Foster care, Treatment complex trauma

An absence of behavioural problems does not necessarily indicate that foster children are thriving

A recent Dutch study investigates the effectiveness of a program, Foster Family Intervention (FFI), at improving the quality of interactions between foster children and their carers.  The rationale is that children who do not exhibit behaviour problems may react in avoidant and resistant manners, giving carers the impression that these children do not need additional care. However, carers may not be meeting the child’s need for emotional security and thus place them at risk of future psychological harm.

The study

One hundred and twenty three preschool age children were randomly allocated to a treatment group, i.e. FFI  or Care As Usual (CAU). The authors argue that the emotional well-being of the foster children will improve if their foster carers can demonstrate the following six capabilities: Sensitivity, Structuring, Non-Intrusiveness, Non-Hostility, Responsiveness and Involvement. A series of interactions between carers and children are videotaped and then assessed by independent reviewers  using a process called Emotional Availability Scales (EAS).

Carers were assessed using the EAS process within 2 weeks of a child being placed with them as well as at the six month mark of the child’s placement.

What is the Foster Family Intervention (FFI) Program?

The intervention is designed with inclusion of the principles from attachment theory, psych-education, mindfulness therapy and video reflection. It is described in the box below.

 The results

The findings of this study demonstrate that FFI results in ‘clinically significant’ improvements in four of the six EAS dimensions: Sensitivity, Non-intrusiveness, Structuring and Responsivity, but not Involvement. In this context, clinical significance means that on average, case managers would likely notice significant improvements in these dimensions for any foster carer that undertook the FFI program.

Take outs for Practitioners

  • Foster care agencies should consider using the EAS process for improving the skills of foster carers. Potentially, case managers could use the process when they visit foster children and their carers (see
  • The article provides a brief overview of the effectiveness of evidenced based intervention programs for foster children, i.e. Incredible Years, Parent-Child Interaction Therapy, Multidimensional Treatment Foster Care for Pre-Schoolers, Parent Management Training Program (Oregon). This may be a useful summary for those interested in the effectiveness of such programs but do not have time study the whole literature.


Foster Family Intervention (FFI) Program


Session 1: “Getting to know your child.” The foster carer learns to observe the child, learns what he or she feels and how to accept this.

Session 2: “Emotional security.” The foster carer learns to be mindful and sensitive to the often covert signals of the child.

Session 3: “Management of emotions.” The foster carer learns how to calm down the child and how to repair a broken contact or relationship.

Session 4: “Dealing with feelings of insecurity and trauma.” The foster carer learns about the consequences of insecurity and its possible effects on attachment relations.

Session 5: “Giving trust.” The foster carers learn to give age-appropriate developmental help to the child.

Session 6: “Surroundings and blind spots.” The foster carer is stimulated to reflect on his or her expectations as a foster carer, the attunement and collaboration with the biological parents, and the way the foster child adapts to his or her new family. Future plans are discussed.



Van Andel, H., et al. (2016). “Optimizing Foster Family Placement for Infants and Toddlers: A Randomized Controlled Trial on the Effect of the Foster Family Intervention.” American Journal of Orthopsychiatry 86(3): 332-344.











About graemembaird

I am a psychologist with a special interest in improving the outcomes of families, children and young people in the Out of Home Care and Juvenile Justice systems.
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