Parent training in foster families with children with behavior problems: Follow-up results from a randomized controlled trial

The present randomized controlled trial examined the four months follow-up effectiveness of Parent Management Training Oregon (PMTO) for parents with foster children (aged 4–12) with severe externalizing behavior problems in long-term foster care arrangements. The aim of PMTO, a relative long and intensive (6–9 months, with weekly sessions) parent management training is to reduce children's problem behavior through improvement of parenting practices. We specifically investigated whether PMTO is effective to reduce foster parenting stress. It was expected that PMTO would reduce parenting stress in foster parents, improve the quality of parenting practices, and reduce children's problem behavior. Multi-informant (foster mothers, foster fathers, and teachers) data were used from 86 families. Multilevel analyses based on the intention to treat principle (retention rate 73%) showed that PMTO, compared to care as usual, had no significant direct, nor indirect or sleeper effects at follow-up on parenting stress, parenting behavior and child behavior problems. Earlier reported immediate effects of PMTO on reduced parenting stress at posttest disappeared at follow-up. Additional analyses on the role of non-specific intervention factors in PMTO effects showed that higher therapist fidelity scores resulted in stronger effects of PMTO on parenting responsiveness, parental explaining and autonomy granting. Unexpectedly, higher fidelity scores also predicted less decrease of parenting stress at follow-up.     

Replication of the KEEP foster and kinship parent training program for youth with externalizing behaviors

This article presents findings from Maryland KEEP, a replication of KEEP (Keeping Foster and Kinship Parents Trained and Supported), a foster and kinship parent training intervention. We examined child behavior change, changes in caregiver parenting style, and permanency and placement stability at baseline and then after the KEEP intervention. The KEEP intervention was provided to 65 foster and kinship parents providing care for children ages 4–12. Children who participated in the study were referred due to behavior problems, as reported by foster parents: they all scored in the clinical range for externalizing behavior on the Child Behavior Checklist (CBCL). Baseline and posttest analyses assessed for child behavior and parenting style changes. Permanency data, including placement moves and exits from child welfare were examined. Overall, foster and kinship parents reported significantly fewer child behavior problems at posttest; severity levels on the CBCL and scores on the Parent Daily Report decreased. However, there were not any changes in parenting styles from baseline to posttest. Placement stability significantly increased between baseline and post-KEEP intervention. The results provide support for the effectiveness of KEEP for a child welfare population with a high level of behavior problems and for the effectiveness of KEEP as a training program for foster and kinship parents.     

Do Parent Preferences for Child Conduct Problem Interventions Impact Parenting Outcomes? A Pilot Study in Community Children's Mental Health Settings

A pilot, doubly randomized preference trial was conducted to investigate the impact of providing parents preferences on parenting outcomes. Families with children having conduct problems were randomly assigned to a choice group in which they received their preferred treatment among the four intervention options or a no‐choice group in which they were randomized assigned to one of the four options. Results of mixed‐effects models showed that parents in the choice group who selected Parent Management Training‐Oregon Model (PMTO) had better parenting outcomes over time compared to parents in the choice group who selected child therapy. It highlights the importance of incorporating parent preferences in the delivery of evidence‐based treatments.     

Foster parents' coping style and attitudes toward parenting

Foster parents have the greatest influence on the well-being of a foster child. A good selection procedure is needed to recruit capable and high quality foster families, and to reduce the risk of breakdown. Therefore we examined the coping style of foster parents and their attitudes toward parenting. The attitudes toward parenting and the coping style of 188 Flemish non-kinship foster parents were examined using a Dutch version of the Adult–Adolescent Parenting Inventory (AAPI-2) and a Dutch version of the short form of the Coping Inventory for Stressful Situations (CISS-SF). Flemish foster parents had average scores on the four subscales or were at medium risk for negative parenting. Only for the two subscales inappropriate expectations and role reversal half of the foster parents had positive attitudes toward parenting. A total foster parents ranging from 0.5% to 8% were at high risk for negative parenting. No foster and family characteristics were associated with attitudes toward parenting. Foster parents use all of the four different coping styles (task-oriented, emotion and avoidant (treat oneself and find a friend) coping). The preferable coping style is for half of the foster parents taskoriented coping. An emotional coping style could be predicted by age and total years as foster parents. This research shows that foster parents were at medium risk for negative parenting and prefer a taskoriented coping style to handle foster care problems.     

