The Impact of Foster Parent Training on Parenting Skills and Child Disruptive Behavior

An Evaluation of Self-Assessed Caregiver Readiness to Foster and Adopt After Participating in the National Training and Development Curriculum

PURPOSE

The self-assessment is a component of the National Training and Development Curriculum (NTDC) used by resource (i.e. foster, adoptive, and kinship) parents to understand strengths and areas of potential growth associated with successful parenting. This outcome evaluation assesses changes in caregiver self-assessment results after receiving the NTDC classroom-based training.

MATERIALS AND METHODS

Resource parents from six U.S. states completed the self-assessment at baseline before the NTDC classroom-based training and 90 days after completing the training. Regression analyses were conducted for 20 training competencies and 14 parenting characteristics, controlling for demographic and caregiver characteristics and using propensity-score weights to account for potential bias from attrition between completion of the self-assessment at baseline and follow-up. The number of participant responses in the analytic sample varied across the training competencies and parenting characteristics, with an average of n = 321 responses per construct.

RESULTS

All training competencies and parenting characteristics observed statistically significant improvements in participant scores from baseline to follow-up, with average training competency scores improving by 11% and parenting characteristic scores by 5%.

DISCUSSION

These results suggest that the NTDC classroom-based curriculum may help caregivers to develop knowledge and skills in content areas related to effective parenting.

CONCLUSION

The NTDC self-assessment seems to function as intended for participants to understand areas of strength and potential growth in a variety of training competencies and parenting characteristics associated with effective parenting.

Access to best-evidenced mental health support for care-experienced young people: Learnings from the implementation of cognitive therapy for PTSD

OBJECTIVES

Rates of PTSD are up to 12 times higher in care-experienced young people (CEYP) compared to their peers. Trauma-focused CBTs (tf-CBT) are the best-evidenced treatment for youth with PTSD, yet, in practice, CEYP often struggle to access this treatment. We worked alongside services to understand barriers and facilitators of the implementation of cognitive therapy for PTSD (a type of tf-CBT) to CEYP.

DESIGN

This was an active, open implementation trial.

METHODS

We recruited 28 mental health teams across England, including general CAMHS, targeted CAMHS for CEYP and social care-based teams. From these teams, participants were 243 mental health professionals, from a wide variety of professional backgrounds. Following recruitment/intervention training, teams participated in rolling three monthly focus groups and individual interviews, to understand what helped and hindered implementation. Data were analysed using a framework analysis conducted using CFIR 2.0.

RESULTS

Almost half of the teams were able to implement, but only approximately one quarter with CEYP, specifically. Universal barriers that were discussed by almost all teams particularly highlighted service structures and poor resourcing as major barriers to delivery to CEYP, as well as the complexities of the young person and their network. Unique factors that differentiated teams who did and did not implement included commissioning practices, the culture of the team, leadership engagement and style, and the development of supervision structures.

CONCLUSIONS

Findings offer key considerations for mental health teams, service leads, commissioners and policy-makers to enhance delivery of best-evidenced mental health treatments like CT-PTSD, for CEYP.

What does it mean to be a 'foster parent'? -exploring Foster parent narratives using ideal-type analysis

OBJECTIVE

Foster care services in Denmark, as in many other countries, face challenges with recruitment, assessment, and retention of foster families. It is essential to understand how foster parents understand their role and how this might relate to child outcomes. This paper develops a typology of foster parent types through an ideal-type analysis of interviews with foster parents.

PARTICIPANTS AND SETTING

The sample consist of 14 Danish foster parents who had participated in a quasi-randomized trial exploring the effects of Mentalization Based Therapy for foster families.

METHODS

Foster parents were interviewed using a semi-structured interview schedule, interview material was transcribed and subsequently an ideal-type analysis was performed.

RESULTS

Based on foster parents' perceptions of their role in the children's lives, we identified three ideal-types of foster parents: 1) emotional foster parents, 2) ambiguous foster parents, and 3) professional foster parents.

CONCLUSIONS

Foster parent perceptions of their fostering role have implications for understanding foster care as a developmental context.

Interventions to improve mental health and well-being in care-experienced children and young people aged less than 25: the CHIMES systematic review

Background

Children and young people with experience of being in care (e.g. foster care, kinship care, residential care or at home with a supervision requirement order) are at higher risk of adverse mental health and well-being outcomes compared to the general population. Despite a range of policy recommendations and interventions, it is not clear what approaches are effective in the United Kingdom, or how context factors give rise to facilitators and inhibitors of implementation and acceptability.

