Treatment Model

A home is in the heart of every child.

T3C IDD/Autism Spectrum Disorder Support Services

Foundation: This treatment model builds upon and enhances the Basic Foster Family Home TBRI® Resource Guide. All foundational TBRI® principles are enhanced with specialized developmental and behavioral supports for children with IDD/ASD. For complete information on core TBRI® principles, please refer to the foundational guide.

Overview

Refuge House implements Trust-Based Relational Intervention® (TBRI®) as our primary treatment model, enhanced with developmental and behavioral supports for providing the T3C IDD/Autism Spectrum Disorder Support Services. TBRI provides the trauma-informed, attachment-based foundation essential for children in foster care, while incorporating evidence-based practices for children who have or are pending DSM-5 diagnoses of Intellectual or Developmental Disability and/or Autism Spectrum Disorder.

Enhanced TBRI® Framework

This package builds upon the foundational TBRI® model with developmental and behavioral adaptations:

Connecting Principles +

Visual communication supports and social stories
Alternative communication methods when verbal language is limited
Sensory-aware connection strategies
Structured social interactions with clear expectations
Modified eye contact expectations based on comfort

Empowering Principles +

Visual schedules and routine-based structure
Sensory accommodations based on individual assessment
Environmental modifications to support regulation
Predictable transitions with advance warnings
Physical activity and motor skill support

Correcting Principles +

Positive Behavioral Interventions and Supports (PBIS)
Visual behavior support strategies
Functional communication training
Skills taught at developmental level
Natural consequences with cognitive considerations

Service Integration

Required Therapeutic Services

Individual therapy weekly (adapted for developmental level)
Family therapy as appropriate to strengthen relationships
Speech and language therapy based on assessment
Occupational therapy for sensory and motor needs
Social skills groups using evidence-based curricula
Behavioral support services for skill development

Medical Support Structure

24/7 Registered Nurse availability for consultation and crisis support
Custom care plans addressing individual medical complexities
Medication administration protocols with specialized monitoring
Coordination with developmental specialists
Management of co-occurring conditions common in IDD/ASD

Meeting Custom Physical, Emotional, Social, and Spiritual Well-being Needs

Physical Well-being

Up to 70% of children with autism have at least one co-occurring medical condition

Proactive monitoring of common co-occurring conditions
Nutrition planning that respects food selectivity
Adapted physical activities accommodating motor differences
Medication management with careful monitoring
Dental care accommodations for sensory sensitivities

Emotional Well-being

Supporting emotional health with understanding of developmental differences

Visual emotion identification tools (zones of regulation)
Coping strategies taught at developmental level
Recognition that challenging behavior communicates emotional needs
Structured approaches to managing anxiety and depression
Trauma-informed adaptations respecting processing differences

Social Well-being

Creating opportunities for positive social engagement in adaptive ways

Supported opportunities for peer interaction in structured settings
Teaching social cues through direct instruction and role-playing
Facilitating participation in community activities with accommodations
Building self-advocacy skills for navigating social situations
Emphasis on inclusive practices within foster family and community

Spiritual Well-being

Finding meaning and purpose through individualized approaches

Respecting and supporting diverse religious/spiritual beliefs
Providing opportunities for connection to nature and contemplative practices
Encouraging expression of personal values and sense of self-worth
Access to spiritual guidance or community groups with accommodations
Focus on inner peace and sense of belonging

Evidence-Based Practice Foundation

CEBC Recognition: TBRI® Caregiver Training is rated as a "Promising Practice" by the California Evidence-Based Clearinghouse for Child Welfare, demonstrating improved outcomes for children who experienced trauma, abuse, and neglect.

Title IV-E Recognition: TBRI® is recognized by the Title IV-E Prevention Services Clearinghouse for mental health prevention and treatment, making it eligible for use in programs requiring evidence-based, trauma-informed interventions.

Key Research Findings:

Significant improvement in attachment behaviors when TBRI is adapted for IDD/ASD
Behavioral interventions in family settings show better outcomes than clinic-only services
Visual supports combined with TBRI demonstrate improved compliance
Family-based interventions show measurable improvements in family functioning

Trauma-Informed Approach for Children Who Have Experienced Abuse and Neglect

Children with IDD/ASD face significantly higher rates of abuse and neglect than their neurotypical peers, with studies showing they are 3-4 times more likely to experience maltreatment.

Assessment Approach

The CANS 3.0 serves as our primary assessment tool, with careful attention to how developmental differences may impact trauma presentation. The 90-day CANS reassessment allows us to track progress while considering developmental factors.

Treatment Adaptations

Trauma treatment is made accessible through developmental adaptations that respect each child's communication style and cognitive abilities. Our therapists use evidence-based approaches modified for developmental level.

Caregiver Support

Foster parents caring for children with both developmental disabilities and trauma histories need comprehensive preparation and ongoing support, including training on recognizing trauma signs and 24/7 consultation access.

Enhanced Staffing Structure

Clinical Team

Treatment Director with IDD/ASD specialization
Licensed therapists (1:12 ratio)
Behavior specialists (1:15 ratio)
Registered Nurse (24/7 availability)

Case Management

Reduced caseload ratios (1:15)
Extensive IDD service systems training
Weekly clinical consultation
Coordination with developmental specialists

Expected Outcomes

Short-Term (3-6 months):

Significant reductions in challenging behaviors
Improved emotional regulation
Engagement in therapeutic services
Placement stability maintained

Intermediate (6-12 months):

Measurable improvements in daily living skills and adaptive functioning
Increased success in educational inclusion with appropriate supports
Enhanced coping skills
Strengthened caregiver-child relationships

Long-Term (12+ months):

Trauma symptom reduction
Achievement of permanency goals
Successful step-down to lower level of care when appropriate
Improved overall well-being and functioning

Quality Assurance and Fidelity

90-day CANS 3.0 administration with clinical interpretation
Progress toward individualized Service Plan goals
Medical stability and medication effectiveness review
Educational progress including IEP goal attainment
Behavioral data analysis showing trends
Continuous quality improvement process aligned with CQI Model

"A home is in the heart of every child."

Last Revised: September 2025