Parenting stress and parenting behavior among foster mothers of foster children with externalizing problems

Foster children often have externalizing problems. Since foster parents are selected and trained, they are often expected to be able to handle the externalizing problems of these children. Very little is, however, known about foster parents' parenting stress and parenting behavior in the context of challenging foster caregiving. In this study, the parenting stress and parenting behavior of 39 foster mothers of recently placed foster children with externalizing problems were studied. By using standardized measures with normative data, foster mothers' scores on different parenting stress and parenting behavior subscales were compared to published norms. Foster mothers of children with externalizing problems experienced more parenting stress than the norm group. The parenting context, provided by these foster mothers, was similar to the parenting context provided by the norm group. The prevalence of specific dysfunctional parenting behaviors (e.g., less involvement in positive parenting) was small to moderate, but nearly half of the foster mothers could be classified as making dysfunctional adaptations to their parenting environment. Moreover, only the minority of foster mothers provided an adaptive parenting context (e.g., more than average involvement in positive parenting). The implications of these results for pre-service training and on-going support for foster parents are discussed.     

The Parent University Program: Factors predicting change in responsive parenting behaviors

Few evidence-based parenting programs exist for children under the age of three and even fewer have been rigorously evaluated in comparison to parenting programs for older children. The Parent University Program (PUP), was developed to serve parents with children birth through three who lived in southwest Baltimore. Parent-child dyads (N = 86) participated in the parenting program with the goal of increasing responsive parenting skills.Participants of the PUP showed a significant increase in responsive parenting behaviors. Participants in this open trial study who completed pre-test, post-test, and follow-up assessments showed a significant change from clinical to non-clinical status after attending the PUP. Neither the type of facilitator nor the number of hours attended showed an association with changing parenting behaviors. The age of the child was associated with the change in responsive parenting. Parents of older children in the birth to three age range had higher scores at pre-test and showed less change over time. The results of this study suggest that the Parent University Program was associated with positive change in responsive parenting behaviors for parents with children birth through three years of age.     

An analysis of the relationship between parenting self-efficacy,the quality of parenting,and parental and child emotional health

ABSTRACT

The relationship between parenting self-efficacy, the quality of parenting, and parental and child emotional health has been conducted with Caucasian families and young children. The purpose of this study was to examine these relationships in ethnically diverse and impoverished families with children who have behavior problems. We examined the relationships between parenting self-efficacy, parenting practices, child externalizing problems, and caregiver depression. Participants included 213 caregivers of children with Oppositional Defiant Disorder (ODD), who rated their parenting self-efficacy and completed questionnaires on parenting practices (APQ and FAD); child externalizing behaviors (Iowa Connors Inattention and ODD subscales); and caregiver depression (CESD). Data were examined using Chi-Square tests, a Linear Regression, and a One-Way ANOVA. Results demonstrate parenting self-efficacy was positively associated with positive parenting and inversely associated with inconsistent discipline. Among parents who perceived themselves as being a “better than average parent,” there was a greater percentage of youth who met cutoff for inattention problems as compared to youth who did not meet this cutoff. Lastly, depression scores were lowest for caregivers identifying as below average parents. This study underscores the need for involving parents and enhancing parenting self-efficacy in interventions targeting Disruptive Behavior Disorders.     

