Parent Management Training, Relationships with Agency Staff, and Child Mental Health: Urban Foster Parents' Perspectives

Many foster parents are ill prepared to meet the behavioral needs of children placed in their homes. Research suggests they lack training in evidence-based behavioral interventions and feel unsupported by child welfare professionals. Given the complex needs of foster children and increased rates of placement disruption for foster children with behavior problems, implementation of effective interventions is essential. However, little is known about foster parents' receptivity to these types of interventions. In this qualitative study, we examine urban foster parents' perceptions of the specific elements of parent management training (PMT), an evidence-based treatment for disruptive behaviors that teaches parents to improve desired behaviors and decrease oppositional behaviors by rewarding positive behaviors (positive reinforcement) and responding to negative behaviors with mild, consistent punishments such as timeout or a privilege removal. We present data from four focus groups (N = 38). While the questions focused on parent's perceptions of PMT, responses often related to parent interactions with agency staff. Four strong themes emerged from the data. First, foster parents discussed a need for more support and training in how to address children's behaviors, but also had concerns that some PMT discipline techniques would be ineffective based on their past experiences with foster children. Second, they described how staff communication skills and allegations of child abuse could affect parents' motivation to continue fostering. Third, they expressed a need for more detailed information about children's histories and visits with biological families as the lack of information contributed to difficulty in meeting foster children's needs. They suggested that joint training of foster parents and staff in the intervention could improve their ability to work together to support the child's positive behaviors. Finally, parents reported little involvement in child mental health services and doubted the effectiveness of the mental health services their foster children received.     

Birthfamilies as permanency resources for children in long-term foster care

Provisions of the Adoption and Safe Families Act of 1997 mandated shorter time frames for making permanency decisions and facilitating adoption. Yet for many children, foster care continued to be a significant portion of their life experiences. This project explored the potential permanency option of birthfamilies and extended kin for children who languished in foster care while being free for adoption. Eighteen children achieved permanent placement with their birthfamilies. In addition, staff found that although many families could not provide permanent placements, they could offer appropriate relationships with the children. This project team recommends viewing family relationships as an integral component where placement is one option on a continuum that includes letters, phone calls, and visits.     

Flemish Foster Mothers’ Perceptions of Support Needs Regarding Difficult Behaviors of Their Foster Child and Their Own Parental Approach

Family foster care is a valuable, but vulnerable type of out-of-home placement. Adequate support of foster parents is an important factor for placement success. This requires an accurate assessment of the support needs of foster parents. This paper focuses on the support needs of foster mothers concerning difficult behavior of the child and their own parenting behavior. Data were gathered from 282 foster mothers. 46 % of the foster mothers needed support on at least one behavior of the child, 40 % on at least one parenting behavior. Foster mothers, who felt less competent to deal with the child, expressed a higher support need on both areas. A high support need concerning difficult behaviors was further predicted by the foster mother’s age, the type of foster care, and the number of biological children. A high support need concerning parenting was further predicted by the quality of support by the foster care worker and the number of foster children. Careful monitoring of all types of foster care situations with special attention to problem behaviors and how to handle them could make this type of out-of-home-placement more effective.     

Planned and unplanned terminations of foster care placements in the Netherlands: Relationships with characteristics of foster children and foster placements

This study examined the role of placement and child characteristics in the unplanned termination of foster placements. Data were used from 169 foster children aged 0 to 20. Results showed that 35% of all foster placement terminations were unplanned. Outcomes of logistic regression analyses demonstrated that behavior problems, parenting stress and a non-Dutch ethnic background of the foster child increased the likelihood of a placement termination. Furthermore, risk accumulation contributed to unplanned terminations. The results indicate that supporting foster parents in managing problem behavior of the foster child and reducing parenting stress may be a key to an effective prevention of disrupted foster care placements.     

"Reasonable efforts": toward implementation in permanency planning

The "reasonable efforts" criterion for provision of services to the families of children in foster care and to the families of children at risk of entering foster care is designed to provide for external, and presumably more objective, monitoring by a court of the quantity and quality of these services. A standard of "reasonable effort" applicable to all cases in the two populations of concern is both impractical and probably unethical. Legally there must be a case-by-case determination of "reasonable efforts" that will weigh the unique elements of each case. It is hoped that the working guideline proposed here will provide a basis in child welfare practice for minimizing potentially great variations in court decisions. The guideline begins with a list of problems, verified via an adversarial review, as to why the child(ren) entered foster care or is at risk of doing so, followed by the establishment of the relevance of proffered services to those problems, followed by documentation of a sustained effort to facilitate the use of those services.     

