Healing at Home — Intensive Alternative Family Treatment (IAFT®)

As Meredith Newman explains the Intensive Alternative Family Treatment (IAFT®) program, she remembers one little girl who entered the foster care system at age 7. By 14, this child had lived in 22 different places.

“How is she supposed to flourish academically, maintain connection to a sibling, or have any sense of normalcy when she is being moved around that much?” Newman asked. ​“As long as we keep moving kids around, it’s another trauma — one more trauma on top of the last one.”

The solution, Newman asserts, is IAFT.

In New Bern, N.C., Newman serves as executive director of Rapid Resource for Families, an organization that oversees the statewide implementation of IAFT. IAFT is an evidence-informed model that helps youth avoid or exit institutional placement by providing specialized treatment in home settings. This intervention is intended to minimize disruptions and maximize the child’s potential to thrive.

IAFT is designed to offer a more intensive level of care for young people than traditional therapeutic foster care. In IAFT, licensed therapeutic foster parents, known as ​“treatment parents,” undergo rigorous training. They also receive support from a designated team of counselors, psychiatrists, qualified professionals, and case managers.

“A child’s behavior is a manifestation of the trauma they experience,” Newman said. ​“The more information we give providers and funders, the more they can prepare and make sure kids are getting what they need. Our treatment parents don’t just provide a ​‘home’ — they are professionals with a seat at the table who advocate for those kids’ needs.”

Walking alongside children, treatment parents, and permanent families is paramount. Each IAFT team provides daily monitoring and support for families. Crucial data points are also collected and maintained within a comprehensive database. This provides all team members with a clear and current line of sight into each child’s distinct and changing needs.

“With IAFT, everyone is more prepared and informed,” Newman pointed out. ​“There are no secrets. Anything that needs to be addressed is brought to the table. That’s what makes the big difference with placement.”

Proof of concept

IAFT is championed by The Duke Endowment, which is committed to advancing the field through developing and testing innovative models with strong evidence of effectiveness. The Endowment invests in such models with the hope of determining if they can ultimately be scaled up for replication.

Since 2010, The Duke Endowment has awarded approximately $1.6 million to create, pilot and increase the number of foster parents in IAFT and to conduct a randomized controlled trial of the model. The trial began in 2023, and early outcomes for children are promising.

“Eighty-six percent of those kids have now stepped down to lower levels of care,” said Newman. ​“This shows that communication and an intentional scope of work with relationship-building has made a difference.” Newman added that participants are also demonstrating reduced anxiety, impulsivity, depression and other clinical improvements.

Early results also show that IAFT has the potential to provide a financial return on investment, and leaders in the state of North Carolina have taken note. A two-year, $11 million investment in the model was announced in April 2024, enabling a partnership between Rapid Resource and the North Carolina Division of Child and Family Well-Being to support recruitment of additional community-based providers throughout the state.

“Our treatment model shows that we are bending the curve,” said Newman. ​“A lot of what The Duke Endowment did helped us get awareness and recognition of what an amazing model IAFT is.”

Charting the course

While the allure of evidence-based practices is compelling, successful implementation in new locations can be a heavy lift for organizations and requires strong infrastructure. To position such work for success, the Endowment applies implementation science principles to grantmaking, particularly when a program like IAFT holds promise for future replication.

Newman agreed that rigorous preparation, training, and evaluation for future IAFT providers is vital — such rigor will only strengthen the potential for continued expansion throughout the state. She envisions expanding into other states as well.

“Unfortunately, mental health is approached so much differently than physical health,” Newman reflected. ​“If you step on a nail, a doctor will throw everything they have at it to make sure it doesn’t become infected. But we don’t do that with kids with mental health problems — we make kids fail forward because we don’t want to give them the highest level of care to get them stabilized. We want to change that with IAFT.”