The Center for the Study of Violence Against Children (CSVAC)

THE COMPREHENSIVE ASESSMENT AND TRAINING SERVICES (CATS) PROJECT TREATMENT PROGRAM

The CATS treatment initiative is designed to 1) address the needs of foster/adoptive children and their families who had been assessed in the CATS program, and 2) to respond to concerns raised by the Cabinet for Health and Family Services about the growing number of adoptions that were being disrupted in Kentucky. A first step in the development of treatment protocols was the identification of existing model programs in the literature and new technologies under development and receiving support from the National Institute of Mental Health. Programs specifically designed for children ages 0 –5 and their families were selected for further study. Several evidence-based treatment protocols are used to address the unique challenges of adoptive families. The selection of all intervention protocols was guided by the following philosophy.

Philosophy

A child’s biopsychosocial development is greatly impacted by experiences in the first five years of life. Events such as trauma, neglect and child maltreatment can have a deleterious effect on the course of development and the child’s overall well-being. Intervention approaches must consider the child in context of their social environment and primary attachment relationships. With this in mind, the intervention protocols utilized by CATS are guided by the following principles.

Treatment should

Emphasize the importance of the relationship rather than behavior.
Empower the parent(s) to nurture the child even when the child resists.
Recognize that parents are doing the best they can and need help and encouragement rather than criticism.
Assist by modeling appropriate behavior. Parents need to experience support and encouragement in the relationship with the therapist in order to do the same with the child.
Teach parents to identify their own biases that may interfere with effective parenting.
F. Help parents feel supported and recognize their struggles are not unique, e.g. parent group.
Provide opportunities for experiential learning rather than relying on purely didactic presentations. Experience is the best way to learn and change behavior.
Help the parent understand that the child’s behavior results from frustration with caregivers not being nurturing and dependable in the past.
Stress the importance of allowing children to affect their world through their relationship with the parent.

Mission Statement

The CATS project seeks to develop, implement and evaluate “best practice” treatment for families dealing with an adoptive/concurrent placement child suffering from attachment spectrum difficulties, using innovative and empirically tested methodologies.

Goals

To prevent adoption disruptions by providing tailored treatment experiences to children and families identified as “at-risk” for adoption disruption during the CATS assessment process.
Improve the quality of the parent-child relationship and reduce barriers to the development of secure attachment relationships in families who are experiencing difficulties, but who are not at immediate risk for disruption.
Marshal community resources to address the unique needs of each family.
Create a supportive network of adoptive/foster families and professionals throughout the Commonwealth of Kentucky.
Determine, with research, the effectiveness of this intervention and train others in the appropriate use of the protocol.

Scope

Ten weekly, in- home, sessions for 4-6 families at a time. Three groups will be conducted per year.
The Partners In Relationships intervention program is offered to families with children five and under in Fayette and surrounding counties.
Support group services are open to families across the Commonwealth.
Crisis Intervention, advocacy and psychoeducational programs are offered to families throughout Kentucky with the assistance of telemedicine technology.
Individually designed treatment programs for families identified
during the CATS assessment process as having needs that
cannot be met elsewhere are offered on a limited basis.

Eligibility

Families with children who have been identified by DCBS as a concurrent planning or adoptive home, or those who have adopted children and have (or have had in the past) an open DCBS case. The “Partners In Relationships” intervention program only accepts children ages 0-5 and their families.

Referral Process

Individuals and families who have been assessed by the CATS project can be referred by a CATS team member using the “Treatment Referral Form”. Referrals from outside sources (treatment facilities or providers) are accepted at the discretion of the principal investigators, as long as they qualify under the eligibility criteria described above. Potential participants are then sorted based on the type of service requested. The treatment team then reviews these referrals and responds in one of the following ways:

Accepts the referral and schedules the appropriate intervention.
Declines the referral and provides alternative treatment options to the referring clinician.
Accepts the referral and (if a candidate for the Partners In Relationships program) places the referral in the candidate pool for group assignment. Participants are then sent a letter of invitation (see addendum) and, if interested, will be scheduled a time to begin the intervention.

Consent to Treatment

All treatment participants are provided with the “Consent to Treatment and Limits to Confidentiality” form to sign during their first session. Additionally, a signed “Photographic/Video Release” consent form is obtained since many of the intervention procedures are videotaped and used as part of the intervention process. Because the CATS project is a University-based program and a training facility for graduate students and medical residents, a permission form allowing students to observe and participate in procedures is also obtained.

Evaluation

The effectiveness of the “Partners In Relationships” program is being determined by a concurrent research protocol conducted by the CATS project. All research protocols have been approved by the University of Kentucky Institutional Review Board, as well as the Institutional Review Board for the Cabinet for Health and Family Services. A “Consent to Participate in a Research Study” form is reviewed and obtained from all treatment participants that elect to participate in the research protocol. Pre and Post-test data are obtained from all participants in the areas of parenting stress, attachment, family stress, child abuse potential, and child behavior and functioning. Additionally, a qualitative analysis of the parent’s relationship with their child and the type and quality of weekly interactions is conducted by the treating clinicians following each session using a weekly performance rating sheet. Parent satisfaction with the intervention is assessed at the end of the 10-week program. The satisfaction survey and the weekly rating sheets are included in an addendum.