The role of family interactions in HIV risk for gay and bisexual male youth: A pilot study

Despite ongoing prevention efforts, young gay and bisexual males continue to engage in sexual behaviors that place them at disproportionately high risk for HIV infection. Parental monitoring and parent–child communication have been found to be associated with low-risk sexual behavior among heterosexual youth, but the role of family interactions for gay and bisexual male youth remains largely unexplored. To help address this gap, an exploratory study of recorded and coded interactions among 35 gay and bisexual youth and their parents was done to begin to identify which types of family interactions were associated with youth high-risk sexual behavior. Parent–son communication that was mutual and low in conflict was found to be most prevalent among youth with the fewest reported high-risk sexual behaviors. These preliminary findings, along with a case example, demonstrate how social workers can coach families to engage in productive and potentially influential interactions that reduce HIV-related sexual behaviors among young gay and bisexual males.     

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.     

Children with problematic sexualized behaviors in the child welfare system

This study assessed the utility of the Child Sexual Behavior Inventory (CSBI) in a child welfare sample. In this study, 97 children from ages 10 to 12 from either foster boarding homes or a residential treatment center participated. Researchers interviewed foster parents or primary therapists about children's sexual behavior, traumatic events, clinical symptoms, and their attitudes toward the child. Findings revealed that problematic sexualized behaviors were more prevalent in the residential treatment center (RTC) sample than they were in a normative sample. The pattern of associations between sexual behavior problems, traumatic events, and clinical syndromes in both the RTC and the foster boarding home (FBH) samples was similar to what has been found in samples in which biological custodial parents were the respondents. Analyses comparing youth who met the criterion for having problematic sexualized behaviors and youth who did not meet the criterion revealed that the two groups differed on clinical symptoms, prior traumatic events, and negative reports by caregivers. Results confirm the utility of the CSBI measure for this population and highlight several important clinical and programmatic concerns for addressing problematic sexual behavior in children in the child welfare system.     

Improving Relationships in Child Welfare Practice: Perspectives of Foster Care Providers

Foster parents care for our nation’s most vulnerable children and adolescents. Their ability to provide care is impacted directly and indirectly by their interactions with public child welfare agencies and workers. This study examines the perspectives of 1095 foster parents in a southwestern state in the U.S. regarding what they believe child welfare workers are doing well and their suggestions for ways to improve relationships between foster care providers and child welfare workers. Foster parents commended caseworkers who were responsive to their needs and provided ongoing concrete and emotional support, and believed there was a need for improved communication and enhanced teamwork. Foster parents consistently acknowledged an overwhelmed child welfare system and the impact on child welfare workers and child welfare-involved families. Understanding the perspectives of foster parents can improve relationships between child welfare workers and foster parents, improve recruitment and retention efforts of foster parents, prevent disruption of children from foster homes due to license closure, and improve the overall well-being of child welfare-involved children and families.     

Competencies and problem behaviors of children in family foster care: variations by kinship placement status and race

Formal kinship foster care is an increasingly common form of out-of-home placement, and several important distinctions between kinship care and non-relative foster care have been identified. The present study evaluated the behavior of kinship foster children in comparison to non-relative foster children and children in the general population. A geographically and ethnically diverse sample of foster children (N=240) was assessed for competence and problem behaviors using the Child Behavior Checklist (CBCL: Achenbach, 1991). Kinship foster children closely resembled children in the general population but differed significantly from their counterparts in non-relative foster care, who consistently scored lower on competence and higher on problem behaviors. Substantial proportions of non-relative foster children were in the clinical range on most CBCL measures, but kinship foster children were no more likely than children from the general population to score above clinical cut-offs. Differences between kinship and non-kinship foster children became less dramatic after accounting for child race and gender, which were both associated with kinship status. Child race had a strong main effect for almost all types of problem behaviors, with children of color showing significantly less problematic behavior. Discussion of these results centers on potential explanations for the observed variations in child behavior by kinship status and race.     

Compliance and Internalization in Preschool Foster Children

Child compliance and internalization are socio-cognitive developmental processes which are critical for children's social outcomes in multiple arenas. These developmental processes are found to be compromised in maltreated children. The current study was designed to add to the extremely limited literature on compliance and internalization in maltreated children in foster care. Compliance and internalization tasks were administered to preschool foster children, videotaped and later coded. Through parent-report questionnaires completed by the foster parents and observations of the foster home, the relation of compliance/internalization to child behavior problems, foster care experiences, and the foster home environment was examined. Findings revealed that most children showed committed compliance, but over 50% of children exhibited “deviation” behaviors in the internalization task. HOME acceptance scores (via observation of parent and child in home setting) significantly contributed to children's compliance levels but did not significantly contribute to their internalization. Internalization was related to children's externalizing behavior problems. These findings are considered in the context of future research and practice with respect to young children in foster care.     