Are At-Risk Parents Getting What They Need? Perspectives of Parents Involved with Child Protective Services

This qualitative study explores the perspective of 24 parents who were at risk for having their children placed in foster care but ultimately retained custody of their children. We asked participants to reflect on their parenting needs prior to Child and Protective Services involvement and if and/or how they implemented parent education skills post-intervention. Parents most frequently cited stressors such as financial strain and single parenthood as contributing factors associated with their involvement with the child welfare system. Many parents stated that they wanted help with their parenting practices and provided their thoughts about time-out and physical punishment. Implications include assessing parental stress at the onset of services, seeking to understand the unique needs of families, evaluating the impact of length of time services are offered, and helping parents utilize age-appropriate discipline strategies.     

A model for training foster parents in behavior modificiation techniques

A training program for foster parents applying the techniques of behavior modification produced measurable gains in parenting and in the management of the children.     

Coming Closer in Adolescence: Convergence in Mother,Father, and Adolescent Reports of Parenting

Parent–child relationships change during adolescence. Furthermore, parents and adolescents perceive parenting differently. We examined the changes in perceptions of parental practices in fathers, mothers, and adolescents during adolescence. Furthermore, we investigated if fathers', mothers', and adolescents' perceptions converge during adolescence. Following 497 families across six waves (ages 13–18), we investigated the development of parental support and behavioral control using mother and father self‐reports, and adolescent reports for mothers and fathers. We found curvilinear decrease for support and control. Parent–adolescent convergence emerged over the 6 years: those with higher intercepts had a steeper decrease, whereas correlations among parent and adolescent reports increased. This multi‐informant study sheds light on the development of parent–adolescent convergence on perceptions of parenting.     

Joining formative evaluation with translational science to assess an EBI in foster care: Examining social–emotional well-being and placement stability

This study examined measures of placement stability and social–emotional well-being for a federally-funded demonstration project of inhome Parent Management Training-Oregon model (PMTO) for children in foster care with serious emotional disturbance (SED). Following a cultural exchange framework for translational research and a tollgate approach to evaluation, this formative study tested these measures prior to further investment in summative evaluation. The research aim was to observe whether measures of social–emotional well-being and placement stability performed as expected. Using a pretest–posttest randomized consent trial, children identified as SED within six months of entering foster care were randomly assigned to PMTO or to a services-as-usual comparison group (N = 121). A multi-group structural equation model was tested to observe the relationship of baseline social–emotional wellbeing and placement stability on post-test social–emotional well-being. Results showed that post-test well-being was significantly predicted by baseline well-being for both groups and, importantly, only the intervention group demonstrated significant effects of placement stability on post-test well-being. For the intervention group, as placement stability increased, post-test social skills significantly improved, demonstrating an association between well-being and placement stability that was not evident in the comparison group. Overall, wellbeing measures performed as expected and detected relationships between variables and variation as hypothesized. Additionally, placement stability may have been mediated by the PMTO intervention. In conclusion, by using a real world example of the translational research concept of cultural exchange between university-based researchers and agency-based practitioners, this study shows that formative evaluation offers an important opportunity to test ad hoc research questions inspired by the process of implementation itself.     

A multi-site evaluation of Parents Raising Safe Kids Violence Prevention Program

The Parents Raising Safe Kids Program (PRSK) is a research-based manualized violence prevention curriculum designed to decrease coercive parenting behavior, encourage positive discipline, increase media violence literacy, and increase child development knowledge. This study is a multi-site pre-post comparison evaluation of PRSK's effectiveness with diverse parents, including those who are incarcerated, in drug treatment and both English and Spanish speaking. Results indicate that PRSK was successful at improving media violence literacy, positive parenting behavior, child development knowledge, anger management, and prosocial problem solving. Additionally, PRSK was especially efficacious for Spanish speaking participants, who improved more than English speakers. Due to the need for appropriate and cost-effective programs for underrepresented groups, these results add to the growing evidence base supporting the use of PRSK with diverse parents. PRSK is effective in educating caregivers about nonviolent parenting behavior and child development. It is flexible, focuses on parents of very young children, and is cost effective. The program costs a fraction of other evidence-based practices yet statistical effect sizes for change over time are comparable.     