Objectives

The CHIMES review is a complex-systems-informed mixed-method systematic review that aimed to synthesise the international evidence base for interventions addressing the mental health and well-being of care-experienced children and young people (age ≤ 25 years) and to assess the potential transportability of this evidence base to the United Kingdom context.

Data sources

We searched 16 electronic bibliographic databases and 22 websites from 1990 to May 2022. We conducted citation tracking, screened relevant systematic reviews and contacted international experts.

Method

We used a convergent synthesis design. We first constructed an evidence map to confirm review scope before undertaking method-level syntheses for outcome evaluations, process evaluations and economic evaluations. These elements were integrated into a review-level synthesis to identify potential evidence-based interventions that may progress to further development, adaptation and evaluation in the United Kingdom. We conducted stakeholder consultations to prioritise intervention theories, types and outcomes.

Results

We identified 64 interventions from 124 study reports. Interventions were primarily evaluated in the United States and targeted young people's competencies or carers' parenting practices. Meta-analysis reported limited evidence that interventions effectively improved mental health in the shorter term (0-6 months): total social, emotional and behavioural problems (d = -0.15, 95% confidence interval -0.28 to -0.02); internalising problem behaviours (d = -0.35, 95% confidence interval -0.61 to -0.08); externalising problem behaviours (d = -0.30, 95% confidence interval -0.53 to -0.08); depression and anxiety (d = -0.26, 95% confidence interval -0.40 to -0.13) and social-emotional functioning difficulties (d = -0.18, 95% confidence interval -0.31 to -0.05), but these impacts were not observed in the longer term (> 6 months). Five key context factors potentially explain challenges to implementation and acceptability: lack of system resources; the time, cognitive and emotional burden of delivery or participation; interprofessional tensions; the devaluing of young people, meaning that they felt unable to express dissatisfaction with interventions; and the devaluating of carers' expertise and needs. From the evidence, stakeholder consultation identified two priority interventions: (1) mentoring by individuals with knowledge and experience of care and (2) system and ethos change to create harmonisation between organisations and facilitate interprofessional relationships. Well-being and suicide-related behaviours are priority outcomes alongside mental health.

Limitations

The review was limited by a paucity of theory and economic evaluations, so it is unclear how interventions might function or their potential cost-effectiveness. Interventions were insufficiently described, making it challenging to map the evidence base. Outcome evaluations were poorly reported. Due to ongoing restrictions with COVID-19, stakeholder consultations were conducted later than intended with a smaller number of attendees.

Conclusions

The review identified some evidence for interventions impacting mental health in the short term. There is a lack of system-level interventions and approaches that target subjective well-being and suicide-related outcomes. Future intervention might prioritise mentoring and targeting system culture.

Study registration

This study is registered as PROSPERO CRD42020177478.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR129113) and is published in full in Public Health Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.

Effectiveness of Mental Health and Wellbeing Interventions for Children and Young People in Foster, Kinship, and Residential Care: Systematic Review and Meta-Analysis

The mental health and wellbeing of children and young people who have been in care, primarily foster care, kinship care or residential care, remains a public health priority. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) synthesized evidence for the effectiveness of interventions targeting: subjective wellbeing; mental, behavioral and neurodevelopmental disorders; and suicide-related outcomes. Searches were conducted in 16 bibliographic databases and 22 websites between 1990 and 2022. This was supplemented by citation tracking, screening of relevant systematic reviews, and expert recommendation. We identified 35 interventions, with 44 evaluations via randomized controlled trials. Through meta-analyses, we found that interventions have a small beneficial impact on a variety of mental health outcomes in the short term (0-6 months). Interventions improved total social, emotional, and behavioral problems (d = -0.15, 95% CI [-0.28, -0.02]), social-emotional functioning difficulties (d = -0.18, 95% CI [-0.31, -0.05]), externalizing problem behaviors (d = -0.30, 95% CI [-0.53, -0.08]), internalizing problem behaviors (d = -0.35, 95% CI [-0.61, -0.08]); and depression and anxiety (d = -0.26, 95% CI [-0.40, -0.13]). Interventions did not demonstrate any effectiveness for outcomes assessed in the longer term (>6 months). Certainty of effectiveness was limited by risk of bias and imprecision. There was limited available evidence for interventions targeting subjective wellbeing and suicide-related outcomes. Future intervention design and delivery must ensure that programs are sufficient to activate causal mechanisms and facilitate change. Evaluation research should use a robust methodology.PROSPERO Registration: CRD42020177478.

