Siegel
as spanning roughly from 12 to 24
years old (Siegel, 2013). In a best case
scenario, when a youth comes from a
loving and supportive home, this is a
time of great transition and personal
development that can often appear
chaotic. In the case of youth aging out
of foster care during this period of
development, there’s an additionally
complex web of needs and concerns.
While it’s certain that these transition
age youth (TAY) need support in devel-
oping tangible skills, such as managing
a budget, building a résumé, or plan-
ning meals for the week, a lot more is
required of young adults to be success-
ful in life than these basic strategies of
financial and time management.
Fostering Connections to Success legis-
lation of 2008 has opened the doors for
services to be extended through those
first few years of legal adulthood, but
the type of support provided during
these transitional years is critical. Not
all tasks of adulthood can be taught
through weekly participation in classes,
and having the skills to get a job and
manage a budget doesn’t absolutely
insulate a young adult from future set-
backs, no more than setting up an 18-
year-old in her first apartment does.
With the current state of the economy
and job market, many adolescents
remain with their parents much longer
than they did in the past, and even
those who attain a college degree fre-
quently return “to the nest” following
their graduation but prior to fully tran-
sitioning to independence. The Pew
Research poll has quoted rates as high
as 56% of 18- to 24-year-olds living
with their parents in 2012, and even
16% of 25- to 31-year-olds were still at
home (Pew Research, 2013). Humans
are social creatures, and throughout
development having close relationships
is an essential part of living. While we
support TAY in arming themselves with
the things they will need to survive in
the adult world, we need to not forget
that supportive relationships are central
among these.
Building and maintaining supportive
relationships is an essential skill in
young adulthood, and one that’s very
difficult to master without modeling
and direct practice. Daniel Siegel
describes connections with caregivers as
the basis for each individual’s “models
of attachment” and cites these models
as the guide for the development of
future relationships with peers and
romantic partners (Siegel, 2013). This
would suggest that even in this later
stage of childhood it’s absolutely essen-
tial to have at least one supportive rela-
tionship with a caring adult in order to
provide a model for future relationship
success. So where are these supportive
adults coming from?
Over the past decade the child wel-
fare field as a whole has come to a
greater understanding of the need for
—by Shelby Howard, MFT

7
lifelong supports and permanent connec-
tions for youth. This understanding
seems to be slower to take root in the
needs identified for the TAY population.
It’s possible that part of the reason for
this is that TAY have less time left “in
the system,” and it may seem like a wiser
investment to put resources into tangible
skill development rather than searching
out relatives or mediating family sessions
when it seems as though there’s no guar-
anteed return on that investment of time.
In fact, as family or other safe and caring
adults are identified, unique complexities
must be navigated in these relationships
as youth progress through adolescence
and work on the developmentally appro-
priate task of individualization and
autonomy. Transition age youth may
express less and less desire for family
connections. They may even refuse to
engage with family when presented with
the option, or say they don’t want to be
adopted by the caring foster parent
who’s expressed that intention. All of
these complexities, however, are exactly
why it is so important that the profes-
sionals who are working for these young
adults don’t forget that permanent con-
nections continue to be a need, because
all of us who have passed through ado-
lescence know that independence is just
a gateway to return to the truth of inter-
dependence. It’s also essential that work-
ers maintain the hope that it’s still possi-
ble for an older youth to develop mean-
ingful relationships with long-separated
family members or newly identified car-
ing adults and even to achieve legal,
physical, and emotional permanency.
Achieving permanency for older youth is
dynamic and challenging, just as it is for
foster youth of all ages. But it’s not fruit-
less. Programs like You Gotta Believe—
Adopting Older Kids and Youth, based
in New York City, are examples of how
with concentrated effort, permanency
outcomes are still possible for TAY.
Even after the age of 18 the power of
adoption is tremendous, and the poten-
tial for isolation and desperation with
lack of natural supports is palpable.
Anyone who has ever gotten sick or
injured, gotten married, or had a baby of
his or her own knows that the need for
parental support doesn’t end when you
can sign your own paperwork. By stay-
ing involved as a natural support to a
young adult who has graduated from
services and is in her final year of
extended foster care support, I see the
daily struggles she encounters by not
having a true parent in her life. Even
though she’s reconnected to both of her
biological parents, neither is in a posi-
tion to provide parental care or guidance
to her, and this lack of support leaves
her adrift in many ways. For a com-
pelling story of youth who were fortu-
nate enough to be connected to
a caring forever father, I encourage a
quick viewing of this video: http://you
gottabelieve.org/the-toles-family-a-story-
of-adoption/.
Because of this continuing need for
connection and attachment, some pro-
grams that support TAY are incorporat-
ing family finding and connection work
into their model. In San Francisco, the
county-sponsored Independent Living
Skills Program (ILSP) has a full-time staff
dedicated to family finding work. Ideally
this work would have been started as
youth entered care and continued
throughout their time in care with the
goal of exiting the system before this
stage. For older youth who missed this
opportunity, however, these services
have been essential in answering ques-
tions of identity and belonging as they
enter adulthood. Staff doing this work
have found it very rewarding to partner
with these young adults and enable them
to find the people they wanted to con-
nect with, while supporting their rela-
tional skill development as they navigate
the complex dynamics of reciprocal
adult relationships. I have heard it said
that the lingering problem of “permanen-
cy work” is that it continues to be
viewed as separate from the other core
tasks of social work. It may be time that
all programs serving youth in their final
stage of dependency recognize that if
there is no transition plan, aside from
“independent living,” the remaining crisis
for even a young adult is one of connect-
edness. When the goal of developing
lifetime supports becomes central to all
work on behalf of foster youth, from
their first point of entry to the system
through their last day, even if that’s their
21st birthday, then we may truly be sup-
porting youth to transition into adult-
hood and interdependence.
References
PewResearch: Social and Demographic Trends.
(2013). A Rising Share of Young Adults Live in
Their Parents’ Home. Retrieved from
http://www.pewsocialtrends.org
/2013/08/01/a-rising-share-of-young-adults-
live-in-their-parents-home/
Siegel, D. (2013). Brainstorm: The power and
purpose of the teenage brain. New York:
Tarcher/Penguin.
You Gotta Believe: Adopting Older Kids and
Youth [Homepage]. Retrieved from
http://yougottabelieve.org/
Shelby Howard, MFT, is Director, Intensive
Treatment Foster Care, at Seneca Family of
Agencies in Oakland, CA. She serves on
the FFTA Editorial Committee.
Supporting Lifelong Connections for Transition Age Youth: The True Work of “Independent” Living Programs
| continued from pg. 6
Achieving permanency
for older youth is
dynamic and challenging,
just as it is for foster
youth of all ages.
But it’s not fruitless.

