Home Program

Intensive Alternative Family Treatment (IAFT®)

Topic Areas
Scientific Rating
Child Welfare Relevance
Placement Stabilization Programs
3  — Promising Research Evidence
High

About This Program

Target Population: Children and adolescents ages 5-18 years of age (allowable up to age 21 with approval) with high behavioral health needs requiring an out-of-home placement, and their caregivers

For children/adolescents ages: 5 – 21

For parents/caregivers of children ages: 5 – 21

Program Overview

Intensive Alternative Family Treatment (IAFT®) is a specialized family type, therapeutic treatment foster care service provided to children/youth and their families in a community setting founded on (14) IAFT® Practice Elements. Individuals with a need for this level of care often present with challenging behaviors; need an out-of-home placement; will benefit from clinically focused treatment to avoid placement in a higher level of care; and/or are making a planned transition from a more restrictive setting. The desired outcome is to exhibit improved individual and family system functioning upon successful return to a natural living home/least restrictive setting after treatment. IAFT® provides a trauma-informed, structured, therapeutic, and supervised home environment to decrease problem behaviors and improve the level of functioning for children/youth and their families or natural supports. Through continuous quality improvement activities and quarterly compliance reviews, fidelity to the IAFT model and its 14 practice elements is monitored.

Program Goals

The goals of Intensive Alternative Family Treatment (IAFT®) are:

  • Prevent or divert placement in a higher level of care.
  • Improve functioning by self and with family system.
  • Decrease problem behaviors/symptoms.
  • Progress towards independence and successful community tenure without a return to higher levels of care.
  • Improve communication, social, conflict resolution, and emotional regulation skills.
  • Improve overall wellness.
  • Improve independent living skills.

Logic Model

View the Logic Model for Intensive Alternative Family Treatment (IAFT®).

Essential Components

The essential components of Intensive Alternative Family Treatment (IAFT®) include:

  • IAFT® is an intensive treatment service designed to improve the overall emotional health and functioning of the youth and their family/support system.
  • Individualized behavior management program:
    • Proactive, consistent, teaching-oriented behavioral intervention system provided to the youth by IAFT® treatment parents
    • Behavioral interventions must be in place and utilized by IAFT® staff in a manner that works to improve or maintain the youth’s behavioral health and prevent development of additional problems.
    • Strength-based interventions and positive reinforcement are key to behavior change and self-efficacy of the youth.
  • One child focus:
    • Single child placement per IAFT® treatment home to enable concentrated behavioral interventions (sibling exceptions made)
    • Focused one-on-one interventions and purposeful day-to-day interaction between the youth and treatment parent(s) allows for heightened treatment and intensive management of behavior towards rehabilitation of presenting needs
  • IAFT® Team which consists of:
    • IAFT® Supervisor
    • Family Coordinator/Consultant
    • Therapist
    • Treatment Parent(s)
    • Psychiatric Provider
  • Child and Family team which consists of:
    • The child/youth
    • A family of permanence (birth parents, relatives, etc.)
    • Legal guardian
    • Legal Advocates
    • Teachers/academic staff
    • Pediatrician
    • Probation
    • Other natural supports
  • Shared parenting:
    • Transfers knowledge between the family of permanence and Treatment Parent(s) regarding the youth's success while in treatment, positive behavioral interventions
    • Grounded on a partnership approach to ensure reunification efforts are based on skill enhancement and replication following discharge
    • Examples include:
      • Phone calls
      • In-person meetings prior to/following home visits
      • Conjoint attendance at meetings, appointments, and family therapy sessions
      • Routine Child and Family Team meetings
  • Lighter caseloads:
    • Caseload of 8 to 10 children per IAFT® family coordinator:
    • Allows for deliberate organization of case management and care coordination activities between all child and family team members involved in the youth’s care to facilitate the appropriate delivery of IAFT® services.
    • The IAFT® Coordinator/Consultant has daily contact and weekly supervision with Treatment Parent:
      • Provides consultative skill building based on behaviors/needs reported.
      • Addresses placement stability, shared parenting, and burnout prevention.
  • Behavior change tracking:
    • Data for all 7 days recorded in the database by Treatment Parents allowing for:
      • Enhanced level of support to the treatment parent
      • On the spot problem solving and ongoing evaluation of youth behaviors and interventions that are tied to target/problematic youth behaviors
      • Tracking and discussion of frequency of observed target youth behaviors throughout the day
      • Evaluation of the effectiveness of IAFT® treatment parent intervention and overall progression or regression of youth behavioral response and motivation to change
      • Attention to stress level variations of IAFT® treatment parent that might indicate additional supervision, training, or respite care need
      • Building and maintenance of rapport and support of team through increased, purposeful, and productive communication to promote placement stability
      • Tracking of incidents or efforts at shared parenting sessions with family of permanence to support transition/discharge plans
  • Outcomes measured and evaluated: clinical level outcomes for youths and families, agency process outcomes are completed, tracked in the agency database (CCW), and analyzed for treatment indicators of progression, and emerging needs.
  • 24/7 crisis support:
    • Proactive crisis planning, response, and prevention
    • Addresses challenging behaviors while providing the youth a safe and supervised opportunity to utilize new skills and coping strategies.
    • Crisis supports operate on:
      • Known predictive behaviors
      • Trauma triggers
      • Past successful interventions and response strategies for the youth and their supports
  • Psychiatric consultation:
    • At a minimum of once every 30 days
    • Psychiatric staff
      • Review and coordinate the overall clinical direction of treatment
      • Determine with team members any other needed supports, services, or recommendations.
    • Team approach to assess therapeutic interventions and supports to achieve youth/family outcomes and transition planning
  • Respite care:
    • Available 2 days a month for the IAFT® treatment parent and youth
    • Planned Respite for the IAFT® treatment parent provides a break from the day-to-day caregiving
    • Not meant solely for crisis management of the youth
    • Helps maintain relationships
    • Helps prevent burnout
    • Helps prevent potential placement disruption
    • Weekly therapy:
      • Designed for the youth and their family of permanence, Treatment Parents, and support system; conjoint sessions with Treatment Parents and Family Therapy Sessions with family of permanence are expected throughout treatment
      • Designed to ensure treatment progress and reduction in presenting needs
      • Designed to add support to transition/discharge permanency plans
    • Weekly documentation allows for parental, or family of permanence, engagement in IAFT® treatment and/or development of natural community supports:
      • The IAFT® Coordinator/Consultant typically documents weekly efforts reflective of Treatment Parents activities, engagement with the family of permanence or natural supports.
      • The Treatment Parent(s) also document daily in "Grid/service notes" engagement interventions and interactions.
      • Designed to engage, empower, motivate, and strengthen family functioning and reintegration of the youth into the family system or community upon treatment completion
      • All members of the IAFT® team embrace a systems of care approach that is collaborative, strength-based, and solution-focused.
      • All efforts should identify solutions that will remove barriers, increase healthy functioning, strengthen caregiver–youth interactions, and build protective capacity for the youth and/or family system.
    • Therapeutic Leave:
      • Scheduled "home visits" when the youth leaves the Treatment Home and goes back to the family home for brief 2-3 days to practice new skills, works on family bonds/reunification.
      • Ideally, the family of permanence maintains the structure, rules, and positive behavioral interventions communicated through shared parenting with treatment parent(s) for maximum consistency.
      • Specific skills and techniques are person-centered based on the individual youth's trauma history, diagnoses, and skill/cognitive level.
    • For those youth without an identified/involved family of permanence, IAFT® is designed to develop and strengthen community connections based on natural supports for the youth to support independent living and community tenure.

Program Delivery

Child/Adolescent Services

Intensive Alternative Family Treatment (IAFT®) directly provides services to children/adolescents and addresses the following:

  • Disruptive behaviors (e.g., AWOL/leaving without permission, poor conflict resolution, aggression (verbal/physical), defiance, hyperactivity, stealing, substance use/abuse); emotional dysregulation (e.g., anxiety, fearful behavioral responses, reactive behaviors/trauma-linked behaviors, depression, mood dysregulation, self-injurious behaviors); problematic behaviors linked to trauma response or skill deficit (e.g., food issues (e.g., hoarding, overeating, refusing to eat), encopresis/enuresis, hygiene skills (self-care) concerns, executive functioning deficits, sexualized behaviors (e.g., reactive or inappropriate); and school problems (e.g., academic, social, compliance)

Parent/Caregiver Services

Intensive Alternative Family Treatment (IAFT®) directly provides services to parents/caregivers and addresses the following:

  • Parent/Caregiver/family member of permanence of child/adolescent with disruptive behaviors, behavioral health stressors, child welfare involvement leading to out-of-home placement, exposure to past trauma, and unhealthy family system communication/relationships
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: IAFT® may include direct collaboration with teachers, mentors, legal guardians, prior treatment parents, extended family members (e.g., potential kinship placements or connections), potential adoptive family, advocates, appropriate peers and community partners.