Mandated Parent Education: Applications, Impacts, and Future Directions

Mandated participation in parent education programs is a common practice across the United States for families who are undergoing divorce or who are involved in the child welfare or juvenile justice systems. Mandates to participate in parenting programs create substantial challenges for families, service providers, and service systems. Furthermore, the type and quality of the parenting services accessed vary widely, and their impacts need to be better understood. To address this need, an overview of the current state of the empirical literature on the impacts and outcomes of mandated parenting interventions for divorce and in child welfare and juvenile justice settings is provided, and suggestions to the field are offered to refine research related to mandated parenting programs. Given the challenges that mandated parenting programs pose, an alternative approach that views parenting through a public health lens is highlighted to build on the growing body of research on the impacts of population-wide applications of parenting support programs, and as a possible way to decrease the number of parents who are required to attend parenting programs. Opportunities to advance universal parenting support within a range of community settings, including primary care, early childhood education, and community mental health systems are offered. Gaps in knowledge regarding mechanisms of action of universal supports and impacts on the number of parents mandated to treatment are highlighted, and future directions for research in this area are suggested.

Delivery and Impact of Foster Parent Training: Similarities and Differences for Relative and Non-Relative Foster Parents

Literature on the delivery and impact of foster parent training, such as the Nurturing Parenting Program (NPP), is sparse, particularly for relative foster parents. This study investigates (a) how NPP referral, initiation, and completion rates vary between relative and non-relative foster parents, (b) reasons for not initiating NPP, and (c) changes in parenting attitudes and behaviors for relative and non-relative foster parents after participating in NPP. The study analyzed data from the Illinois Birth to Three (IB3) study for 722 relative and 397 non-relative foster parents of children ages three and younger. Relative and non-relative foster parents had similar NPP referral and initiation rates, but relatives had significantly lower completion rates. Content analysis of case notes for 498 cases showed that relative foster parents more frequently noted barriers (e.g., childcare, transportation) to NPP initiation. Among NPP completers, both groups reported similar levels of improvements in parenting attitudes and behaviors at the end of NPP, but a pattern of lower scores was observed for relative foster parents. The findings suggest a need for more support for foster parents, particularly relative foster parents.

Design and evaluation of child abuse web-based application for parent education & strengthen

BACKGROUND

Child abuse is one of the major health and social problems in the world and has severe short-term and long-term consequences on children's psychological, social and physical functioning. One of the effective strategies to control and prevent child abuse is training parent through web-based applications. The aim of this study is to design and evaluation of child abuse web-based application for parent education and strengthen.

METHODS

This study is an applied-developmental study that performed in Razi Educational and Therapeutic Center in Tabriz. The study consisted of three main phases. The requirements assessment and design phases were completed between November 2022 and February 2023. The research community was parents referring to Razi Center and convenience sampling was used to select the samples. In firststage, a questionnaire was designed by searching in library sources and consulting with specialists for needs assessment and application design. The questionnaire was completed by psychiatric specialists, health information management and health information technology.Finally, the usability of designed application was evaluated with the participation of 30 parents and specialists.

RESULTS

Based on the identified information elements and capabilities, a child abuse web-based application was designed. Application capabilities were such as concepts of child abuse, prevention and treatment strategies, parenting skills, childrens behavioral disorders, child abuse laws and interaction with clinical specialists. Finally, the result of the web-based application usability evaluation was evaluated at a good level equal to an average of 7.6 out of a total of 9 points.

CONCLUSIONS

The possibility of expressing experiences, exchanging message, attractiveness, ease of use, and accessibility of parents, they were designed as application features. The usability of the web-based application was satisfactory to users in various of overall functionality, display, terminology, learning ability and overall application capability.

National training and development curriculum training program impact on placement, permanency, and stability

BACKGROUND

Resource parent trainings are an important factor in caregiver readiness and retention, which can improve placement stability and permanency achievement for children and youth, especially those who are marginalized.