8
Transition to
Independence
Process (TIP) Model:
An Evidence-Supported
Practice for Improving the
Progress and Outcomes of
Youth and Young Adults with
Emotional/Behavioral
Difficulties (EBD)
—by Hewitt B. “Rusty” Clark, PhD
continued on pg. 9
CHALLENGES
During their transition period, all youth and young adults face deci-
sions about new social situations and responsibilities, future career and
educational goals, self-management of behavior and substance use, and
development and maintenance of supportive and intimate relationships
(Arnett, 2004). For these emerging adults, this is a period of “discov-
ery.” Young people with emotional/behavioral difficulties (EBD) are
particularly challenged during this transition period and, as a group,
experience some of the poorest secondary school and postsecondary
school outcomes among any disability group (Clark & Unruh, 2009;
Pleis, Ward, & Lucas, 2010; Wagner, Newman, Cameto, & Levine,
2005). Those youth from foster care face additional hurdles such as
possible frequent placement changes, runaway behaviors, school place-
ment changes, substance use, arrests, and lack of preparation for eman-
cipating into adulthood roles (Courtney et al., 2005; Courtney et al.,
2011; Newton, Litrownik, & Landsverk, 2000; Ryan & Testa, 2005).
OVERVIEW OF THE TRANSITION TO INDEPENDENCE
PROCESS (TIP) MODEL
The TIP model prepares youth and young adults with EBD for their
movement into adult roles through an individualized process, engaging
them in their own future planning process, as well as providing devel-
opmentally appropriate and appealing supports and services (Clark &
Hart, 2009). The TIP model involves youth and young adults (ages
14–29) in a process that facilitates their movement toward greater
self-sufficiency and successful achievement of their goals. Young
people are encouraged to explore their interests and futures as related
to each of the transition domains: employment and career, education,
living situation, personal effectiveness and well-being, and communi-
ty-life functioning. The TIP system also supports and involves family
or foster family members and other informal key players (e.g., an
older sister, girlfriend, roommate) as relevant in meeting their needs
and those of the young person.
The TIP model is operationalized through seven guidelines that
drive practice-level activities with young people to provide the deliv-
ery of coordinated, non-stigmatizing, trauma-informed, developmen-
tally appropriate, appealing supports and services to them. The guide-
lines also provide a framework for program and community systems to
support, facilitate, and sustain this effort (Clark & Hart, 2009; Dresser,
Clark, & Deschênes, 2014).
At the heart of the TIP practice model are “proactive case managers”
with small caseloads (i.e., transition facilitators, aka life coaches, tran-
sition specialists, or coaches, serving 15 or fewer youth/young adults).
The TIP transition facilitators use the guidelines and core practices
(e.g., Problem Solving, In-vivo Teaching, Prevention Planning of
High-Risk Behaviors) in their work with young people to facilitate
youth making better decisions, as well as improve their progress and
outcomes. The TIP model also provides for the use of other evidence-
based interventions (e.g., CBT, SPARCS/DBT) or other clinical inter-
ventions to address a critical need of a particular young person.

9
e following brief description of Kendra illustrates the TIP model
approach as it has been applied with her at one of our sites.
APPLICATION OF THE TIP MODEL: KENDRA’S STORY
Kendra, a 17-year-old girl, was diagnosed with bipolar disor-
der and was refusing to take her prescribed medications. Her
use of street drugs was possibly her way of self-medicating.
Although she was in high school, her attendance, disciplinary
record, and grades were all on the edge. Kendra’s transition
facilitator, Ronda, began meeting with her in settings such as
Starbucks and neighborhood parks. While taking walks with
Kendra, Ronda began conducting informal Strength Discovery
assessments and person-centered planning. Over the first six
weeks, Ronda was earning Kendra’s trust and learning about her
interests, strengths, needs, resources, challenges, dreams, prefer-
ences, and social connections, from Kendra herself as well as
from conversations with her foster mother. During this period,
Ronda was also prompting, cajoling, and supporting school
attendance as well as teaching Kendra to manage her anger
when someone would get “in her face” or tease her at school or
at her foster home. School continued to be a major challenge,
and Kendra continued to use drugs on occasion as well as experi-
ence episodes of severe depression. Although she seemed to be
developing a more trusting relationship with Ronda, she contin-
ued to refuse to attend any therapy or medication reviews.
Ronda continued to reach out to her and after about two and a
half months, Kendra revealed that the loss of her grandmother a
year earlier was devastating to her. She felt that her grandmother
was the only family member to ever show that she loved
Kendra. Ronda also learned through the informal Strength
Discovery conversations that Kendra dreamed of being a nurse
as her grandmother had been.Using this new information, Ronda
worked with Kendra to explore how she might be able to improve her sense of family with her foster mother and an older sis-
ter who lived in the community and to get a sense of what options Kendra would have in the nursing profession. Ronda
arranged for Kendra to visit the community college program for nursing and to meet with the program coordinator. The coor-
dinator gave Kendra a tour, discussed program options, and arranged for Kendra to sit in on a class on several occasions to see
what was being studied and to meet some of the students. Kendra was very inspired by what she experienced and what she
learned regarding the AA degree program option.Concurrently, Ronda and Kendra met with a mental health therapist to see if
Kendra would be willing to engage in individual therapy and try a new type of medication that might not have the side effects
that she had experienced previously. She reluctantly began attending individual therapy twice a week, often wanting Ronda to
attend with her. Over the course of the next month, Kendra was stabilized on a new medication and decided to expand her
therapy to include her foster mother and sister in an attempt to create a sense of family. Ronda worked with Kendra on devel-
oping a résumé and learning interview skills so that Kendra might interview more successfully for a receptionist position at a
doctor’s office for the summer. Ronda had also learned from conversations with Kendra and her sister that they used to do a lot
of roller-skating when they were younger. Ronda explored with Kendra and her sister whether they might want to do some
rollerblading at the local rink. Ronda was able to get a couple of passes to cover rink costs for a few months. Kendra and her
sister really enjoyed their time together on the rink, made some new friends, and began to do more things together. Now in
her senior year of high school, Kendra is working, making good progress in completing high school, taking one class at the
community college, making some new friends there, and living with a better sense of family. Ronda facilitated these outcomes
through informal strength assessments and person-centered planning that engaged Kendra and that revealed her strengths,
needs, and dreams. Ronda then provided tailored supports and services to assist Kendra in addressing her needs and achieving
her goals. This process has allowed Kendra to find a new trajectory for her life and future.
For more information, visit www.ffta.org/ppi
or contact the FFTA office at ffta@ffta.org
Transition to Independence Process (TIP) Model
continued on pg. 10