Recommended Intensity:

Child/youth: Behavioral interventions available 24 hours a day/7 days a week via the treatment parent; minimum 1 hour of weekly individual or family therapy or more as clinically appropriate with parents or family of permanence; monthly respite to give a break from being with treatment parent. Family of permanence: Shared parenting as frequently as possible; planned therapeutic leave with child to work on relationship repair, skill acquisition, and preparedness for reunification; visitation with parents/family of permanence (supervised or unsupervised) as directed by any legal child welfare recommendations to support permanency.

Recommended Duration:

Average length of stay with treatment family is 9–12 months, however there is no set maximum or minimum.

Delivery Setting

This program is typically conducted in a(n):

  • Foster / Kinship Care

Homework

Intensive Alternative Family Treatment (IAFT®) includes a homework component:

Homework is not required, but often given as part of ongoing individual or family therapy for the youth/child (and family) in treatment.

Resources Needed to Run Program

The typical resources for implementing the program are:

Internet access for documentation, training space, mobile phones or landlines for daily check-ins, office space for team meetings, licensed and trained treatment parents/homes, computers for documentation, and vehicles for appointment transportation

Manuals and Training

Prerequisite/Minimum Provider Qualifications

IAFT® Treatment Parent(s) should have a high school diploma or higher and be licensed to provide Therapeutic Foster Care.

IAFT® Program Coordinator and Supervisor(s) should have a Bachelor’s degree or higher and 2 years of experience in the behavioral health or child welfare field.

IAFT® Therapists should be licensed professional clinicians with a Master’s degree or higher.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual Information:

  • Newman, M., Lauret, R., & McClarin, P. (2021). Intensive Alternative Family Treatment user manual, (ver. III-2021). Rapid Resource for Families.

The manual is available directly from Rapid Resource for Families.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Training can be provided either: Onsite training at trainee organization (initial and ongoing), online/virtually, or regional training can be provided to multiple trainee organizations -often for refreshers or following program updates.

Number of days/hours:

Intensive 2-day training for all staff delivering IAFT® and an additional 4 hours of model focused content for IAFT® parent training (in addition to required training for licensing body and agency model).

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Intensive Alternative Family Treatment (IAFT®) as listed below:

Agencies/Organizations interested in becoming an IAFT® Provider complete an application (readiness assessment) which elicits information to ensure entity is ready to move forward in the application/review process. For more information, please contact the program representative listed at the end of the page.

Formal Support for Implementation

There is formal support available for implementation of Intensive Alternative Family Treatment (IAFT®) as listed below:

As an agency is approved, the agency is provided one-on-one assistance during the onboarding, training, and beginning stages of implementation. This can be done in any combination of onsite visits, virtual meetings, and telephone and/or email support/communication. Additionally, a data analyst is assigned to the agency to assist with data entry and database usage and technology support/help-desk activities. If needed, marketing and recruitment of treatment parent resources, materials, and formal support is/can be provided.

Reflective team supervision: Weekly face-to-face contact between IAFT® staff, therapist, and supervisor. Effective group/team supervision both clinical and administrative is integral to the adherence to IAFT® fidelity. Equally important is the teamwork and communication among team members. A designated time is provided for the team to review current IAFT® caseload.

Fidelity Measures

There are fidelity measures for Intensive Alternative Family Treatment (IAFT®) as listed below:

  • Model fidelity monitoring: IAFT® quality standards are ensured by supporting provider Agencies with ongoing training, feedback, and quarterly compliance review processes. In addition, monitoring Agency (RRFF) engages Agency in continuous quality improvement processes by tracking model successes and adjusting treatment delivery or agency implementation of the IAFT® model.
  • Quarterly monitoring of IAFT® provider agency: A combination of documentation/file review of the (14) IAFT® Elements and database compliance. As compliance reviews are completed, a file score is provided as well as aggregated for all files for the agency that quarter. Consultative feedback is provided to each agency to support ongoing model fidelity, address any model fidelity drift, and provide action items for agencies to implement to improve process outcomes.
  • Data reporting and analysis: Reports and outcomes (clinical and process) are tracked continuously and reported out to agencies on a quarterly basis but available by request at any time.
  • Fidelity checklists and database checklists are also available to assist agencies in conducting internal peer reviews outside of fixed quarterly compliance reviews. These checklists are available on the agency website: www.ncrapidresource.org) or direct contact to Rapid Resource for Families.

For more information, please contact the program representative listed at the end of the page.

Implementation Guides or Manuals

There are implementation guides or manuals for Intensive Alternative Family Treatment (IAFT®) as listed below:

The implementation guide is available upon request:

  • Newman, M. (2021). Onboarding network guide. Rapid Resources for Families.

For more information, please contact the program representative listed at the end of the page.