Children placed in long-term family foster care: A longitudinal study into the development of problem behavior and associated factors

Due to prior experiences of trauma and abuse, many foster children have behavioral problems. The placement of the child in a family foster home is expected to reduce the behavioral problems. However, this expectation is seldom met and mostly behavioral problems increase or remain stable during placement. Research on the development of behavioral problems in foster children is scarce. Moreover, most of the research results are situated on a group level, which obscures the development of problem behavior on a case level. This study investigated the development of problem behavior of 49 foster children on a case level and the association of global, contextual, familial and child factors with the increase or decrease of problem behavior. Over a two year period 18 foster children had more, 23 just as much and 8 less problem behavior. An increase was associated with the use of more negative parenting strategies by the foster mothers. A decrease was related to the use of supportive parenting. Support of foster parents aiming at reducing the use of negative discipline practices and promoting the use of supportive parenting may have a positive effect on the development of foster children.     

Adaptation and Evaluation of a Nonviolent Resistance Intervention for Foster Parents: A Progress Report

Foster care faces serious challenges, such as behavioral problems in foster children and parental stress and ineffective parenting behavior in foster parents. The results of a pilot study that evaluated a training program for foster parents based on nonviolent resistance are described. In a pretest–posttest design, data were collected from 25 families. Significant reductions in externalizing, internalizing, and total problem behavior in the foster children and in parenting stress were found. Using a reliable change index, significant improvements in externalizing, internalizing, and total problem behavior were found in, respectively, 72, 44, and 80% of the cases. Most improvements proved to be clinically relevant. Effect sizes ranged from medium to large for problem behavior, and from small to medium for parenting stress.     

“It's really overwhelming”: Parent and service provider perspectives of parents aging out of foster care

Rates of pregnancy and parenthood among current and former foster youth are two to three times higher than non-foster youth peers. Repeat pregnancies among young mothers aging out of foster care also occur at higher rates than peers not involved with the child welfare system. Furthermore, mothers aging out of foster care demonstrate high levels of parenting stress and risk for child maltreatment. Indeed, this population is in significant need of help; however, beyond anecdotal evidence, little is known about the needs and day-to day experiences of this population. In order to tailor interventions to meet the needs of parents aging out, the perspectives of stakeholders must be taken into account. Using qualitative data gathered from separate small group interviews with parents aging out and service providers, this study examined participants' perceptions of parents' daily experiences, strengths, and needs. Findings indicated that parents aging out face overwhelming adversity and stress with little outside financial, emotional, or parenting support from family or friends. Yet, parents also expressed motivation to be good parents, resilience, and the desire to gain effective parenting skills. Although similar themes arose among parent and provider interviews, perceptions differed. Parents expressed hope and optimism in providing for their children while providers expressed systemic failure in preparing parents for independent living. Based on these findings, we conclude that parenting interventions specific to parents aging out may need to address three fundamental and key components: basic needs, social support, and effective parenting techniques.     

Foster parent perceptions of competency: Implications for foster parent training

Studies have examined factors that impact successful placements in foster care. Absent from this body of research, however, are factors that promote foster parent competence. The purpose of this study was to assess perceived competency of foster parents, subsequent to pre-service training, in tasks of foster parenting across 12 domains of foster parenting as recommended by previous research. The sample consisted of 20 foster parents who had completed foster parent training within the past five years. Although foster parents in this study rated themselves as competent in primary domains of foster parenting, there were mixed results as to their satisfaction and acceptance of demands of foster parenting in relation to foster family adjustment and working with a complex care system. Implications for therapeutic interventions are discussed.     