10
TIP MODEL IMPLEMENTATION AND SUSTAINABILITY
The TIP model is an evidence-supported practice that has been demon-
strated to be effective in improving the outcomes of youth and young adults
with EBD from families of origin, foster care, and other settings (e.g., home-
less/runaway, residential facilities). To learn more about our program devel-
opment and research efforts and how they have been guided by the voices
and perspectives of young people, parents, and practitioners in the field, as
well as science, please refer to the TIP Theory and Research section of our
website, www.TIPstars.org.
In order to achieve these outcomes with youth and young adults, the TIP
Model Consultants provide competency-based training and technical assis-
tance to agencies, community collaboratives, and counties. The transition
facilitators and the supervisory personnel at transition sites are taught and
coached in the application of the TIP model guidelines and are provided
competency training in the use of TIP model core practices, such as Futures
Planning, In-vivo Teaching, Problem Solving, Prevention Planning on High-
Risk Behaviors, and Mediation with Young People and Other Key Players.
The TIP Model Consultants and Assessors also assist sites with sustainabili-
ty by providing technical assistance and mentoring on implementation
strategies and by building site capacity on topics such as (a) establishing peer
support and leadership; (b) conducting TIP Solutions Reviews for ongoing
competency enhancement of all transition personnel; (c) mentoring supervi-
sory personnel in coaching methods for working more effectively with their
transition team; (d) providing technical assistance on tracking of progress
and outcome indicators for youth and young adults; (e) establishing TIP
Model Site-Based Trainers through mentoring; (f) conducting and building
site capacity for TIP Model Fidelity Quality Improvement Assessments; and
(g) providing certification of sites. It is our goal to ensure that the TIP model
is implemented and sustained so as to improve the outcomes for transition-
age youth and young adults with EBD (Dresser et al., 2014).
Hewitt B. “Rusty” Clark, PhD, is the director of the National Network on Youth Transition and
professor emeritus at the University of South Florida in Tampa, FL.
Transition to Independence Process (TIP) Model: An Evidence-Supported Practice for Improving the Progress
and Outcomes of Youth and Young Adults with Emotional/Behavioral Difficulties (EBD) | continued from pg. 9
References
Arnett, J. J. (2004). Emerging adulthood: The winding road
from the late teens through the twenties. New York, NY:
Oxford University Press.
Clark, H. B., & Hart, K. (2009). Navigating the
obstacle course: An evidence-supported commu-
nity transition system. In H. B. Clark & D. K.
Unruh (Eds.), Transition of youth and young adults
with emotional or behavioral difficulties: An evidence-sup-
ported handbook (pp. 47–106). Baltimore, MD:
Brookes Publishing.
Clark, H. B., & Unruh, D. K. (2009). Understanding
and addressing the needs of transition-age youth
and young adults and their families. In H. B.
Clark & D. K. Unruh (Eds.), Transition of youth and
young adults with emotional or behavioral difficulties: An
evidence-supported handbook (pp. 3–22). Baltimore,
MD: Brookes Publishing.
Courtney, M. E., Dworsky, A., Brown, A., Cary, C.,
Love, K., & Vorhies, V. (2011). Midwest evaluation
of the adult functioning of former foster youth: Outcomes
at age 26. Chicago, IL: Chapin Hall Center for
Children, University of Chicago.
Courtney, M. E., Skyles, A., Miranda, G., Zinn, A.,
Howard, E., & Goerge, R. M. (2005). Youth who
run away from substitute care (Issue Brief No. 103).
Chicago, IL: Chapin Hall Center for Children,
University of Chicago. Available at
http://www.chapinhall.org/sites/default/files/old_
reports/174.pdf. Requires registration (free).
Dresser, K., Clark, H. B., & Deschênes, N. (2014).
Implementation of a positive development, evi-
dence-supported practice for emerging adults
with serious mental health conditions: The
Transition to Independence Process (TIP)
Model. Journal of Behavioral Health Services &
Research. doi: 10.1007/s11414-014-9438-3.
Available at http://www.springer.com/
-/9/cd1d41bfc46042199f05fb958109c087.
In 2015, this article will appear in a bound copy
of the JBHS&R.
Newton, R. R., Litrownik, A. J., & Landsverk, J. A.
(2000). Children and youth in foster care:
Disentangling the relationship between problem
behaviors and number of placements. Child Abuse &
Neglect, 24, 1363–1374.
Pleis, J. R., Ward, B. W., & Lucas, J. W. (2010). Vital
and health statistics: Summary health statistics for U.S.
adults: National health interview survey, 2009. Series 10:
No. 249. Hyattsville, MD: U.S. Department of
Health and Human Services, Centers for Disease
Control and Prevention, National Center for
Health Statistics.
Ryan, J. P., & Testa, M. F. (2005). Child maltreat-
ment and juvenile delinquency: Investigating the
role of placement and placement instability.
Children and Youth Services Review, 27, 227–249.
Wagner, M., Newman, L., Cameto, R., & Levine, P.
(2005). Changes over time in the early postschool out-
comes of youth with disabilities: A report of findings from
the National Longitudinal Transition Study (NLTS) and
the National Longitudinal Transition Study-2 (NLTS2).
Menlo Park, CA: SRI International.

Adolescents represent about 20% of the foster care
population, and each year more than 20,000 youth exit
the foster care system with the expectation that they will
be able to live self-sufficiently. Studies have shown that
after foster care youth exit the system, they face serious
problems, including homelessness, poverty, incarceration,
early pregnancy, lack of medical and mental health care,
and unstable employment. The research indicates that low
educational achievement, poor support systems, lack of life
skills and vocational training, and foster care experiences
contribute to poor transition outcomes. Additionally, many
youth involved in the foster care system struggle because of
their adverse childhood experiences and often have biologi-
cal, cognitive, social, and emotional deficits that limit their
ability to function independently, problem solve, and devel-
op a healthy self-concept.
Trauma Integrative Model and Transition
To address some of these challenges, the Kennedy
Krieger Institute Therapeutic Foster Care (KKI-TFC) pro-
gram developed the Trauma Integrative Model (TIM),
which integrates the basic elements found in traditional
treatment foster care (proactive behavioral interventions,
supervision, support and training of the treatment parent,
and permanency) with the Attachment, Regulation, and
Competency (ARC) (Kinniburg et al., 2010) framework for
the treatment of complex trauma, and the Transition to
Independence Process (TIP) (Clarke & Davis, 2000.) The
TIP is a best practice model that meets the needs of those
youth preparing to age out of care. A unique feature of the
TIM is its “focus of change.” In the TIM’s “focus of change,”
the social worker is the primary clinician intervening to
develop and support a therapeutic relationship between the
youth, the treatment parent(s), and the youth’s family/kin.
The clinical role of the social worker is integrated with his
or her role as case manager, treatment parent supervisor/
trainer, and team leader, as he or she intervenes with the
treatment foster parent(s), the youth, and the youth’s
biological family/kin to promote permanency, while address-
ing complex trauma and transition. The TIM highlights and
recognizes the importance of maximized connections for
meaningful lifelong relationships, family support, and an
individualized strength-based approach in improving posi-
tive outcomes for youth.
Integration of Treatment Tools to Support
Transition
The KKI-TFC program strives to ensure that youth
achieve maximum self-reliance and self-sufficiency before
transitioning into independence. As a means to prepare
youth for independence, the program has developed the
Transition Planning Assessment (TPA) to assess the youth’s
current functioning, to support the development of service
and treatment planning, and to measure progress over time.
The tool also facilitates team communication and collabora-
tion, necessary for productive transition planning. The
youth’s participation is critical to the effectiveness of transi-
tion treatment; thus, the TPA aims to engage and empower
the youth to have autonomy over her or his individual treat-
ment, while the social worker facilitates collaboration with
the biological and foster families, the local Department of
Social Services (DSS) worker, and other service providers.
The TPA consists of three referenced components: (1) the
TIP Model, which incorporates seven system guidelines and
five transition domains to address while utilizing transition
11
Integration
of Trauma-Focused
Treatment with
Transition Age Youth
—by Lauren Capel, MSW, LCSW-C, and Martin Zayon, MSW, LGSW
The clinical role of the social worker
is integrated with his or her role as
case manager, treatment parent
supervisor/trainer, and team leader
continued on pg. 12

