Fostering Hope: Improving Outcomes for Youth in Foster Care





Project Title: Improving Outcomes for Youth in Foster Care: Trauma-focused CBT (R34)
PI: Shannon Dorsey, Ph.D.
Co-Investigators: Lucy Berliner, LICSW; Robert McMahon, Ph.D.
Funding: National Institute of Mental Health (NIMH, 2008 – 2012)


Children and adolescents in foster care have significant, and often unmet, mental health needs1. For school-aged youth, the most common problems are disruptive behavior disorders and sequelae of trauma exposure (e.g., Posttraumatic Stress Disorder [PTSD], Depression)2. Such mental health problems, in turn, are linked to a range of negative outcomes (e.g., functioning, placement stability/permanency)3,4. There is tremendous interest in the field to increase use of evidence-based treatments that target specific mental health problems and needs of youth in foster care. Trauma-focused Cognitive Behavioral Therapy (TF-CBT) potentially provides an excellent fit. Evidence from randomized trials supports the efficacy of TF-CBT in treating PTSD, behavior problems, and other trauma sequelae5. Although TF-CBT holds promise for youth in foster care, there are likely complexities in providing it to such youth. Findings from dismantling research indicate that caregiver involvement is crucial for maximizing treatment effects of TF-CBT6. However, available evidence and our clinical experience suggest that foster parents are infrequently engaged in a proactive and ongoing manner in their foster children’s mental health treatment. Therefore the primary aim of the proposed R34 is to conduct a pilot study of TF-CBT with children and adolescents in foster care, with a targeted focus on engaging foster parents in treatment. The proposed project brings together two complementary interventions—evidence-based engagement strategies7 and TF-CBT8,9—in an attempt to improve treatment and outcomes for youth in foster care. The project includes two phases: Phase 1: (a) preliminary feasibility study (N = 10) of the evidence-based engagement strategies and TF-CBT; and (b) refinement and development of a manualized engagement intervention based on feedback from foster parents and other key informants. Phase 2: pilot study (N=80) of the refined engagement strategies and TF-CBT (E+TF-CBT) compared to ‘usual practice’ TF-CBT (i.e., no specialized engagement) to assess implementation of the combined intervention and provide preliminary data on critical outcomes (e.g., PTS symptoms, behavioral problems, placement stability). Findings will be used to inform a large-scale randomized trial (i.e., R-01) on effectiveness of E+TF-CBT to improve outcomes for youth in foster care with mental health problems.

Referenced on the Web:


  1. Dorsey, S., Cox, J. R., Conover, K. L., & Berliner, L. (2011). Trauma-focused cognitive behavioral therapy for children and adolescents in foster care. Children, Youth, and Family News, APA, Summer 2011 Issue.
  2. Dorsey, S., Burns, B.  J., Southerland, D., Cox, J. C., Wagner, R., & Farmer, E. M. Z. (2011). Prior trauma exposure for youth in treatment foster care.  Journal of Child and Family Studies, 6, 1–9.
  3. Dorsey, S., & Deblinger, E. (2012).  TF-CBT applications for children in foster care. In J. Cohen, A. Mannarino, & E. Deblinger  (Eds.), Applications of Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents (p. 49-72).Guilford Press.
  4.  Dorsey, S., Pullmann, M., Berliner, L., Koschmann, E.F., McKay, M., & Deblinger, E. (2014). Engaging foster parents in treatment: A randomized trial of supplementing Trauma-focused Cognitive Behavioral Therapy with evidence-based engagement strategies. Child Abuse and Neglect. Advance online publication.
  5. Dorsey, S., Conover, K., & Cox, J. R. (2014). Improving foster parent engagement: Using qualitative methods to guide tailoring of evidence-based engagement strategies. Journal of Clinical Child and Adolescent Psychology. Advance online publication.


  1. Dorsey, S. (2009, May). Fostering hope: TF-CBT and evidence-based practices with youth in foster care. Invited Plenary. Delaware Child Mental Health Conference, Newark, DE. Invited Plenary.
  2. Dorsey, S. (2009, June). Fostering HOPE: Improving outcomes for youth in foster care with trauma-focused cognitive behavioral therapy. Presented at the American Professional Society on the Abuse of Children, Atlanta, GA.
  3. Dorsey, S. & Feldman, E. S. (2010, January). Fostering Hope: Trauma-focused cognitive behavioral therapy with youth in foster care. Presented at the 24th Annual San Diego International Conference on Child and Family Maltreatment, San Diego, CA.
  4. Dorsey, S., Feldman, E., Conover, K., & Cox, J. R.  (2011, January). Fostering Hope: Trauma Focused CBT with youth in foster care. Presented at the 25th Annual San Diego International Conference on Child and Family Maltreatment, San Diego, CA.
  5. Dorsey, S., Cox, J. R., & Conover, K. L. (2011, November). Trauma-focused Cognitive Behavioral Therapy with Youth in Foster Care: Engaging Foster Parents. In Using Stakeholder Input to Refine Evidence-Based Treatments for Dissemination. Symposium presented at ABCT’s 45th Annual Convention, Toronto, Canada.


1 Leslie, L., Hurlburt, M., Landsverk, J., Barth, P., & Slymen, D. (2004). Outpatient mental health services for children in foster care: A national perspective. Child Abuse & Neglect, 28, 699-714.

2 Landsverk, J., Burns, B. J., Stambaugh, L. F., & Reutz, J. A. R. (2006). Mental health care for children and adolescents in foster care: Review of research literature. Report prepared for Casey Family Programs. Seattle, WA: Casey Family Programs.

3 James, S., Landsverk, J., & Slyman, D. (2004) Patterns of placement movement in out-of-home care. Children and Youth Services Review, 26, 185-206.

4 Landsverk, J., Davis, I., Ganger, W. Newton, R., & Johnson, I. (1996). Impact of psychosocial functioning on reunification from out-of-home placement. Children and Youth Services Review, 18, 447-462.

5 Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 393-403.

6 Deblinger, E., Lippmann, J., & Steer, R. A. (1996). Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1, 310-321.

7 McKay, M. M., Stoewe, J., McCadam, K., & Gonzales, J. (1998) Increasing access to child mental health services for urban children and their caregivers. Health Social Work, 23 (1), 9-15.

8 Cohen. J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press.

9 Deblinger, E., & Heflin, A. H. (1996). Treating sexually abused children and their nonoffending parents: A cognitive behavioral approach. Thousand Oaks, CA: Sage Publications.