OBJECTIVE

Resource parents need access to evidence-based training programs attentive to caring for children and youth from a variety of diverse backgrounds. This study evaluates placement, permanency, and stability outcomes of children whose resource parents were trained in one such program: the National Training and Development Curriculum (NTDC).

PARTICIPANTS AND SETTING

Participants include adults who completed a resource parent training program (N = 3822) and children in their care (N = 2565) in the U.S. states of Florida, Georgia, Illinois, and Missouri.

METHODS

This quasi-experimental study involved statistical testing of caregivers and children using AFCARS data. Propensity-score matching was used to control for differences in the child permanency analysis.

RESULTS

With a better understanding of the realities of fostering, NTDC participants were slightly less likely to foster after training (OR = 0.6; p < .001), self-selecting out before taking a child into the home. Those who did foster were more likely to foster a child who is a teen (OR = 1.4; p = .004), Asian/Asian American (OR = 3.8; p = .02), Black/African American (OR = 1.6; p < .001), or Hispanic/Latinx (OR = 1.7; p = .002). Children of NTDC caregivers entered legal adoptions (OR = 2.0; p = .003) and guardianships (OR = 2.9; p = .03) at higher rates than children of comparison caregivers, while rates of reunification (OR = 1.3; p = .11) were not statistically different.

CONCLUSIONS

Evidence points to the effectiveness of NTDC in preparing resource parents to provide care for a diverse range of children by age, race, and ethnicity, and for those children to achieve permanency.

The Triple P System of Evidence-Based Parenting Support: Past, Present, and Future Directions

Triple P is an integrated, multi-level system of evidence-based parenting support designed to promote the well-being of children and families to reduce prevalence rates of social, emotional, and behavioral problems in children and adolescents and to prevent child maltreatment. The system developed gradually over four decades to address the complex needs of parents and children from diverse family, socioeconomic and cultural backgrounds. It blends universal and targeted programs, a focus on developing parental self-regulation capabilities, and adopts a life span perspective with a population health framework. The Triple P system is used as a case example to discuss the past, present and future challenges, and opportunities involved in developing, evaluating, adapting, scaling and maintaining a sustainable system of evidence-based parenting intervention. Seven stages of program development are outlined from initial theory building and development of the core parenting program through to the sustained deployment of the intervention system delivered at scale. The importance of ongoing research and evaluation is highlighted so that different programs within the system evolve and adapt to address the contemporary concerns and priorities of families in diverse cultural contexts. A well-trained workforce is essential to deliver evidence-based programs, in a need-responsive manner that blends both fidelity of delivery and flexibility and is tailored to respond to the needs of individual families and local context. Programs need to be gender-sensitive, culturally informed, and attuned to the local context including relevant policies, resources, cultural factors, funding, workforce availability and their capacity to implement programs.

Experiences of counselors participating in an innovative project to develop a training program for specialized foster parents of youth (13-18 years)

Background

Children placed in foster care represent a vulnerable and distressed group that requires a high level of care. However, good training programs designed to address specific problems presented in specialized foster care are not easily accessible due to logistical, economic and structural barriers. The lack of easy access and a strong desire to provide high-quality services inspired counselors from a specialized foster care center on the frontline to initiate an innovative, developmentally relevant and locally grounded training program.

Aims

This study focuses on counselors' experiences with the development of the training program and its impact on their work life.

Method

A qualitative research design within a participatory approach framework was used to understand the experiences of the counselors. All the counselors employed in the department and the leaders (n = 14) participated in the study. Data were gathered from participants, including the lead and second authors, using a semi-structured interview, and analyzed using thematic analysis.

Results

The analyses yielded three main categories: (i) Psychological Factors, (ii) Social Dynamics, and (iii) Leadership Style and Support. Each of the first two categories consisted of three subcategories. At the psychological level, the employees' experiences reflected the psychological states and traits required to fuel the tasks required by the project. The social dynamics of working in a team influenced the work process and, in turn, were impacted by it. Lastly, leadership style and support provided the foundation for innovation to germinate and grow.

Conclusion

Engaging in a locally created training program was associated with a strong sense of collaboration and team spirit. Counselors reported high intrinsic motivation and a strong sense of personal pride and drive for their jobs. They were proactive in seeking colleagues with particular expertise and collaborated on project tasks despite differences. The leadership style reflected the presence of transformational leadership behaviors, signaling an organizational culture conducive to innovation. The study provides an example of how aligning employees' personal aspirations with workplace goals and professional development can create a workplace in which employees feel it is enjoyable to go to work.