12
planning tools; (2) the Adolescent Needs and Strengths
Assessment—Transition to Adulthood (ANSA-T) measure,
which entails needs and strengths subcategories under each
domain; and (3) the state of Maryland’s Ready by 21 bench-
marks. The TIP model domains include employment, educa-
tion, housing/living situation, community life functioning, and
personal effectiveness/well-being. Each domain is further bro-
ken down into subcategories provided by the ANSA-T: job
functioning, vocational development, educational attainment,
living situation, permanency, leisure time activities, community
participation and inclusion within the community, independ-
ent living skills, emotional/behavioral well-being, knowledge
of illness and mental health conditions, interpersonal skills,
physical and mental health stability, parenting/sexuality needs,
and self-determination. These subcategories allow the treat-
ment team to assess a baseline functioning for the youth in
each domain and to identify transition-related treatment goals
based on the benchmarks and target age brackets referenced in
the Ready by 21 manual. Each subcategory provides a rating
for the age ranges of 14–16, 16–18, 18–20, and 20–21.
The youth is then rated as basic, intermediate, advanced, or
exceptional (for strength-based subcategories), or mild, mod-
erate, or profound (for need categories) on the ANSA-T sub-
categories. The TPA is also integrated with the Child and
Adolescent Needs and Strengths (CANS) instrument. The
ratings of mild, moderate, and profound are equivalent to 1,
2, and 3 in the CANS domain. For example, a youth who is
18 years of age without vocational or volunteer experience is
rated as profound on the TPA and 3 in the vocational subcat-
egory in the CANS; this indicates a need for action. The inte-
gration of the TPA and CANS allows the treatment team to
be proactive in identifying the need for more support and
services, monitoring the youth’s progress over time, and
determining the youth’s readiness for transition.
The social worker typically begins to use the TPA when
the youth reaches 14 years of age. The tool is integrated
within the youth’s treatment/service plan. The TPA can be
administered quarterly or at least annually as determined by
the youth and the treatment team.
Integration of Trauma-Focused Treatment
with Transition Age Youth | continued from pg. 11 The TIP model domains include
employment, education, housing/living
situation, community life functioning,
and personal effectiveness/well-being.
continued on pg. 13

13
Integration of Transition
Planning and Trauma
Intervention
Youth who have experi-
enced complex trauma often
have functional impairments,
struggle with developmental
tasks, and have a fragmented
self-concept, all of which
limit their capacity to engage
in planning and developing
competency for transition;
therefore, it is important that
youth are supported in build-
ing on competency areas and
strengths as well as needs
identified in the TPA.
The Competency domain
in the ARC framework sup-
ports the development of
executive functioning, self-
development, and the identity
needs required for youth to
be successful in transitioning to adulthood. The overarching
goal is to encourage youth to be active players in their own
lives and to improve their capacity to act purposefully and
demonstrate cognitive control (think then act) when faced
with challenges. Self-identity and self-development encour-
age youth to have a sense of themselves that is positive,
coherent, and unique, and to have the ability to imagine
future possibilities (Kinniburg et al., 2010). The TPA sup-
ports the social worker in providing training and intervention
that in turn support the treatment parent in working with the
youth to develop the competencies necessary for transition-
ing. The TPA also supports the collaboration with communi-
ty partners to identify opportunities for youth to engage in
programs or services that improve competency-based skills.
Some examples are (a) partnering with the Department of
Social Services (DSS) to assist youth with participating in the
summer work program as well as other DSS- and community-
sponsored programs tailored to promote independence and
skill building, and (b) referring youth who present with
developmental challenges to the Division of Rehabilitation
Services (DORS) for assistance with obtaining vocational
training and support.
It is vital that outpatient
mental health services continue
to be an integral part of the
treatment process. The TPA
allows the clinical social worker
to communicate with mental
health providers regarding the
youth’s mental health needs
and to support the youth in
working toward his or her indi-
vidual treatment goals.
Conclusion
Transition age youth are
faced with many challenges
when preparing for termination
from the foster care system.
Transition can be very fright-
ening and stressful and can cre-
ate trauma reminders for youth
preparing to exit the foster care
system. As a result, child wel-
fare programs must work to
integrate models and treatment tools to address these chal-
lenges. These models must be flexible in meeting the com-
plex needs of transitioning youth while engaging and
empowering them in the process. Programs must develop
methods to assess needs and strengths of transition age
youth, which effectively informs interventions and services,
while measuring outcomes to improve program practices.
References
Blaustein, M. E., & Kinniburgh, K. M. (2010). Treating traumatic stress
in children and adolescents: How to foster resilience through attachment,
self-regulation, and competency. New York, NY: Guilford Press.
Clark, H. B., Deschenes, N., & Jones, J. (2000). A framework for the
development and operation of a transition system. In H. B. Clark &
M. Davis (Eds.), Transition to adulthood: A resource for assisting young people
with emotional or behavioral difficulties (pp. 29–51). Baltimore, MD:
Paul H. Brookes.
Lauren Capel, LCSW-C, is a Senior Clinical Social Worker in the Therapeutic
Foster Care Program at Kennedy Krieger Institute in Baltimore, MD.
She is the leader of the program’s Professional Development Committee.
Martin Zayon, LGSW, is a Clinical Social Worker in the Therapeutic Foster
Care Program at Kennedy Krieger Institute. He leads the program’s Youth
Transition Committee.
Integration of Trauma-Focused Treatment
with Transition Age Youth | continued from pg. 12
Self-identity and self-development
encourage youth to have a sense
of themselves that is positive,
coherent, and unique, and to
have the ability to imagine
future possibilities

