Improving Foster Parent Engagement: Using Qualitative Methods to Guide Tailoring of Evidence-Based Engagement Strategies

Abstract

Objective This qualitative study examined applicability and need for tailoring of an evidence-based engagement intervention, combined with Trauma-focused Cognitive Behavioral Therapy, for foster parents. Method Qualitative methods were used, including individual interviews with participating foster parents (N = 7), review of interview findings with an independent group of foster parents (N = 5), and review of the combined foster parent findings by child welfare caseworkers (N = 5), an important stakeholder group. Results The engagement intervention, with its primary focus on perceptual barriers (e.g., past experiences with mental health), was relevant for the foster care population. However, the study identified areas for tailoring to better recognize and address the unique needs and situation of foster parents as substitute caregivers. Conclusions Perceptually-focused engagement interventions may have broad applicability to a range of populations, including foster parents, with the potential for improving caregiver participation in children’s mental health services.

Qualitative and Mixed Methods in Mental Health Services and Implementation Research

“…Similarly, Lyon, Ludwig, Romano, Koltracht, Vander Stoep, and McCauley (2013) used qualitative methods to elicit provider perspectives on the appropriateness of implementing an evidence-based, modular therapeutic approach within a school-based health clinic. Dorsey, Conover and Cox (in press) sampled foster parents to elicit their perspectives on engagement that could be incorporated into the adaptation of an existing engagement intervention. Murray and colleagues (2013) assessed counselors, children and caregivers perspectives on the use of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in Zambia.…”

“…Chew-Graham, Slade, Montana, Stewart, and Gask (2007) used qualitative methods to explore the function of community health teams in managing referral decisions at the primary-specialist interface from the perspectives of both referrers (primary care providers) and referred to (mental health specialists). In this special series, Lyon and colleagues (2013) employed qualitative methods “because the study of modular psychotherapy is in its infancy.” Dorsey and colleagues (in press) used qualitative methods as part of a pilot project effort to tailor an existing engagement intervention for use in implementing TF-CBT with a small group of foster parents to identify any population-specific areas of adaptation to the engagement intervention. Such exploration can be used to develop new theories or conceptual frameworks or to expand upon existing ones and to generate new hypotheses that may be tested using quantitative methods or to develop valid and reliable quantitative methods by identifying the content and form of questions to be asked and by identifying the target population through observation and interviews.…”

“…Validity has also been supported by means of “member checking” whereby study participants or others who share similar characteristics review study findings to confirm and potential elaborate on them. In their study, Dorsey and colleagues (in press) presented the findings of their interviews with foster parents to two boards, one comprised of foster parents and one comprised of caseworkers. They further “triangulated” the data collected from both boards.…”

“…Rodriguez and colleagues (in press) appear to have used both methods to insure the reliability of coding assigned; however, they also acknowledge that they relied primarily on a priori codes rather than identify new or emergent codes. (in press) and colleagues, Lyon and colleagues (2013) and Dorsey and colleagues (in press) rely only on the first method.…”

“…They did so by sampling the universe of directors and clinic-affiliated therapists who worked in the study clinics and a subset of parents through informational flyers and invitations from providers. The other studies also appear to have used criterion sampling to identify potential participants, including full-time mental health provider in their respective schools (Lyon et al, 2013), foster parents based on referrals from caseworkers and youth exposure to at least one traumatic event and youth PTS symptoms (Dorsey et al, in press), all “outer” and “inner” context stakeholders involved in the implementation of an evidence-based practice in one county (Aarons et al, in press) and participants in a larger feasibility study of TF-CBT in Zambia (Murray et al, 2013). While these strategies are commonly employed in mental health services researchers, investigators should be mindful of the fact that representativeness is only one criterion for purposeful sampling.…”