The trauma attachment model, as articulated by the Sanctuary Model or Bruce Perry etc, is the dominant treatment model or paradigm for residential care in Australia. This 2017 study from the USA serves as a reminder that there is an alternative paradigm, namely the Teaching Family Model (TFM). (See YouTube presentation on TFM here.)
TFM is based on the work of behavioural psychologist Montrose Wolfe. It implements the group home model whereby a married couple are paid to look after high risk 4-6 youth in addition to their own children. TFM is based on a behavioural approach whereby residents earn points for positive behaviours and lose points for inappropriate behaviours.
Behavioural approaches are also referred to as ‘positive behaviour support’ and ‘applied behaviour analysis’ (ABA) – the latter being invented by the aforementioned Montrose Wolfe (who, incidentally, is credited with the invention of ‘time out’ in the 1960s).
In Australia, TFM is not only rejected but actively disparaged because it is ‘behavioural’ in its approach. However, it is teasy to forget that TFM has amassed a significant body of evidence supporting its approach.
The California Evidence-Based Clearinghouse for Child Welfare (CEBC) is an organisation that assesses the effectiveness of interventions in child welfare. CEBC rate both TFM and the Sanctuary Model at the same level in terms of scientific validity. Furthermore, behavioural approaches remain first line evidenced-based interventions for people who have an intellectual disability and/or an autism related disability.
The study compared the results of 358 youth who were placed in FTM group homes to 196 youth who were placed in non-FTM homes. The Strengths and Difficulties Questionnaire (SDQ) was used to assess outcomes. The results showed that youth in both samples improved considerably over the 20-month placement. No surprise here. However, the TFM youth did much better on the 8 month mark post-placement.
Take out for Practitioners
I am not suggesting that the study should invoke a whole-scale revision of the trauma attachment model; far from it. The study is not especially strong on the methodological front. Rather, the study is a reminder that the trauma attachment model is not the only game in town. Moreover, whilst some aspects of the behavioural approach generate intense debate (e.g. the use of ‘time out’ and the points systems), other elements are relevant to all Practitioners who work with traumatised children (e.g. when to ignore negative behaviour, how to model and prompt appropriate behaviour and reinforcing pro-social behaviour).
I know of at least one large-scale residential care provider (in the child protection space) in Australia that is now formally training residential care staff in both trauma and positive behaviour approaches. This would seem to be a very sensible approach considering the supporting evidence of both approaches.