Program Profile: Fostering Healthy Futures® for Preteens

This is a positive youth development program for preadolescent children (ages 9-11) who have current or previous child welfare involvement due to one or more adverse childhood experiences. The program is rated Promising. Children who participated in the program displayed statistically significant reductions in posttraumatic stress symptoms, dissociation symptoms, and scores on key mental health outcomes, compared with children in the control group.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals/Target Population

Fostering Healthy Futures® for Preteens is a positive youth development program for preadolescent children (ages 9-11) who have current or previous child welfare involvement due to one or more adverse childhood experiences. The program is designed to support and promote the children’s skills and competencies with the goal of increasing overall child well-being and functioning in multiple domains.

Program Activities

Fostering Healthy Futures® for Preteens is a 9-month intervention that is composed of two major components: 1) manualized skills groups and 2) one-to-one mentoring with social work and psychology graduate students.

The manualized skills groups meet for 90 minutes a week for 30 weeks during the academic year. The groups consist of 8 children and 2 group facilitators—a clinician and a graduate student trainee. The skills group sessions are structured around a standardized program curriculum that includes cognitive–behavioral skill-building activities and process-oriented material. Curriculum units address topics such as emotion recognition, perspective taking, problem solving, anger management, cultural identity, change and loss, healthy relations, peer pressure, abuse prevention, and future orientation (Taussig, Culhane, and Hettleman, 2007). The skills group curriculum includes weekly activities that encourage children to practice newly learned skills with mentors in the community.

The program also includes a 30-week, one-on-one mentoring component. Mentors are graduate student interns in social work and psychology, who receive course credit for their time. Mentors are paired with two children with whom they spend 2 to 4 hours of individual time each week. Mentors are tasked with 1) creating an empowering relationship with the children that serve as positive examples for future relationships; 2) ensuring that children receive the appropriate services across various systems, and serving as a support for children as they face challenges in these systems; 3) helping children with using the skills learned in the skills group component in the real world through weekly activities; 4) engaging children in extracurricular, educational, cultural, social, and recreational activities; and 5) promoting a positive outlook for the future. Mentors also transport children to and from skills group activities and join the skills group for dinner.

Program Theory

The program is based on factors associated with adaptive functioning among high-risk youths. This model posits that adverse experiences and child welfare involvement can negatively affect psychological, social, and behavioral functioning, often contributing to mental health problems, risky behaviors, lower levels of competence, and poor quality of life (Milan and Pinderhughes, 2000; Schofield and Beek, 2005). Using this research as its foundation, the program seeks to create a supportive environment for children to learn from one another, while also reducing stigma.

Further, in an effort to promote adaptive functioning, the program matches each child with a mentor who serves as an additional role model and advocate. The program also uses positive youth development programming, which takes the perspective that children have strengths and resources to be fostered rather than that children have problems to be fixed. Three important components to promote positive youth development are 1) a positive sustained relationship with a mentor, 2) activities for building life skills, and 3) opportunities to use life skills in meaningful community activities (Taussig et al., 2019).

Key Personnel

Mentors are matched with children on factors such as geographic proximity, interest, demographic factors, child or family preferences, and mentors’ prior experience. Mentors receive weekly individual and group supervision and attend a didactic seminar.

Study

Taussig and colleagues (2019) conducted a randomized controlled trial to examine the effects of Fostering Healthy Futures® for Preteens on mental health outcomes for youth in foster care. The trial was conducted in Denver, Colo., beginning in 2002 and expanded to four metropolitan-area counties in 2007. This study was an extension of a pilot study (Taussig and Culhane, 2010). Participants were recruited in 10 cohorts over 10 consecutive summers from a list of all children ages 9–11 who were placed in foster care. Children were included as participants if they 1) had been placed in any type of out-of-home care (e.g., foster care, kinship care, residential treatment) by a court order because of maltreatment within the last year; 2) resided within a 35-minute drive to the skills group sites; 3) had lived with their caregiver for at least 2 weeks; 4) were not developmentally delayed; and 5) were proficient in English (although caregivers could be Spanish speaking). Eligible siblings were paired for randomization, and both were included in the trial (there were 22 sibling pairs included in the study).

The final sample of 426 children were randomized into an intervention group (n = 233, who received an assessment plus Fostering Healthy Futures® for Preteens) and a control group (n = 193, who received an assessment and recommendations for services). The mean sample age was 10.3. A little more than half of the sample (51.9 percent) identified as male. The intervention group consisted of children identifying as Hispanic/Latino (51.5 percent), white (50.6 percent), and Black (28.4 percent) [race/ethnicity was not mutually exclusive]. The mean number of referrals to social services before out-of-home placement was 4.69 referrals. The control group consisted of children identifying as white (49.7 percent), Hispanic/Latino (49.2 percent), and Black (25.4 percent) [race/ethnicity was not mutually exclusive]. The mean number of referrals to social services before out-of-home placement was 4.70 referrals. The baseline comparison analysis showed two statistically significant differences between the intervention and control groups. Mothers of children in the intervention group had a higher percentage of criminal history than the mothers of children in the control group (65.2 percent versus 55.4 percent, respectively), and children in the intervention group were more likely to have previously received mental health therapy than children in the control group (83.2 percent versus 75.6 percent, respectively). There were no other statistically significant differences between the groups at baseline.