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.     

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.     

Maternal Work Absence: A Longitudinal Study of Language Impairment and Behavior Problems in Preschool Children

Combining work and family responsibilities is challenging when children have special needs, and mothers commonly make employment‐related adjustments. In this study, the authors examined associations between maternal work absence and child language impairment and behavior problems in preschool children. Questionnaire data at child age 3 years from 33,778 mothers participating in the prospective population‐based Norwegian Mother and Child Cohort Study were linked to national register data on employment and long‐term physician‐certified sick leave at child age 3–5 years. Mothers who reported having a child with language impairment had a consistently higher risk of not being employed and were at increased risk of taking long‐term sick leave at child age 5 years. Co‐occurring problems were associated with excess risk. Language impairments in preschool children, in particular when they are co‐occurring with behavior problems, are likely to have a range of negative short‐ and long‐term consequences for the financial and overall health and well‐being of mothers and their families.     

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.     

Homelessness and aging out of foster care: A national comparison of child welfare-involved adolescents

The present study represents the first large-scale, prospective comparison to test whether aging out of foster care contributes to homelessness risk in emerging adulthood. A nationally representative sample of adolescents investigated by the child welfare system in 2008 to 2009 from the second cohort of the National Survey of Child and Adolescent Well-being Study (NSCAW II) reported experiences of housing problems at 18- and 36-month follow-ups. Latent class analyses identified subtypes of housing problems, including literal homelessness, housing instability, and stable housing. Regressions predicted subgroup membership based on aging out experiences, receipt of foster care services, and youth and county characteristics. Youth who reunified after out-of-home placement in adolescence exhibited the lowest probability of literal homelessness, while youth who aged out experienced similar rates of literal homelessness as youth investigated by child welfare but never placed out of home. No differences existed between groups on prevalence of unstable housing. Exposure to independent living services and extended foster care did not relate with homelessness prevention. Findings emphasize the developmental importance of families in promoting housing stability in the transition to adulthood, while questioning child welfare current focus on preparing foster youth to live.     

A Family System Approach to Investigate Family‐Based Pathways Between Financial Stress and Adolescent Problem Behavior

This article proposes a family system approach to improve our understanding on family stress processes. Examining effects within (actor) and between (partner) parents, we explored family‐based pathways through which financial stress is associated with adolescent externalizing problem behavior. Data from 340 families were analyzed, with both parents rating their financial stress and parenting stress, and parents as well as adolescents rating the parent–child communication and adolescent problem behavior. The results revealed that the association between financial stress and adolescent externalizing problem behaviors was mediated by parenting stress and parent–child communication. Although our results provided evidence for both actor and partner effects, actor effects were more prominent. No parent gender differences were found in the strength of the pathways.     

Foster parent perceptions of placement breakdown

The purpose of the study was to describe the perceived causes of placement breakdown by foster parents. Sixty-three foster parents from fifty families were asked to describe their challenges in response to the following question: “What would make you consider ending a foster placement”? The responses to this question were analyzed using multidimensional scaling and cluster analysis, to yield nine themes. Foster parents indicated that they would consider ending a placement if there was a danger to their family, if the child could not adapt to the home or if they could not handle the child's behavior. Participants reported that the complex health needs of a foster child, problems dealing with the foster agency, and several unsuccessful attempts to make the placement work would cause a placement to breakdown. Foster parents also indicated that they would consider ending a placement if their personal circumstances changed, their own health deteriorated, or there was a lack of appropriate external support in place. The results of the study point to gaps in the research on violence in general foster care, foster parent perceptions of contributions to a foster child's transition back to his or her birth family, and the process of foster parent decision-making in cases of placement breakdown.     

Placement Instability and Risky Behaviors of Youth Aging Out of Foster Care

Youth who age out of foster care are at risk of poor outcomes and risky behaviors in young adulthood. Yet, little is known about what child welfare workers can do to decrease these risks. The effect of foster care placement instability on substance use and risky sexual behaviors is examined using data from 114 young adults who aged out of care. When controlling for variables commonly associated with these behaviors, a history of foster care placement instability increased the young adults’ likelihood to use substances. Child welfare practitioners could potentially reduce the vulnerability of this population by providing them greater stability during adolescence.     

Behavior Problems of Sexually Abused Children in Foster Care

Research has shown that sexually abused children display a number of behavior problems. Many of these children are placed in substitute care, especially foster homes. The current project was undertaken to measure foster parents' perceptions about the behavior problems of sexually abused children in their care. Two studies were completed. The first was a large survey of foster parents in a Midwestern state. The second study utilized a sample of foster parents to complete a standardized behavior inventory which has previously been used in child sexual abuse research. The types of behavior problems described by foster parents and implications for future research are discussed.