Interventions for Young Children's Mental Health: A Review of Reviews

To determine the efficacy of intervention programs for young children (4-9 years) with emerging mental health needs, we conducted a review of meta-analytic and systematic reviews of the intervention literature. Of 41,061 abstracts identified and 15,076 screened, 152 review articles met the inclusion criteria. We reviewed interventions across multiple disciplines targeting: (1) general mental health concerns; (2) internalizing symptoms; (3) externalizing symptoms; (4) anxiety; (5) depression; (6) trauma; (7) symptoms of attention-deficit/hyperactivity disorder; and (8) mental health concerns associated with autism spectrum disorder. Substantial evidence was found for the efficacy of behavioral and cognitive behavioral interventions for general mental health concerns, externalizing symptoms (generally, as well as ADHD, conduct, and other behavioral symptoms) and internalizing symptoms (generally, as well as anxiety) aged 4-9 years. Emerging evidence was identified for interventions targeting trauma symptoms, depression symptoms, and social, emotional and behavioral symptoms in autism spectrum disorder in children aged 4-9 years. Currently there is only limited emerging evidence regarding non-behavioral or non-cognitive behavioral interventions for programs targeting children ages 4-9 years where the aim is to deliver an evidence-based program to improve child social, emotional and/or behavioral functioning. Given the recent rises in mental health needs reported in children, targeted behavioral-and/or cognitive behavior therapy-based interventions should be made widely available to children (and their families) who experience elevated symptoms.

Interventions targeting the mental health and wellbeing of care-experienced children and young people in higher-income countries: Evidence map and systematic review

BACKGROUND

The mental health and wellbeing of care-experienced children and young people (i.e. foster care, kinship care, residential care) is poorer than non-care-experienced populations. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise the international evidence base for interventions targeting subjective wellbeing, mental health and suicide amongst care-experienced young people aged ≤ 25 years.

METHODS

For the first phase of the review, we constructed an evidence map identifying key clusters and gaps in interventions and evaluations. Studies were identified through 16 electronic databases and 22 health and social care websites, in addition to expert recommendations, citation tracking and screening of relevant systematic reviews. We charted interventions and evaluations with a summary narrative, tables and infographics.

RESULTS

In total, 64 interventions with 124 associated study reports were eligible. The majority of study reports were from the USA (n = 77). Interventions primarily targeted children and young people's skills and competencies (n = 9 interventions), the parental functioning and practices of carers (n = 26), or a combination of the two (n = 15). While theoretically under-specified, interventions were largely informed by theories of Attachment, Positive Youth Development, and Social Learning Theory. Current evaluations prioritised outcomes (n = 86) and processes (n = 50), with a paucity of study reports including theoretical descriptions (n = 24) or economic evaluations (n = 1). Interventions most frequently targeted outcomes related to mental, behavioural or neurodevelopmental disorders, notably total social, emotional and behavioural problems (n = 48 interventions) and externalising problem behaviours (n = 26). There were a limited number of interventions targeting subjective wellbeing or suicide-related outcomes.

CONCLUSIONS

Future intervention development might focus on structural-level intervention theories and components, and target outcomes related to subjective wellbeing and suicide. In accordance with current methodological guidance for intervention development and evaluation, research needs to integrate theoretical, outcome, process and economic evaluation in order to strengthen the evidence base.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020177478.

Policies are Needed to Increase the Reach and Impact of Evidence-Based Parenting Supports: A Call for a Population-Based Approach to Supporting Parents, Children, and Families

Parents can be essential change-agents in their children's lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.

Evaluation of a Trauma-Informed Parenting Program for Resource Parents

Child maltreatment impacts many young people involved in the child welfare system, and it is important that the resource parents supporting these youth have knowledge and skills in trauma-informed care. The current study is a preliminary evaluation of the Resource Parent Curriculum (RPC), an in-service, 8-module, group-based parenting program developed by the National Child Traumatic Stress Network. Youth and caregiver outcomes were examined by way of a quasi-experimental design that included 22 resource parents in the experimental group and 21 in the waitlist control group and involved baseline, post-program, and 2-month follow-up assessments. For learning outcomes, RPC resulted in improvements in resource parents' knowledge and beliefs about trauma-informed parenting. While not statistically significant, potential effects included improvements in resource parents' tolerance of challenging youth behaviors and parenting self-efficacy. For behavioral outcomes, several non-significant potential effects were noted, including improvements in resource parents' attachment relationships with their youth and increased social supports. This study was the first to evaluate RPC using a quasi-experimental design within a Canadian context and through a virtual delivery. Findings highlighted several benefits of the program and resource parents' ongoing training needs.

