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.     

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.     

Administrative case reviews: Improving outcomes for children in out-of-home care

For nearly three decades foster care review has been required and practiced in the United States. It is well established that foster care review was designed with the intent to reduce the time children spend in foster care and increase permanent placements for children. This article presents that foster care review, as practiced in Colorado, is a social work intervention and quantitative results of this study demonstrate that as an intervention, timely administrative case review is an effective social work intervention related to improving child welfare outcomes for the children and families served in Colorado. The major findings show that timely administrative case review and increased levels of review attendance (mother, father, Guardian ad litem's, and foster parents) are predictors of the child welfare outcomes of permanency and length of time in out-of-home care. Bivariate results indicate a median length of stay approximately 10.76 months longer for children who do not consistently receive timely case reviews. Additionally, the results show that timely care review moderates the underlying casework process related to caseworker contacts, demonstrating that a child's length of stay differs depending on the level of timely case review. In essence, the administrative case review process in Colorado is effectively achieving its goal and is an effective intervention for improving the lives of children in foster care.     

Foster Parents Speak: Preferred Characteristics of Foster Children and Experiences in the Role of Foster Parent

Foster parents play a pivotal role in the child welfare system. A study that employed focus groups with foster parents was conducted at a private foster care agency with the initial purpose of understanding the characteristics of foster children that foster parents both preferred and not preferred. In the qualitative research tradition, their answers addressed the topic of characteristics and expanded to provide additional data on their experience as foster parents. Using theme analysis, the following themes were generated: foster care as service; foster parents' preferences of foster children's characteristics; foster parents do not feel valued or trusted; increased caseworker and foster parent partnership; problems in the foster care and related systems; and focus group as support. Implications for research and practice are forwarded.     

Measuring the willingness to foster children with emotional and behavioral problems

Many children in foster care have emotional or behavioral problems or are at risk for these problems. It is important to identify parents willing to foster children with these problems in order to ensure placement, care, stability and well-being of such children. This study presents a new 40-item self-report measure of the willingness of parents to foster children with emotional and behavioral problems, and two 20-item parallel forms of this measure. In addition, this study presents evidence of reliability and validity of scores derived from these measures with a national sample of 297 foster mothers. Coefficient alpha for these measures was .92 or greater, indicating excellent internal consistency reliability. Scores from these measures were unrelated to demographic characteristics, providing evidence of discriminant validity. In addition, scores from these measures were higher for foster mothers licensed to provide treatment foster care than for mothers only licensed to provide regular foster care, providing support for known groups validity. Finally, support for construct validity is provided by the fact that foster mothers with higher scores on these measures had fostered longer, were fostering more children at the time of this study, and had fewer children removed from their home at their request.     

Externalizing problems in young foster children: Prevalence rates,predictors and service use

Objective

Examining the prevalence of externalizing problems, their predictors and mental health service use for these problems by foster children and foster parents in a representative group of foster children aged 3 to 12 in Flanders.

Method

Survey data were collected on 212 foster children, who had been in the foster family for approximately four months. Foster parents filled out a Child Behavior Checklist to measure foster children's externalizing problems. Foster care workers reported on several potential risk variables for externalizing problems and on foster children's and foster parent's mental health service use. Predictors of externalizing problems were identified from a large number of variables using the method of purposeful selection of variables in linear regression.

Results

40.6% of the foster children had externalizing problems. Foster children who were placed because of behavioral problems had more externalizing problems. Only 20.9% of the foster children with externalizing problems and only 13.9% of their foster parents received professional help.

Conclusions

This study showed that externalizing problems are prevalent in this young foster care population, that it is hard to predict which foster children had externalizing problems, and that foster children and their foster parents rarely receive services for these problems. These findings call for a standard protocol of assessment of foster children's externalizing problems. Moreover, from a preventive viewpoint, guidelines are needed to systematically link young foster children with externalizing problems and their foster parents to appropriate services.     