14
These are just three of the 23,000
youth who age out of the foster care
system each year. For youth who have
been in state custody, the struggle to
transition to independent living is mag-
nified. With no means of support, these
youth are basically sent off to fend for
themselves, and they’re not doing well.
The Midwest Evaluation of Adult
Functioning of Former Foster Youth
(http://www.chapinhall.org/sites/default/f
iles/ChapinHallDocument_2.pdf), the
most nationally referenced study of this
population, confirms that about half of
former foster youth experience extreme
difficulty. Eighteen months
after discharge from state
custody, 55% live in pover-
ty, half are unemployed,
45% have dropped out of
high school, and one in four
is homeless. By age 26, more
than half have been arrested,
and 25% suffer from post-
traumatic stress disorders.
“These young adults are at
the most vulnerable point in
their life,” said Patrick W.
Lawler, Youth Villages
CEO. “The barriers they
face to become independent can appear
insurmountable. They haven’t learned
how to find a job or a home. They don’t
know the steps to graduating college or
enrolling in a trade school. They don’t
know how to reach their dreams.”
The answer is simple: Show them.
In 1999, Youth Villages began the
transitional living (TL) program to help
youth aging out of foster care. Since
then, TL has helped more than 7,300
young people build independent and
successful lives. Today,TL serves 1,700
young people each year across five states
(Georgia, Massachusetts, Mississippi,
North Carolina, and Tennessee) with a
success rate of 87%.
Cody said TL showed him how to
cope with his frustration. More impor-
tantly, his TL specialist, Micah, support-
ed him in enrolling in community col-
lege to earn the requirements to enlist
in the Navy. “Without Youth Villages,
I’d probably be back in my old ways,”
Cody said. “I’d be making bad choices
and hanging out with bad people.”
Alexis turned to her TL specialist,
Michael, who supported her legal battle
and helped her find a safe place to live.
She began working part-time. Together,
they exhausted legal
resources and community
supports to help ensure both
mother and daughter were
safe, warm, and well fed.
Tabitha found a job,
began school, saved her
money, and bought a car.
With the help of her TL
specialist, she began to
recover from years of
abuse and neglect and
move forward.
YouthVillages’
Transitional
LivingProgram:
HelpingYouth
Successfully
Transitionto
Adulthood
—by Mary Lee
Cody said he needed help being 18. He struggled with
physical aggression and frustration over fulfilling the require-
ments to enlist in the Navy’s underwater welding program,
something he said he’s wanted to do since he was 11 years old.
Alexis had just left an abusive relationship and had nowhere
to go. She knew nothing about getting a job, insurance, or a
place to live. She also didn’t understand the legal process and
how to fight to keep custody of her child. Facing homelessness
with an infant daughter, she turned to the only person she
knew who would help.
Tabitha had just entered foster care with her younger
sisters after growing up in an abusive and neglectful home.
At 17, she lacked self-confidence and didn’t have high
expectations for her future.
continued on pg. 15

15
Youth spend about nine months in the
program. They set their goals for hous-
ing, education, employment, and other
independent living skills, and the TL
specialists help them achieve it.
“TL is driven by the youth in the
program,” Lawler said. “It’s voluntary.
When they sign up, they get a dedicat-
ed specialist who meets with them at
least once a week and is available 24/7.”
It’s intense and it’s effective. Staff
take advantage of extensive training,
consultations, and continuing educa-
tion to customize an evidence-based
plan for each young person to achieve
her or his goals. Youth are evaluated
throughout their time in TL and fol-
lowing discharge.
“We want to know from them what
works,” Lawler said. “We assess each
youth at admission, throughout the
program, and through 24 months fol-
lowing discharge.”
At each evaluation, a research team
finds out whether the youth is living
with family or independently and
whether the young person has had
any involvement with the law and
verifies the youth’s education and
employment status.
“Constantly measuring TL’s effec-
tiveness means it’s constantly chang-
ing,” Lawler said. “One way won’t
work for every youth. You have to
adjust and meet their needs, and that’s
the great thing about TL. It’s different
for every person.”
Alexis, Cody, and Tabitha all came
from different backgrounds and entered
the TL program with distinct needs.
Through TL, each received the support
she or he needed to break through into
the adult world.
Alexis began pursuing her GED. She
was able to keep custody of her daugh-
ter and found a place to live. Instead
of living moment-to-moment in fear
of failing herself and her daughter,
she’s planning for a future. “Without
Michael’s help, I’d probably be home-
less and without my daughter,” she said.
Cody has found stability and is work-
ing toward his goals. “Now, I’ve got the
confidence to try new things and work
toward getting in the Navy,” he said.
Today, Tabitha carries herself with
more confidence. She reads a lot. Her
shyness has transformed into a quiet
confidence. Most important, through
her work and TL, she expects more
from herself. “I think I’m ready to
receive good things and accept accom-
plishments,” she said. “I feel like I can
accomplish whatever I set my mind to.
No girl should have to go through
what I did, and I want to be in a posi-
tion to help those who have.”
In continuing its commitment to find
what works, Youth Villages embarked
on a randomized controlled trial of the
transitional living program in 2010 to
determine the program’s effectiveness in
helping this group of young people.
Conducted by Dr. Mark Courtney and
MDRC, it is the largest rigorous study
to date of services for transition age
youth who have a history of foster care.
More than 1,300 youth were enrolled in
the study. A 2013 report from the study
found that the program was well imple-
mented and that participants received
substantial services. Findings on the
effects of the program will be released
in spring 2015, although preliminary
indications are that the program is mak-
ing a difference.
To learn more about Youth Villages’
transitional living program, please visit
www.youthvillages.org.
References
http://www.chapinhall.org/sites/default/
files/ChapinHallDocument_2.pdf
Mary Lee is the national transitional living
coordinator at Youth Villages, in Memphis, TN.
YouthVillages’
Transitional
LivingProgram:
HelpingYouth
Successfully
Transitionto
Adulthood
Alexis, Cody, and Tabitha
all came from different
backgrounds and entered the
TL program with distinct
needs. Through TL, each
received the support she or
he needed to break through
into the adult world.