Effects of formal center-based care and positive parenting practices on children in foster care

BACKGROUND

The current study examined whether children in foster care have better cognitive and social-emotional outcomes at kindergarten age when they enroll in formal center-based care and when they receive positive parenting practices at home.

OBJECTIVE

Two primary questions were addressed: (1) Do children in foster care who attended formal center-based care (including Head Start) have higher cognitive and socio-emotional outcomes than children in foster care who did not attend formal center-based care? (2) Does positive parenting practice promote better cognitive and socio-emotional outcomes?

PARTICIPANTS AND SETTING

Based on the Early Childhood Longitudinal Study-K: 2011 data, 299 children in foster care were selected.

METHODS

Regression analyses were conducted on children's cognitive and social-emotional scores by types of children's childcare arrangements (formal vs informal care) and positive parenting practices. Active parental involvement was measured based on how frequently parents read books with their children, and authoritarian parenting discipline was measured based on whether parents spanked their children.

RESULTS

Children in foster care who enrolled in formal center-based childcare at pre-school age have higher cognitive and socio-emotional scores at kindergarten age. Positive parenting practice also promotes children's outcomes. Children in foster care who are both enrolled in formal center-based care and experience positive parenting practice had the most positive outcomes.

CONCLUSIONS

Parents raising children in foster care should be informed about the positive impacts of certain parenting practices on their children. Foster parents should be connected to available community resources, including formal-center-based preschool programs and required to continuously attend parenting classes to sustain positive impact of parenting practice on foster children.

Web-Based Parent Training in Parents with Adolescents Admitted to Psychiatric Residential Treatment: A Mixed-Methods Study

Despite intensive treatment, adolescents discharged from residential treatment (RT) often do not maintain treatment gains in the community. Providing support and education to caregivers through parent training may ameliorate the loss of treatment gains. Successful parent training programs have been delivered to this population; however, these interventions were delivered in-person, posing significant barriers affecting reach, access, and engagement. A convergent mixed methods design was used to assess the acceptability, appropriateness, and feasibility of a web-based parent training in a sample of parents (N = 20) with adolescents admitted to RT. Parents completed two interviews and an end-of-program survey. Parents completed at least 80% of the assigned modules and felt that PW was easy to use and that the features facilitated learning. Parents reported practicing the skills in their daily lives and found it beneficial to have a partner to practice with. Consistent with previous studies, parents perceived the delivery method as a strength because the web-based delivery circumvented multiple known barriers to in-person interventions. A large subset of parents related to the scenarios, while a small subset of parents felt the modules were challenging to relate to because of the severity of their adolescent's mental health challenges. Overall, findings indicate that web-based parent training programs may be an acceptable, appropriate, and feasible adjuvant evidence-based support. However, tailoring the intervention content is necessary to create a more relatable intervention that captures the breadth and severity of mental health challenges adolescents in RT face.

Australian foster carers' views of supporting maternal breastfeeding and attachment in out-of-home care

BACKGROUND

Breastfeeding supports infant health, growth and development, and promotes maternal attachment and sensitive caregiving. Maternal separation due to child protection concerns can result in termination of breastfeeding with associated adverse outcomes. How to preserve breastfeeding when infants are placed in out-of-home care is an issue of concern.

OBJECTIVE

To consider the views of foster carers towards provision of breastmilk and breastfeeding for infants in their care.

PARTICIPANTS AND SETTING

Foster carers (including kinship carers), in Australia, who had cared for at least one infant in the years 2013-2018 completed an online survey.

METHODS

Foster carer's views were collected via an online survey and subjected to content analysis.