Promoting birth parents' relationships with their toddlers upon reunification: Results from Promoting First Relationships® home visiting program

Birth parents, once reunified with their child after a foster care placement, are in need of in-home support services to prevent reoccurrence of maltreatment and reentry into foster care, establish a strong relationship with their child, and enhance child well-being. Few studies have addressed the efficacy of home visiting services for reunified birth parents of toddlers. This study reports on the findings from a randomized control trial of a 10-week home visiting program, Promoting First Relationships® (Kelly, Sandoval, Zuckerman, & Buehlman, 2008), for a subsample of 43 reunified birth parents that were part of the larger trial. We describe how the elements of the intervention align with the needs of parents and children in child welfare. Although the sample size was small and most of the estimates of intervention effects were not statistically significant, the effect sizes and the pattern of results suggest that the intervention may have improved both observed parenting sensitivity and observed child behaviors as well as decreased parent report of child behavior problems. Implications are that providing in-home services soon after a reunification may be efficacious in strengthening birth parents' capacity to respond sensitively to their children as well as improving child social and emotional outcomes and well-being.     

The vital few foster mothers

Many foster parents serve only briefly, and foster and adopt few children. Anecdotal reports suggest that a small percentage of foster parents provide a disproportionate amount of care; however, we know virtually nothing about these parents. This study applied the Pareto Principle, also known as the 80–20 rule or Vital Few, as a framework to conceptualize these foster parents. Using latent class analysis, two classes of mothers were identified: one accounted for 21% of mothers and the other 79%. We refer to the former as the Vital Few and the latter as the Useful Many. Vital Few mothers fostered 73% of foster children — 10 times more than Useful Many mothers although only fostering three times longer. They adopted twice as many foster children while experiencing half the yearly rate of placement disruptions. Vital Few mothers were less likely to work outside the home, had better parenting attitudes, more stable home environments, more time to foster, and more professional support for fostering, but less support from kin. Further, they were as competent as the Useful Many on numerous other psychosocial measures. Understanding characteristics of these resilient Vital Few can inform recruitment and retention efforts and offer realistic expectations of foster parents.     

The early home environment and developmental outcomes for young children in the child welfare system

The quality of the early home environment is predictive of young children's subsequent cognitive, academic, and behavioral functioning. Limited research has focused on the effects of the early caregiving environment on the functioning of young children involved with the child welfare system. This study investigated the influence of children's home environments (i.e., number of children in the home, number of moves the child experienced, level of cognitive stimulation, and level of emotional support) during the first 2 years of life on their preschool developmental outcomes (i.e., cognition, language, social skills, and behavior problems).As anticipated, a high-quality early home environment promoted the well-being of preschool children who had entered the child welfare system as infants. Children who lived with greater numbers of children incurred more compromised cognitive, language, behavioral, and social outcomes. No significant associations emerged between the total number of placements and developmental outcomes; children who remained in the same home during infancy (typically the birth family home) had more compromised developmental outcomes in every domain except behavioral problems.Both cognitive stimulation and emotional support in the home predicted higher cognitive and language scores, decreased behavioral problems, and increased social skills. Early out-of-home placement and lack of emotional support interacted to predict children's behavioral problems. These findings are considered in the context of extant research and policy relevant to young children in the child welfare system.     

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.     

Effects of a Foster Parent Training Program on Young Children’s Attachment Behaviors: Preliminary Evidence from a Randomized Clinical Trial

Young children who enter foster care experience disruptions in care and maltreatment at a point when maintaining attachment relationships is a key, biologically based task. In previous research, we have found that young children experience challenges as they form attachments with new caregivers. They tend to push their new caregivers away, even though such children are especially in need of nurturing care. Further, many caregivers do not respond in nurturing ways when their children are distressed, which we have found is problematic for young children in foster care. We developed an intervention that is designed to help caregivers provide nurturance even when children do not elicit it, and even when it does not come naturally to them. This paper presents preliminary findings of the effectiveness of this intervention on children’s attachment behaviors. Forty-six children were randomly assigned to either the experimental intervention or to an educational intervention. For three consecutive days, attachment behaviors were reported across three distress-eliciting situations. Children whose parents had received the experimental intervention showed significantly less avoidance than children whose parents had received the educational intervention. These preliminary results suggest that the intervention is successful in helping children develop trusting relationships with new caregivers.     