Use of a Parent Management Training Intervention with Urban Foster Parents: A Pilot Study

The development of effective interventions for foster children with behavior problems is essential given the consequences of behavior problems for children's placement stability and permanency outcomes. This article presents findings from a pilot study of an intervention providing parent management training (PMT) and support to foster parents in groups and home visits. The intervention was an adaptation of the KEEP (Keeping Foster Parents Trained and Supported) group intervention, provided in a large urban child welfare agency serving predominantly African American foster parents. The study used an intent-to-treat design, with 25 foster parents of 31 children (ages 4-12) in specialized foster care assigned to either an intervention or treatment as usual control group. Longitudinal outcomes were analyzed using random effect regression models. Over time, children's behavior problems were significantly lower in the intervention group relative to the control group, and the effect of the intervention was partially mediated by parents' understanding of how to appropriately use the intervention parenting skills. These results provide support for the effectiveness of KEEP with urban foster children with significant behavior problems.     

Parenting Under Pressure: Experiences of Parenting While Aging Out of Foster Care

Youth “aging out” of foster care experience higher rates of adolescent parenting than their peers who have not been in care. Due to their history of maltreatment, high adolescent pregnancy rates, and poor psychosocial outcomes, youth aging out who are parents are a vulnerable at-risk group. This study examines the parenting experiences of 33 youth aging out (21 mothers and 12 fathers) using data from a larger ethnography. Field notes of observation and transcribed interviews of youth aging out who are parents were analyzed using open coding strategies. Findings show parents encountered challenges while aging out and parenting, yet they found joy in their children and strived to be good parents despite having limited parenting skills, few resources, and little support. Desiring a better life for their children and fearing their children would enter foster care, parents were motivated to improve their lives for their children. Implications are discussed.     

Parenting perceptions among college students: A qualitative examination

This study assessed the knowledge and attitudes of young adults without children in regard to discipline and parenting practices. A qualitative design was utilized (n?=?26) with semistructured focus groups. Results indicated participants believed discipline is important, with spanking and loss of privileges being the most effective strategy for behavior change. The majority of participants reported plans to discipline future children the way in which they were disciplined, suggesting a high percentage intend to utilize spanking. Findings suggest that personal experiences shape parenting beliefs, attitudes, and knowledge. Results inform efforts at educating future parents on appropriate parenting practices and indicate the need for protocols for young adults to educate about practices that may diverge from their personal experiences.     

Computer-mediated parenting education: Digital family service provision

Computer-mediated family service provision holds the promise of equal efficacy, lower cost, and higher accessibility than traditional parent education groups that require parents to travel to a service venue, thereby alleviating often-cited pragmatic barriers to participation in parenting programs. Hence, examinations of which populations are attracted to particular service modalities are a necessary step in building a reliable evidence base. The scant computer-mediated parent education literature indicates that online parenting programs are beneficial to indicated or secondary prevention programs seeking to bolster specific parent, child, or dyadic outcomes; it is reasonable to ask, then, if this service provision mechanism would be equally effective for all parents, outside of targeted intervention designs. The current paper describes the provision of computer-mediated parenting services to a large sample of parents (N = 192, 89.6% female, average age 40 years; 27% racial/ethnic minority) with no shared prevention indicator through an employer-based program. Our research questions on service provision and utilization include: Who is served by primary prevention programs like this? Do participants report satisfaction with computer-mediated services commensurate with traditional face-to face services? In addition to significant differences in perceived social support by gender, marital status, and number of children younger than 18 living in the home, results from three measures of parenting attitudes and behaviors (e.g., discipline style, sense of competence, and locus of control), indicate that this sample has some confidence in their general abilities as parents, but struggle to feel an internal sense of control over their children's behavior, with the greatest number of parents tending towards overreactive discipline. Associations between these indicate a consistent pattern such that dysfunctional parenting practices tend to co-occur, and parents who do employ dysfunctional strategies feel less competent as parents. Participants report high satisfaction with these services, at equal or better rates than reported in the parent education literature. This work provides evidence that computer-mediated parenting services can attract and exceed expectations of participants with clinical and subclinical but moderate parenting needs, indicating that this service delivery mode has the potential to reach a wide number of individuals ideally situated for prevention services.