Improving practice and outcomes
Elizabeth M.Z. (Betsy) Farmer, Ph.D. is professor and associate dean for research at Virginia Commonwealth University School of Social Work. Her work focuses on understanding and improving mental health services for youth. Farmer began her professional career working in a group home with young adults who were dually diagnosed with mental illness and intellectual disabilities. She and her husband then spent several years as treatment foster parents with youth who had mental health problems and severe aggression. These experiences helped her to vividly recognize both the tremendous potential and the significant challenges in providing effective residential treatment. They also highlighted the ways in which the full array of services (from mental health, child welfare, education and health care) influence developmental and treatment outcomes.
Since the mid-1990s Farmer has been conducting a series of NIMH-funded studies on out-of-home treatment for youth with mental health problems. Through this program of work, she and her collaborators at Duke developed Together Facing the Challenge, an evidence-based approach for Treatment Foster Care that involves enhanced training and consultation for treatment foster parents and their supervisors. TFTC uses a hybrid approach to infuse evidence-based elements into current practice in existing TFC programs to improve practice and outcomes. TFTC is now being implemented in agencies across approximately 13 states.
While TFC has been viewed very positively by providers, policy makers and payers, Farmer’s more recent work has focused on a residential option that has been viewed much more negatively—group homes. There have been concerns about outcomes, safety and behavioral contagion in group residential settings, but relatively little research that has focused on this treatment setting. Farmer’s NIMH study from 2006-2013 examined practices and outcomes in group homes. Overall, findings suggest that youth improve while they reside in group homes. Even though there is significant variation in treatment and practices among group homes, patterns of improvement for youth look quite consistent. Better quality of treatment, however, appears to be linked to how well the youth do after they are discharged—youth from homes with higher quality treatment are more likely to sustain the gains made while in care.
Farmer has also been a collaborator/co-investigator on a number of large federally funded studies and projects, including the Great Smoky Mountains Study, Caring for Children in Child Welfare and the National Child Traumatic Stress Network. Farmer’s current work continues to focus on understanding practices, structures and factors that influence treatment and outcomes. She is working with colleagues in the greater Richmond area to expand this focus to enhance understanding and effective practice with an array of youth and families.
Categories Faculty and staff, Research