Adult well-being of foster care alumni: Comparisons to other child welfare recipients and a non-child welfare sample in a high-risk,urban setting

Research has shown that children placed in foster care fall below population norms on many indicators of well-being. Yet few studies have been designed to distill the effects of foster care from conditions that precede foster care. Based on the available evidence, it is also uncertain whether the purported effects of foster care are lasting. This study used data gathered prospectively from an economically disadvantaged, urban cohort to examine whether foster care is associated with decreased educational and economic attainments as well as increased criminality in adulthood. Individuals who were placed in foster care after an indicated allegation of maltreatment were compared to three naturally occurring groups: (a) maltreatment victims who did not reside in foster care, (b) individuals without an indicated maltreatment allegation who were raised in a household with a Child Protective Services (CPS) record, and (c) individuals without an individual or household record of CPS involvement. Using multiple estimation procedures, we found that all participants with a CPS record fared worse in adulthood than their peers without a CPS record. Despite their poor outcomes, foster children functioned as well as other CPS recipients who did not reside in foster care. Our findings indicate that caution is warranted when attributing dysfunction observed in foster children to the effects of foster care. Implications for prevention and intervention within the context of child welfare are discussed.     

Nonviolent resistance: a treatment for parents of children with acute behavior problems

Nonviolent resistance (NVR) is a new training model aimed at helping parents deal effectively with their helplessness, isolation, and escalatory interactions with their children. The purpose of this study is to evaluate training in NVR with the parents of children with acute behavior problems. Seventy-three parents (41 families) were randomly assigned to a treatment group and wait-list control group. Measures were taken at pretreatment, posttreatment, and a 1-month follow-up. In comparison with the wait-list group, parents who received training in NVR showed a decrease in parental helplessness and escalatory behaviors, and an increase in perceived social support. The children's negative behaviors as assessed by the parents also decreased significantly.     

Socioemotional characteristics of minors in foster care: A comparison between the estimation of parents,teachers and children

During the child's first few years, it's of fundamental importance the presence of a strong emotional base as long as it creates the possibility to open themselves to physical and social world with confidence, and as it acts as a facilitator of cognitive development. For this reason, if the family cannot ensure such base, social services are forced to resort to foster care, a resource that has a lot of difficulties, leading to different implications in the development of the child and of the foster family. It is therefore important to analyze in depth the socio-emotional variables that characterize children who are in a situation of foster care in order to provide adequate assistance to optimize their development. For this 32 minors in foster care, 31 foster parents and 28 teachers from the city of Valencia, were administered the BASC. The results highlight that parents are evaluating children, in general, worse than tutors. Specifically they consider children more aggressive, they detect more behavioral and attention problems and recognize in them a greater tendency to externalize the problems, while the teachers consider these children as with more social and adaptive skills. There were no significant differences between the scores of parents, teachers and children. High levels of psychopathology (which are clinically significant in various cases) and the fact that host parents evaluate minors as more problematic, are indicators of parents' and minors' need of support from public organizations.     

Underserved parents,underserved youth: Considering foster parent willingness to foster substance-using adolescents

Adolescents involved with foster care are five times more likely to receive a drug dependence diagnosis when compared to adolescents in the general population. Prior research has shown that substance use is often hidden from providers, negating any chance for treatment and almost guaranteeing poor post-foster care outcomes. There are virtually no studies that examine the willingness (and its determinants) to foster youth with substance abuse problems. The current study conducted a nationally-distributed survey of 752 currently licensed foster care parents that assessed willingness to foster youth overall and by type of drug used, and possible correlates of this decision (e.g., home factors, system factors, and individual foster parent factors such as ratings of perceived difficulty in fostering this population). Overall, willingness to foster a youth involved with alcohol and other drugs (AOD) was contingent upon the types of drugs used. The odds that a parent would foster an AOD-involved youth were significantly increased by being licensed as a treatment foster home, having fostered an AOD-involved youth in the past, having AOD-specific training and past agency-support when needed, and self-efficacy with respect to positive impact. Surprisingly, when religion played a large part in the decision to foster any child, the odds of willingness to foster an AOD-involved youth dropped significantly. These results suggest that a large proportion of AOD-involved youth who find themselves in the foster care system will not have foster families willing to parent them, thereby forcing placement into a variety of congregate care facilities (e.g., residential treatment facilities, group homes). Specific ways in which the system can address these issues to improve placement and permanency efforts are provided.     

Foster children placed with or separated from siblings: Outcomes based on a national sample

This study examines a range of outcomes for children in foster care who have siblings, using a large, national U.S. database. Three types of sibling placements are defined: split (child has no siblings in the home), splintered (at least one sibling in the home), and together (all siblings in the home). The study analyzes records (n = 1701) from the National Study of Child and Adolescent Wellbeing, including Child Protective Services (CPS) and Long-term Foster Care (LTFC) samples. It contributes to the literature in its inclusive definition of siblings, use of three categories for sibling placement status, and use of outcome measures that include the perceptions of foster children. The study reports limited significant findings. Neither foster parents' nor youths' reports of behavioral problems differ by sibling placement status. As rated by teachers, academic performance in the group placed together exceeds that in both of the other groups. For children in kinship homes, teachers also reported less problematic internalizing and externalizing behavior for the splintered and together groups than for the split group. Children in the splintered group also responded more favorably than those in the split group to questions of closeness to the primary caregiver and liking the people in the foster family.     

