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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 (Grimm, Youth Law News, April–June:3–29, 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 and Wassell, Journal of the American Academy of Child and Adolescent Psychiatry, 39:414–420, 2000; McMahon and Forehand, Helping the noncompliant child, Guilford Press, New York, USA, 2003; Patterson and Forgatch, Parents and adolescents: I. Living together, Castalia Publishing, Eugene, OR, USA, 1987; Webster-Stratton et al., Journal of Clinical Child Pyschology Psychiatry, 42:943–952, 2001). One of these, Multidimensional Treatment Foster Care (MTFC; Chamberlain, Treating chronic juvenile offenders: Advances made through the Oregon Multidimensional Treatment Foster Care model, American Psychological Association, Washington, DC, USA, 2003), has been used with foster parents of youth referred from juvenile justice. The effectiveness of a universal intervention, KEEP (Keeping Foster Parents Trained and Supported) based on MTFC (but less intensive) 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 in foster families reporting more than six behavior problems per day at baseline.

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Fig. 1
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Notes

  1. Because no differences were found between the two training conditions on child behavior or parenting change outcomes, cases trained in both conditions were combined for the present analyses.

  2. The models were also run controlling for the demographic variable in Table 1 that was significantly different across groups (i.e., speaking English). The overall pattern of results remained unchanged.

  3. We found no relationship between attendance rates and study outcomes, possibly due to the overall high attendance rates (i.e., the correlation between the percentage of sessions attended and termination report of child behavior problems was r = 0.044; with the proportion positive reinforcement variable, it was r = 0.044, both ns).

  4. Three calls were attempted at each assessment; 2.98 (0.15) calls were completed at baseline and 2.93 (0.35) at termination. There were no significant differences in the number of calls completed by condition—baseline 2.98 (0.15) intervention, 2.97 (0.16) control; termination 2.92 (0.38) intervention, 2.94 (0.31) control.

  5. Change in proportion positive reinforcement and child behavior problems was indexed by the termination score, controlling for baseline score.

  6. A parallel set of analyses using all cases after multiple imputation with the expectation-maximization (EM) algorithm in PRELIS yielded nearly identical results to those reported here.

  7. Chamberlain et al. (1992) tested a parent training intervention in three counties in Oregon.

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Acknowledgement

Support for this research was provided by Grant Nos. R01 MH 60195 from the Child and Adolescent Treatment and Preventive Intervention Research Branch, DSIR, NIMH, U.S. PHS; R01 DA 15208 and R01 DA 021272 from the Prevention Research Branch, NIDA, U.S. PHS; R01 MH 054257 from the Early Intervention and Epidemiology Branch, NIMH, U.S. PHS; and P20 DA 17592 from the Division of Epidemiology, Services and Prevention Branch, NIDA, U.S. PHS. The authors would like to thank Yvonne Campbell and Patty Rahiser from the San Diego Health and Human Services Agency, Jan Price and Courtenay Paulic, project coordinators, David Kerr and Gordon Harold, statistical consultants, Norma Talamantes and Melissa Woods, lead interventionists, JP Davis, supervisor, and the San Diego foster parents.

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Correspondence to Patricia Chamberlain.

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Chamberlain, P., Price, J., Leve, L.D. et al. Prevention of Behavior Problems for Children in Foster Care: Outcomes and Mediation Effects. Prev Sci 9, 17–27 (2008). https://doi.org/10.1007/s11121-007-0080-7

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Keywords

  • Parent management training
  • Foster parents
  • Effectiveness trial