Participants were assessed at baseline (2 to 3 months before starting the program) and at 6 months postprogram with their caregivers. Teachers were surveyed 10 months postprogram. The trial examined the effects of Fostering Healthy Futures® for Preteens on key mental health outcomes, of which the CrimeSolutions review of this study focused on a multi-informant (child, caregiver, teacher) index of mental health problems and youth-reported posttraumatic stress symptoms (including dissociation symptoms). Mental health functioning was assessed using the Posttraumatic Stress and Dissociation scales of the child self-report Trauma Symptom Checklist for Children and the internalizing scales of the Child Behavior Checklist and the Teacher Report Form. A multi-informant mental health index was created based on a principal-components factor analysis of the children’s mean Trauma Symptom Checklist for Children scores, and the internalizing scales of the Child Behavior Checklist and Teacher Report Form.

Equivalence between intervention and control groups on baseline characteristics and outcome measures was assessed using chi-square tests for categorical variables and t-tests for continuous variables. Linear regression models were used to predict continuous outcome variables with effect sizes estimated with Cohen’s d. Logistic regression was used to examine odds ratios for dichotomous outcomes. Subgroup analysis was conducted to examine whether demographic, adverse childhood events, or baseline functioning variables moderated the impact of the intervention on outcomes.

Fostering Healthy Futures® for Preteens is disseminated through community-based agencies. Manuals and implementation training are available through the program website: https://www.fosteringhealthyfutures.org/

Subgroup Analysis

Taussig and colleagues (2019) conducted subgroup analysis to examine whether the impact of Fostering Healthy Futures® for Preteens was moderated by baseline variables including gender, race/ethnicity, type of placement (foster versus kinship care), intellectual functioning, experiences of adverse childhood events, and mental health functioning. They found three statistically significant interactions. Reporting lower levels of adverse childhood events at baseline was associated with statistically significant stronger treatment effects on measures of posttraumatic stress symptoms and quality of life.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

California Evidence-Based Clearinghouse for Child Welfare. 2014. “Fostering Healthy Futures (FHF)”. San Diego, Calif.: California Department of Social Services, Office of Child Abuse Prevention. Accessed April 20, 2015.

Milan, Stephanie E., and Ellen E. Pinderhughes. 2000. "Factors Influencing Maltreated Children's Early Adjustment in Foster Care." Development and Psychopathology 12(1):63–81.

Taussig, Heather N., and Sara E. Culhane. 2010. “Impact of a Mentoring and Skills Group Program on Mental Health Outcomes for Maltreated Children in Foster Care.” Archives of Pediatrics and Adolescent Medicine 164(8):739–46.

Taussig, Heather N., Sara E. Culhane, Edward Garrido, and Michael D. Knudtson. 2012. “RCT of a Mentoring and Skills Group Program: Placement and Permanency Outcomes for Foster Youth.” Pediatrics 130(1): e33–9. (This study was reviewed but did not meet CrimeSolutions criteria for inclusion in the overall program rating.)

Taussig, Heather N., Sara E. Culhane, and Daniel Hettleman. 2007. “Fostering Healthy Futures: An Innovative Preventive Intervention for Preadolescent Youth in Out-of-Home Care.” Child Welfare 86(5):113–31. 

Taussig, Health N., Julie Dmitrieva, Edward F. Garrido, John L. Cooley, and Erin Crites. 2021. “Fostering Healthy Futures Preventive Intervention for Children in Foster Care: Long-term Delinquency Outcomes from a Randomized Controlled Trial.” Prevention Science 22:1120–33.

Following are CrimeSolutions-rated programs that are related to this practice:

Mentoring for Youth Development

This practice provides youth with a positive and consistent adult or older youth relationship to promote healthy youth development and social functioning and to reduce risk factors. The practice is rated Effective in reducing delinquency and improving educational outcomes; Promising in improving psychological outcomes and cognitive functioning; and Ineffective in reducing substance use.

Evidence Ratings for Outcomes

	Crime & Delinquency - Multiple crime/offense types
	Education - Multiple education outcomes
	Mental Health & Behavioral Health - Psychological functioning
	Mental Health & Behavioral Health - Cognitive functioning
	Mental Health & Behavioral Health - Social functioning
	Drugs & Substance Abuse - Multiple substances

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?