Title The Crucial Role of Foster Parents
AAP Grant ID 2698
Project Year 2021
City & State Fresno, CA
Program Name CATCH Resident
Topic Child Abuse & Neglect
Program Description

​Adverse childhood experiences (ACEs) have been described as the greatest public health threat facing our nation today. The landmark Adverse Childhood Experiences (ACE) Study demonstrated the long-term impact of childhood trauma and adult health. In this study, the seven categories of ACEs included psychological, physical or sexual abuse, violence against mother, living with household members who were substance abusers, mentally ill, suicidal, or imprisoned. As the number of ACEs increased, the number of negative health outcomes also increased. This study and others have shown that children with ACEs are more likely to have learning and behavioral issues, ADHD, oppositional behaviors, early initiation of sexual activity, and adolescent pregnancy (1-4).  In 2019, about 423,997 children in the U.S. were in foster care, of which over 60,000 are Californians (5, 6). Children entering the foster care system are already vulnerable and at risk of experiencing ACEs during foster care and psychological distress during adulthood (1, 4). The National Survey of Child and Adolescent Well-being, a national longitudinal study of the well-being of 5,873 children, found that  more than 50% of all children reported to child protective services (CPS) had experienced at least four ACEs before they even came into contact with CPS. Pediatricians and caregivers of foster children including foster parents, struggle with managing the consequences of unresolved trauma (7).   A trauma-informed approach to care has the potential to mitigate these negative consequences. The Trauma Informed Care (TIC) model is used to provide education and support to foster families by helping them comprehend children’s behaviors from a trauma perspective. Foster parents have the most impact on a child’s trauma recovery as they spend the greatest amount of time with the child, but their role is underutilized. Foster families are often unaware of the impact of ACEs on children, ill-equipped on how to provide TIC, and are therefore not prepared to address the needs of foster children placed with them (8-10).  The “Awareness of the ACES: Supporting Foster Families” program aims to:   Objective 1: To evaluate the knowledge, awareness and understanding among foster families about ACEs and the impact of ACEs on foster children.  Objective 2:  To assess the perceived barriers reported by foster families to provision of a TIC approach and their foster child’s access to a medical home   Objectives 3: Design a longitudinal, sustainable educational workshop regarding ACEs and the principles of trauma-informed care for caregivers of foster children.  Objective 4: To identify and engage leaders from community-based organizations for foster families and determine their barriers to providing trauma informed care.   Objective 5: Create a toolkit that includes resources about ACEs and TIC intervention services and promote access to medical homes.   My proposal aims to build collaboration and increase support among community-based organizations and caregivers of foster children by providing them with access to information and resources regarding trauma informed care, thereby supporting these families in their parenting role.  


​1) By the end of month 3 of the CATCH timeline, information gained from the community based organization survey and foster family focus groups will be used to create the final curriculum for the Trauma Informed Care Workshops. All of the Valley Children's Pediatric Practices will receive their lunch lecture and have information to distribute. 

2) By 6 months into the CATCH timeline, 50 foster families will have attended the Trauma Informed Care Wrokshop and will be able to correctly answer 70% of the questions on the post workshop intervention questionnaire that assesses key concepts of ACEs and TIC. 

3) By the conclusion of the project, 90% of foster families will have established a medical home for their foster child or have utilized the resources in the toolkit.

AAP District District IX
Institutional Name Valley Children's Hospital
Contact 1 Keenia Tappin, MD
Contact 2
ID 908