Implementation Cost

There have been studies of the costs of implementing Intensive Alternative Family Treatment (IAFT®) which are listed below:

Lanier, P., Rose, R., & Domino, M. E. (2023). Comparing Medicaid expenditures for standard and enhanced therapeutic foster care. Administration and Policy in Mental Health and Mental Health Services Research, 50, 702–711. https://doi.org/10.1007/s10488-023-01270-1

Research on How to Implement the Program

Research has not been conducted on how to implement Intensive Alternative Family Treatment (IAFT®).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Permanency

Rose, R. A., Chung, G., & Lanier, P. J. (2021). Effectiveness of Intensive Alternative Family Treatment on reducing re-admissions to psychiatric residential treatment facilities. Journal of Emotional and Behavioral Disorders, 29(2), 113–124. https://doi.org/10.1177/1063426620980700

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 221 youth

Population:

  • Age — Average=17.5 years
  • Race/Ethnicity — 57% White, 35% African American, 7% Latinx, 2% Asian American/ Pacific Islander, and 2% Native American
  • Gender — 44% Female
  • Status — Participants were youth with at least one initial or “prior” psychiatric residential treatment facilities (PRTF) admission.

Location/Institution: North Carolina

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to present findings from a quasi-experimental study examining the effectiveness of Intensive Alternative Family Treatment (IAFT) services. The study linked IAFT program data to Medicaid claims data in order to develop a quasi-experimental study design to compare outcomes for two groups: (a) youth referred to IAFT who received services and (b) youth referred to IAFT who did not receive IAFT services (i.e., usual care). Measures utilized include administrative data from Medicaid claims data (2011–2018) from the state Medicaid agency and referral data from Rapid Resources for Families (RRFF) to identify youth who received IAFT. Results indicate that receipt of IAFT was associated with a 24% lower risk of psychiatric residential treatment facility (PRTF) re-entry compared with youth who exited from a PRTF in the same state but did not receive IAFT. Sensitivity tests yielded mixed results regarding the effect of IAFT. Limitations include reliance on claims data as opposed to structured clinical interviews likely resulted in measurement error, data do not reflect whether sampled youth received services before and after the study period, about a 20% loss of data based on fuzzy matching procedures, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Lanier, P., Chung, G., & Rose, R. (2022). A quasi-experimental study of Intensive Alternative Family Treatment to prevent entry of youth to psychiatric residential treatment. Child and Adolescent Social Work Journal, 39(3), 303–311. https://doi.org/10.1007/s10560-021-00758-9

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 1655

Population:

  • Age — Mean=15.7 years
  • Race/Ethnicity — 44% Black
  • Gender — 44% Female
  • Status — Participants were youth who received IAFT services from 2011 to 2018, and who had not entered a psychiatric residential treatment facility (PRTF).

Location/Institution: North Carolina

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of Intensive Alternative Family Treatment (IAFT) in reducing first entry into psychiatric residential treatment compared to usual care. This study linked IAFT program data to Medicaid claims data in order to develop a quasi-experimental study design to compare outcomes for two groups: (a) youth referred to IAFT who received services and (b) youth referred to IAFT who did not receive IAFT services (i.e., usual care). Measures utilized include administrative data from Medicaid claims data (2011–2018) from the state Medicaid agency and referral data from Rapid Resources for Families (RRFF) to identify youth who received IAFT. Results indicate that there was a significant reduction in risk for entry to psychiatric residential treatment favoring IAFT. Limitations include findings can only be generalized to one Southeastern state, youth were not randomly assigned to IAFT, outcomes were derived from administrative data, which involved a data linkage procedure that had an 80% success rate, youth in the sample may have experienced other unmeasured adverse outcomes aside from PRTF entry, some youth in sample may have entered PRTF prior to sampling, there is no way to know which PRTF admissions were necessary (i.e., due to severe clinical need) and which could have been more appropriate for diversion to a program such as IAFT, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Additional References

Seibert, J., Feinberg, R., Ayub, A., Helburn, A., & Gibbs, D. (2018, April). State practices in treatment/therapeutic foster care. RTI International. https://aspe.hhs.gov/sites/default/files/private/pdf/259121/TREATMENTFOSTERCARE.pdf

Contact Information

Meredith Newman, MA LCAS
Title: Executive Director
Agency/Affiliation: Rapid Resource for Families
Website: ncrapidresource.org/services/iaft
Email:
Phone: (704) 516-4870
Rashel Lauret, MS LMFT
Title: Deputy Director
Agency/Affiliation: Rapid Resource for Families
Website: ncrapidresource.org/services/iaft
Email:
Phone: (910) 330-9995

Date Research Evidence Last Reviewed by CEBC: September 2023

Date Program Content Last Reviewed by Program Staff: May 2023

Date Program Originally Loaded onto CEBC: September 2022