Prevention of Behavior Problems for Children in Foster Care: Outcomes and Mediation Effects

Abstract

Parent training for foster parents is mandated by federal law and supported by state statues in nearly all states; however, little is known about the efficacy of that training, and recent reviews underscore that the most widely used curricula in the child welfare system (CWS) have virtually no empirical support (Farmer et al., 2007;Grimm, 2003). On the other hand, numerous theoretically-based, developmentally-sensitive parent training interventions have been found to be effective in experimental clinical and prevention intervention trials (e.g., Kazdin & Wassell, 2000;McMahon & Forehand, 2003;Patterson & Forgatch, 1987;Webster-Stratton et al., 2001). One of these, Multidimensional Treatment Foster Care (MTFC; Chamberlain 2003), has been used with foster parents of youth referred from juvenile justice. The effectiveness of an intervention based on MTFC was tested in a universal randomized trial with 700 foster and kinship parents in the San Diego County CWS. The goal of the intervention was to reduce child problem behaviors through strengthening foster parents' skills. The trial was designed to examine effects on both child behavior and parenting practices, allowing for specific assessment of the extent to which improvements in child behavior were mediated by the parenting practices targeted in the intervention. Child behavior problems were reduced significantly more in the intervention condition than in the control condition, and specific parenting practices were found to mediate these reductions, especially for high-risk children (i.e., those with more than 6 behavior problems per day at baseline). Keywords parent management training; foster parents; effectiveness trialChild welfare services are estimated to cost $20 billion per year (Allphin et al., 2001), yet very little experimental research has been used to guide the interventions used within that system. In a systematic review of research on children in foster care, Wulczyn et al. (2005) found that most existing studies were descriptive in nature. They and other researchers (e.g., Courtney, 2000) have called for experimental research to improve practices in the child welfare system (CWS), particularly for children in out-of-home care. In this study, we tested Correspondence should be directed to Patricia Chamberlain, Oregon Social Learning Center, 10 Shelton McMurphey Boulevard, Eugene, (541) 485-2711; fax, (541) NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript the effectiveness of an intervention designed to strengthen foster parents' parenting skills through the implementation of a theoretically-based intervention that had been shown in previous randomized studies to have positive short-and long-term effects on child outcomes Chamberlain & Reid, 1991;Leve et al., 2005). The intervention was expected to lead to improvements in foster parent child management skills, which were expected to result in fewer child behavior problems. Previous work has shown that behavior problems (particularly externalizing behaviors) are o...

Could scale-up of parenting programmes improve child disruptive behaviour and reduce social inequalities? Using individual participant data meta-analysis to establish for whom programmes are effective and cost-effective

“…Hypotheses about mechanisms, drawn from existing theory and process evaluations, can then be tested in analyses of moderated mediation. [34][35][36][37] Prior literature on predictors and moderators of parenting intervention effects…”

Broadening the reach of evidence-based parenting interventions: Evaluation of a brief online version of the Triple P – Positive Parenting Program

“…Or perhaps parenting interventions in general might be more beneficial for children with more severe deviant and externalising misbehaviour or more distressed families. Similar results have been reported for other parenting programs (e.g., Chamberlain et al, 2008;Reid, Webster-Stratton, & Baydar, 2004). The same pattern was evident for PS scores, with parents showing higher pre-intervention use of dysfunctional parenting strategies reporting greater improvements in parenting.…”

“…Several studies and meta-analyses indicate that families who report higher levels of baseline child behaviour problems also report greater improvements from parenting interventions (e.g., Chamberlain et al, 2008;Lavigne et al, 2008;Sanders, Kirby, et al, 2014). However, in most of these studies, families displaying fewer problems at pre-intervention still had fewer problems at post-and follow-up assessment.…”

Improving the Mental Health of Children in Child Welfare Through the Implementation of Evidence-Based Parenting Interventions

“…Seven hundred foster families receiving a new placement were randomized to KEEP (Keeping foster and kin caregivers skilled and supported, the PMT condition) or control (case work services as usual). A main effect for decreased child behavior problems was observed in the KEEP but not in the control condition, and the effect was partially mediated by improved parenting skills, specifically higher rates of positive reinforcement relative to discipline in KEEP participants (Chamberlain et al 2008b). Participation in KEEP increased the chances of reunification with biological family and mitigated the risk-enhancing effect of having a history of multiple placements.…”

“…Within the context of an over-stressed child welfare system, one effective and potentially viable solution is to improve foster caregivers' abilities to provide meaningful interventions and supports to the children who are placed with them. Training foster caregivers to serve as therapeutic agents of change shifts foster care from a condition of maintenance to one of active intervention (Ruff et al 1990;Kerker and Dore 2006;Chamberlain et al 2008b). This shift capitalizes on using an existing workforce that ideally, would increase stability and permanency for children in foster care, thereby reducing their risk for many subsequent mental and behavioral health problems.…”