16
continued on pg. 17
and Supporting TFC
Foster Parents to Meet
the Needs of Older Youth
—by Marianne Werth, MSW, LCSW
The role of the Treatment Foster Care (TFC) foster
parent is a dual one: TFC foster parents provide services
to the youth in their care, and they receive services from
the agencies that support them in this work. “These roles
are complex, daily, and involve relationships that are at the
same time both loving and conflicted” (Jarboe & Agosti,
2011). Consequently, foster parents experience the need
for support and training.
Most learning occurs within the context of our daily lives
and our relationships. This is also how most healing and
growth occur for our youth in TFC. The reliance on the rela-
tionship between the TFC foster parent and the youth is a
primary treatment focus of the Treatment Foster Care model
and makes the training and support of foster parents essential
to providing care to TFC youth. As we review the training
needs of foster parents working with older youth, it is impor-
tant to remind ourselves that although the needs of adoles-
cents and young adults in TFC are different from those of
younger children, the skills that TFC foster parents need to
support them are often very similar.
Training for all TFC caregivers should include
• the effects that trauma has on the youth placed in TFC,
• the importance of finding permanency for youth in care,
• the impact of disrupted relationships on current behavior
and the need to help youth learn to develop healthy
relationships, and
• the “normal” process of development for children in all
areas—cognitive, physical, and social–and how they may
be impacted by trauma, disrupted attachment, and mental
health issues.
Training should also focus on helping the TFC foster parent to
• understand the healing power of supportive, consistent,
and nurturing relationships,
• be flexible and able to provide different parenting styles
and strategies based on the unique needs of the youth in
the home, and
• identify and manage the impact on themselves that is pro-
duced by the work of parenting TFC youth (helping fos-
ter parents to learn to remain regulated even when they
become sad, angry, or frustrated).
Training and support for TFC foster parents of older
youth can be adapted in several ways to meet their particu-
lar needs. Training for TFC foster parents of older youth should
include an understanding of the developmental stage of adolescence
and of how trauma, grief and loss, and mental health issues and
cognitive delays can impact that development. Teens and young
adults are challenged with identity formation and the activi-
ties of separating from caregivers. This is the first time in a
child’s life when he or she is capable of seeing himself or
herself as unique. Identity development occurs in relation-
ship with others—peers and adults. Under the best of cir-
cumstances, this process will include some risk taking and
testing of limits, mood unpredictability, and conflict with
caregivers. TFC foster parents need to understand the
importance of this process for all youth to become inde-
pendent, but they also need to be aware of how this process
may be more difficult for youth who have had disrupted
relationships or trauma histories.
Training should also include information on how the brain
is maturing at this time and how previous trauma may have
impacted a youth’s cognitive ability. Traumatized youth may
have more confusion about trusting relationships, making it
more difficult to develop relationships necessary to help them
learn about who they are in relation to others (Fostering
Relationships, n.d.).
Unresolved grief from previous separations may be activat-
ed at this time. Youth in foster care often respond to the
process of “aging out” with an increase in depressive symp-
toms. Losses often include decreased connection with family,
community, and culture, all of which will make the process
of identity formation more complex for individual youth
(San Diego State University, 2003).
Risk taking is part of the process of maturing into adult-
hood. Youth who have been traumatized may have impaired
judgment, and a history of abuse can make them more vulner-
able to reckless behavior or to exploitation by others (finan-
cially, physically, sexually, and more). Some youth may iso-
late and avoid opportunities to try new things or dull their
emotions with substances, serious injurious behavior (SIB), or
eating disorders. TFC foster parents need to be aware of these
possibilities and how they will impact the care of youth
(Fostering Relationships, n.d.).

All training and support for TFC parents should focus on the power of
the relationship in the healing and maturation process for youth. This
continues to be important for adolescents. Though they may
appear to want to pull away and test the limits, older youth
continue to need support and guidance from adults who “hang
in there with them.” It is a time for caregivers to provide the
level of support that the youth need while also allowing and
encouraging opportunities to try new things. Caregivers need
to be prepared to change parenting styles to be less hands-on,
provide more mentoring and guidance, and be able to tolerate
the worry that allowing more freedom can create.
It is important that youth who become legal adults while
still in foster care have relationships with people who will be
part of their lives as they age out. Training for TFC parents
needs to include an understanding of and a commitment to helping
youth in care identify the adults who will be available to them as perma-
nent connections. Foster parents working with youth of this
age should be aware of the need for youth to perhaps recon-
nect with birth relatives, previous caregivers, and other
adults who can become a part of their young adult lives.
Training needs to include strategies to help youth rekindle
or develop these important connections. Training also needs
to include information on the complexities of developing
these relationships while youth may still be managing com-
plex and unresolved grief issues (Henry & Manning, 2011).
A number of curriculums are designed to teach and support
foster youth in the development of independent living (IL) skills.
Foster parents need training to be aware that the needs of
youth in TFC can often make the acquisition of these skills
difficult. Becoming “independent” and leaving the “system”
are emotionally charged processes. Foster parents should be
prepared to support youth in learning the skills necessary
with the understanding of how emotionally challenging these
processes might be. Activities designed to teach skills are also
opportunities for bonding with youth and for teaching
important relationship skills.
Parenting youth who are moving into adulthood can be a
complex and conflicted undertaking. Staff need to be avail-
able and supportive to TFC foster parents to help them
understand and not personalize the youth’s behavior. Many
caretakers worry about youth who may choose to leave their
foster home when they are clearly not prepared. Staff will
need to be available and aware of the needs of TFC foster
parents working with older youth. Grief and secondary trau-
ma continue to be concerns for our foster parents working
with older youth, and staff support will be essential to help
them manage the impacts.
The following resources might be helpful in training and
supporting TFC families working with older youth.
• Child Welfare League of America advertises several
PRIDE foster parent training models focused on older
youth, in the in-service curriculum and in specialized
models (www.CWLA.org).
• Fostering Relationships, a project of the organization A
Home Within, offers online training specifically for care-
givers that focuses on the impact of trauma and includes
suggestions for self-care activities for caregivers
(www.fosteringrelationships.org).
• Ready, Set, Fly! A Parent’s Guide to Teaching Life Skills, devel-
oped by Casey Family Programs, is a curriculum that
provides concrete suggestions for caregivers to use in the
teaching of independent living skills (www.casey.org/
media/CLS_ResourceGuides_subdocs_ReadySetFly.pdf).
References
Casey Family Programs, Foundations for the Future, Tucson Division.
(2001). Ready, set, fly! A parent’s guide to teaching life skills. Retrieved from
www.casey.org/media/CLS_ResourceGuides_subdocs_ReadySetFly.pdf
Fostering Relationships: A Project of A Home Within. (n.d.). Teens and
young adults: Addressing the impact of trauma. Accessed December 2014.
Available from www.fosteringrelationships.org
Henry D. & Manning, G. (2011). Integrating child welfare and mental-
health practices: Actualizing youth permanency using the 3-5-7
Model. Protecting Children, 26(1), 30–48.
Jarboe, K. L. & Agosti, J. (2011). Independent living program transfor-
mation in California: Lessons learned about working with older youth
and implications for permanency. Protecting Children, 26(1), 11–29.
San Diego State University School of Social Work, Academy for
Professional Excellence. (2003). STAR (Successful Transitions for Adult
Readiness): An interdisciplinary training, participant version.
Marianne Werth, MSW, LCSW, is the Director of Operations at Adolescent
and Family Growth Center, Inc. in Springfield, MA. She serves on the FFTA
Editorial Committee.
and Supporting TFC Foster Parents to
Meet the Needs of Older Youth | continued from pg. 16
17