Should I stay or should I go? A mixed methods study examining the factors influencing foster parents' decisions to continue or discontinue providing foster care

The recent economic recession has resulted in dramatic cuts to child welfare programs and services. Licensed foster homes represent an essential component of the child welfare system as these families provide for the care and safety of children during times when their own families are not able to do so. Despite the important role foster parents serve, little attention has been given to understand what impacts their decision about whether to continue fostering. This is especially important when considering the context of recent economic stressors on families and on the systems on which families rely. The purpose of this study was to understand what factors impact a parent's likelihood of continuing fostering. To accomplish this objective, a mixed methods concurrent triangulation design was conducted by sending an online survey to foster parents in one state located in the southwest. Findings based on this sample of 649 foster parents suggest foster families' intentions to continue fostering are positively impacted by their own intrinsic rewards and motivations, satisfaction with fostering, locus of control, and level of emotional and practical supports. Reduction in reimbursement rates, decreases in the amount of quality services available for foster children and for foster families, difficulty navigating the system, and individual-level family changes were cited as reasons foster parents would consider discontinuing fostering. Open-ended responses offer increased understanding about how these factors are perceived by respondents to impact their ability to continue to provide for our nation's most vulnerable children.     

Internet Risks for Foster Families Online

ABSTRACT

Foster parents and children (n = 64 families) who participated in a program to reduce the digital divide among foster children were surveyed about difficulties experienced in use of online communications. Providing Internet access to foster families increased Internet use, but was not perceived by parents or children as taking away time from other family or social relationships. A minority of parents and foster youth, however, reported a variety of problems ranging from benign arguments over access to the computer or frustration over equipment failure to serious concerns about children receiving pornography or meeting a sexual predator online. Although the majority of both parents and social workers were confident in their ability to deal with Internet-related problems, approximately one-third had low confidence in their ability to deal with foster family's Internet-related difficulties. Training foster parents on using filtering software to prevent pornography from coming into the child's experience of the Internet significantly reduced problems related to pornography when compared to foster families not in the program. Implications for social work practice are discussed.     

Does allocation to a control condition in a Randomized Controlled Trial affect the routine care foster parents receive?

‘Strengthening Foster parents in Parenting’ (SFP) is a support program for foster parents who care for foster children with externalizing problem behavior. Its effectiveness was examined with a Randomized Controlled Trial (RCT). In this paper, we examine the treatment as usual (TAU) that was offered in the control condition of this RCT. For this purpose, the TAU from the SFP control group was compared with TAU provided to a similar group of foster parents outside any RCT.Our results show that TAU is diverse and varies widely. Furthermore, being part of the control condition was positively associated with both the counseling frequency from the foster care services and with external help-seeking behavior (finding and using additional support).In order to prevent condition contamination in future trials, TAU should be clearly described and standardized, and treatment fidelity should be carefully monitored.     

Predictors of foster care exits to permanency: A competing risks analysis of reunification, guardianship, and adoption

Although foster care is intended to be temporary, and policy explicitly requires permanency outcomes, many children experience lengthy stays and exit foster care without a permanent family. This study sought to identify which child and placement characteristics were important predictors of exit to three types of permanency outcomes: reunification, guardianship, and adoption. A sample of 3351 children who entered foster care in 2006 was observed for 30 to 42 months. Permanency outcomes were analyzed using competing risks survival analysis. Children exited foster care to different types of permanency at different rates and frequencies. Reunification occurred most quickly and frequently. Guardianship was second in terms of median duration but third in frequency. Adoption was the second most common exit but had the longest median duration. One in four children remained in foster care or exited without permanency. While patterns varied by type of permanency, three major categories of important predictors were identified: 1) demographic characteristics of age at entry and race, 2) clinical needs related to children's disabilities and mental health problems, and 3) continuity and connections represented by kin placements, sibling placements, early stability, and absence of runaway events. Implications for practice, policy, and research are discussed.