In this article we present Surviving
Independence, a video game about
life skills for teens in foster care. Here,
we discuss its game play design and
present the theory behind creating
this simulated world.
Aims of the Game
Surviving Independence aims to make
players question their independent
living (IL) skills and knowledge.
Players will be left wondering how
likely they are to survive, asking
themselves questions like these:
• How hard is it to earn enough to
survive?
• Will I have time to hang out with
my friends?
• Should I borrow money sometimes,
or is it always bad to borrow?
• Whose problem is it if someone
at my apartment gets drunk and out
of control?
The Transtheoretical
Model of Change
(TTM)
Surviving Independence uses
a research-based framework
called the Transtheoretical
Model of Change (TTM) to
address weaknesses in exist-
ing IL training. TTM posits
that successful change occurs
in stages and that change is effective
only when one is already at the previous
stage of change. The model was devel-
oped by Prochaska, Norcross, and
DiClemente (1995), who identified six
stages of change in successful substance
abuse programs. This model has recently
been applied to the area of financial
health (Klontz et al., 2008). Here, we
apply the TTM model to foster youth
transitioning to independent living,
focusing on the first three stages:
Precontemplation: Individuals don’t
know or don’t believe that they lack
knowledge or skills. They have little or
no motivation to change and little
insight that they would benefit from
increased knowledge and skills.
Contemplation: Individuals are willing
and able to acknowledge that they have
a need. They begin gathering informa-
tion to help them learn more about
their challenges and about possible
solutions.
Preparation: Individuals intend to put
change into action within the next
month. They move from gathering
information to planning to take action.
The later stages (Action, Main-
tenance, and Termination) are outside
the scope of this project and must be
covered by additional independent
living services, trainings, and support
services.
Most interventions are designed to
assist individuals in the Action stage,
assuming people are ready and willing to
modify their behaviors. However, only
approximately 20% of individuals are in
the Action stage (Prochaska et al., 1995).
In short, Stages of Change theory
suggests that effective interventions
must be matched to an individual’s
readiness to change. Readiness to
change is a common problem when
teaching money management and other
life skills to youth because they do not
fully realize the challenges they will
face when they emancipate.
Game Play
In the beginning of Surviving
Independence, players survive by “being
good”—using their existing knowledge
of basic survival. Most teens believe that
one must get a job, spend wisely, and
avoid obvious trouble choices to survive,
and most teens find it easy to achieve
those goals initially. Once players are
successful in saving some money, they
get a temporary, subsidized apartment.
At this point the challenge changes
from life skills to social skills. Social
skills become critical: Players must make
friends to hear gossip about the best
jobs and must learn to discern qualities
in others to convince a suitable peer to
be their roommate. Every computer-
controlled character in the
game seeks to fulfill his or
her needs (a design used
by e Sims, an extremely
popular commercial video
game). Different characters
have different needs, as
determined by personality
traits. Some characters use
friends as a resource to
meet their other needs and
so are quick to befriend
the player, are willing to be roommates,
and generally act like friends... but they
are more likely to have high-priority
needs to get drunk or high, and they
ultimately cause problems for the player:
They may invite strangers into the play-
er’s apartment; encourage the player to
drink and smoke; skip work; borrow
money from the player and often fail to
repay; refuse to end parties; and, when
drunk or high, not respect the player’s
wishes. Players must be assertive, state
18
SURVIVING INDEPENDENCE —by Josh Whitkin
continued on pg. 19

their own needs, and take action (e.g.,
kicking out a guy who brings beer) when
the situation is out of hand. Beyond
tactics, players learn to be strategic in
choosing friends: The reliability of
their peers is a key to their survival.
More challenges are introduced as
game play continues. Bosses start hav-
ing bad days, expecting unrealistically
high performance and assigning extra
shifts against the player’s wishes. Players
must decide whether to quit and seek
another job or to comply. Players must
decide if they should live somewhere
cheap and deal with the problems or
pay more for a safer area.
There is no single, prevailing strate-
gy: Sometimes tolerance is best; other
times teens must confront problems to
solve them. Players must decide case by
case how they want to live. There are
many combinations of choices that can
lead to success.
Additional Aims
Primarily, this game-based interven-
tion aims to move foster youth from the
Precontemplation stage to the
Contemplation and Preparation stages
of change. However, the game helps
players explore many other socially
beneficial topics:
• autonomy, decision making,
delayed gratification
• drug and alcohol use
• basic financial literacy
• peer social skills
• adult social skills
• female body acceptance
• racial and gender prejudice
• self-identity and self-exploration
This game weaves these topics into a
single, combined experience—a “scale
model” of real life for teens in foster
care who will age out of the system and
must survive on their own.
Here, we discuss one of these addi-
tional aims: drug- and alcohol-related
messaging.
In Surviving Independence, players see,
and make decisions around, use of
marijuana and beer (no hard alcohol
or other drugs). Our aim in showing
drugs and alcohol is to help teens
• make choices around drinking and
drug use and be held accountable for
the consequences
• protect themself from harm when
adults in their life use drugs and
alcohol
• experience surprising, hidden
impacts of drinking and drug use
To achieve these aims, the game
imparts the following drug- and
alcohol-related experiences:
• Using drugs adds risk and burden to
your bid for survival. It can cost you
your job and keep you from getting
an apartment.
• Friends who need to drink and use
drugs impact your life differently
than friends who don’t.
• “Going with the flow” leads to
trouble. You must seize control of
decisions being made in your life.
• When adults who hold power over
you, such as bosses and landlords,
drink or do drugs, it can impact
your life.
• Landlords may hold you accountable
when others drink or do drugs in
your apartment.
The game reinforces many of the
National Institute on Alcohol Abuse
and Alcoholism’s aims for its web-based
intervention titled e Cool Spot
(http://thecoolspot.gov/):
• Resisting spoken and unspoken
pressure
• Recognizing the myth versus the
reality of drug use
• Choosing the right way to decline
invitations to peer drug and
alcohol use
• Understanding how drinking
impacts more than the drinker.
Realism, Not Glorification,
of Drugs and Alcohol
Surviving Independence grabs player
attention by showing drunk or stoned
game characters. Because most educa-
tional games avoid drugs and alcohol,
this game is inherently funny and
19
SURVIVING INDEPENDENCE| continued from pg. 18
continued on pg. 20

20
attention-getting for almost every teen
player. However, the portrayal focuses
player attention on strategic (not dra-
matic or fun) decisions around drug and
alcohol use. This game intentionally
downplays the entertainment value:
Drunk characters do not stagger
comically. Stoned people aren’t cool,
don’t walk slow, or have red eyes. In
playtests, we have found that our design
is working as intended: Most teen play-
ers giggle about the drug references at
first, then shrug and focus on winning
the game.
This game lets players decide how
involved with drugs and alcohol they
want their social life to be. It is possible
to win the game while tolerating peer
drug use in a way that does not require
players to isolate themselves from all
drug use. However, to win the game,
players must decide on, set, and enforce
clear boundaries with drug users who
threaten players’ safety (for example, by
using drugs in their apartment, which
could get them evicted). The game
gives realistic consequences for each
decision, letting players conclude that
drug use or association with peers who
use drugs adds risk and unnecessary
burden to their attempt to survive.
Study Results
Surviving Independence has been tested
for functionality and engagement in
pilot “playtests.” Using qualitative meth-
ods (unstructured interviews, observa-
tion of teens playing early versions,
discussions with foster agencies), we
have produced convincing evidence
that the game is like to be strongly
engaging and entertaining for most
youth in foster care ages 12–21.
Efficacy studies will begin in 2015.
The overarching goal of these studies
is to see whether at-risk youth can
improve their motivation to effectively
learn life skills while using a simulated
environment that provides opportunities
to learn and apply life skills. To assess
this we will include measures related to
attitudes and motivation linked to the
acquisition of life skills. Specifically, we
will look at whether the game increases
aspects of users’ motivation and readi-
ness to change in ways that are relevant
to their impending emancipation—
including key components such as self-
efficacy and empathy—compared to
those who, using our existing e-learning
site Vstreet.com, do not have the expe-
rience of the simulated environment.
The evaluation will focus on two types
of data:
1. General information about the
demographic characteristics of the
sample and psychometric proper-
ties of the outcome measures
2. Intervention-specific data on the
effects of group on measures of
readiness to change (in relation to
emancipating), self-efficacy, empa-
thy, attitudes and beliefs about
money, money management
knowledge, and overall program
satisfaction and usability.
Participants will include a minimum
of 150 youth recruited from two sites,
representing a broad cross section of
at-risk youth targeted by the proposed
program: 75 from an independent
living program for foster youth, and
75 from a juvenile justice probation
program.
Conclusion
The Surviving Independence game is one
part of a complete IL curriculum. Our
overall objectives in developing this
game are to
• Create an engaging and meaningful
format for imparting life skills to
youth at risk;
SURVIVING INDEPENDENCE| continued from pg. 19
The game-based simulation will add a new
dimension that will help youth in care have
positive learning experiences while acquiring
and applying skills.
continued on last page

FFTA Founders
Action Youth Care, Inc.
Ripley, WV
Alternative Family Services
Santa Rosa, CA
Beech Brook
Cleveland, OH
Boys Town
Boys Town, NE
CONCERN
Fleetwood, PA
EMQ/FamiliesFirst
Campbell, CA
Family Alternatives, Inc.
Minneapolis, MN
Lilliput Children’s Services
Citrus Heights, CA
The MENTOR Network
Boston, MA
National Youth Advocate Program
Columbus, OH
PATH, Inc.
Fargo, ND
People Places, Inc.
Staunton, VA
Pressley Ridge
Pittsburgh, PA
Seneca Family of Agencies
San Leandro, CA
Specialized Alternatives for
Families and Youth
Delphos, OH
Volunteers of America
New Orleans, LA
FFTA Patrons
Bluewater Family Support Services
Parkhill, Ontario
Get in FOCUS
FOCUS is a newsletter distributed to all
Foster Family-based Treatment Association
agency members. Agency membership ranges
between $560 and $2,735 annually. Individual
subscriptions to FOCUS are $60 per year.
To join FFTA or subscribe to FOCUS, contact:
FFTA Headquarters, 294 Union Street,
Hackensack, NJ 07601, phone: (800) 414-FFTA,
fax: (201) 489-6719, e-mail: ffta@ffta.org.
Visit our Web site at www.ffta.org.
Appearance of advertising and listings in this
publication does not indicate endorsement or
support by the FFTA of the product or service.
Foster Family-based Treatment Association (FFTA) • 294 Union Street, Hackensack, NJ 07601 U.S.A.
Phone: (800) 414-3382 Fax: (201) 489-6719 E-mail: ffta@ffta.org Web: www.ffta.org
Newsletter of the Foster Family-based Treatment Association
The Foster Family-based Treatment Association strengthens agencies that
support families caring for vulnerable children.
• Convey the importance of acquiring life skills to at-risk youth and motivate them
to internalize IL training, using the Transtheoretical Model of Change; and
• Offer agencies a cost-effective, accessible, and proven tool to build youth aware-
ness of the skills needed to survive the transition to independence. Every day,
agencies have to confront the difficulty of training youth who have an unrealistic
view of how their lives will change once they emancipate.
Surviving Independence was developed to improve the impact of Vstreet
(www.vstreet.com), Northwest Media’s online life skills / IL training for foster teens.
The original Vstreet.com has several research-based curriculums available for use;
however, without a motivational factor, youth find the site too static. In this project
we will develop challenging game-playing functions to bring a cohesive quality to
the current site. The game-based simulation will add a new dimension that will help
youth in care have positive learning experiences while acquiring and applying skills.
References
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and Processes of Self-Change of Smoking:
Toward an Integrative Model of Change. Journal of Consulting and Clinical Psychology 51(3),
390–395.
Klontz, B. T., Bivens, A., Klontz, P. T.,Wada, J., & Kahler, R. (2008). “The Treatment of Disordered
Money Behaviors: Results of an Open Clinical Trial.” Psychological Services 5(3), 295.
Josh Whitkin is a Designer/Researcher at Northwest Media Inc, and Adjunct Lecturer in Games Art and
Design at School of the Arts at Murdoch University. Josh’s research focuses on mental health issues among
mainstream teens using innovative design of game-based interventions.
SURVIVING INDEPENDENCE
Save the Date!
August 2-5, 2015
FFTA 29th Annual Conference
on Treatment Foster Care
Denver Marriott Tech Center І Denver, CO

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