RESULTS

Respondents (n = 184) expressed mixed views about; mothers breastfeeding during contact visits, increased frequency of contact visits for breastfeeding; and the provision of expressed breastmilk to infants in their care. Concerns were raised about the safety of breastmilk from mothers abusing substances and the value of breastfeeding if reunification was not possible. Because of these concerns, some carers discarded expressed breastmilk and resisted frequent contact. Conversely, breastfeeding was also viewed positively as a way for mothers to maintain attachment with their infants, where reunification of the mother-infant dyad was the goal.

CONCLUSIONS

This study highlights foster carers' view of breastfeeding as a facilitator of attachment between mothers and their infants. While fosters carers were largely supportive of breastfeeding as a way to improve infant health and facilitate mother-infant attachment, they held concerns regarding the safety of breastmilk supplied to them.

Foster family assessment: The assessor's perspective - A qualitative study

Children in foster care are more likely to exhibit emotional, behavioral, social, and developmental problems. Accordingly, foster families should provide them with a safe family environment that promotes their development. Therefore, to ensure that foster families adequately meet children's needs, it is crucial for youth protection services to properly assess prospective foster family applicants. However, the specific assessment methods are understudied. This study aims to capture the experiences of caseworkers and the challenges they face in assessing and selecting potential foster caregivers, as well as their needs for support to perform the assessments. Focus groups were held in child protection services agencies in the province of Québec (Canada). Three group interviews with a total of 15 caseworkers were transcribed and subjected to content analysis using NVivo 11. The caseworkers identified nine most important dimensions for assessing prospective foster families, notably motivation and engagement. Differences in the assessment process between caseworkers were observed, particularly for the type of foster family assessed. The caseworkers reported certain common needs for assessment training, primarily in interview techniques and the handling of multicultural issues. They also complained of lack of time allocated for clinical support during assessments. The results call for collaborative efforts between researchers and practitioners to provide appropriate training and tools to support the assessment process.

Effects of parental attitude and proactive and reactive aggression on cyberbullying and victimization among secondary school students

PURPOSE

To predict the effect of parental attitude and proactive and reactive aggression on the cyberbully, cyber victims, and cyberbully/victim among students aged 9-14 years.

METHODS

This study is a cross-sectional, correlational, and predictive study. The sample included 360 students. Data were collected with the "Adolescence Information Form," "Parental Attitude Scale," "Proactive-Reactive Aggression Scale," and "Cyberbully/Victim Questionnaire." Logistic regression analysis was used.

FINDINGS

This study was determined that proactive-reactive aggression and parental attitude predicted 30.3% of cyberbully/victim cases. Proactive aggression and Internet usage time are essential predictors of cyberbullying cases.

PRACTICE IMPLICATIONS

To protect and improve their children's health, children should be informed about cyberbullying, proactive-reactive aggression, and the duration of Internet use.

Taking Care Triple P for Foster Parents With Young Children in Foster Care: Results of a 1-Year Randomized Trial

Young children with a history of maltreatment or neglect in foster families often confront their caregivers with particularly challenging behaviors. This may lead to more parenting stress, an increased risk for the child in foster care to experience further maltreatment, and placement disruptions. We conducted a randomized controlled trial to investigate the efficacy of a parent group training tailored to the special needs of foster families. We hypothesized significant short- and long-term improvements regarding foster parents' parenting competencies, child mental health problems, and related outcomes. Eighty-one families with 87 children in foster care aged 2 to 7 years participated in the trial. For the intervention study, 44 randomly selected families (54%) were offered to participate in the parent group training. Intervention and control group families were reassessed three times over a period of 1 year. Contrary to our expectations, we found no advantages of the intervention group compared with the usual care control group on any outcome measure. Instead, we found some significant changes in both groups across time. Placement into foster care is associated with some favorable outcomes for children in foster care. Additional support for foster families beyond the services delivered in the youth welfare system to foster parents was not associated with more favorable outcomes. The present intervention is likely associated with a low risk of harm but also with a high likelihood of a lack of significant benefits for foster parents and their young children going beyond feeling satisfied about the delivered services. Participating foster families showed favorable baseline results on parenting measures which may have impeded intervention effects to unfold on these proximal variables.

Foster Parents' Parenting and the Social-Emotional Development and Adaptive Functioning of Children in Foster Care: A PRISMA-Guided Literature Review and Meta-Analysis

Children in foster care (CFC) are at increased risk for negative developmental outcomes. Given the potential influence of foster parents' parenting on the development of CFC, this literature review and meta-analysis provide an initial overview of how parenting factors in foster families relate to CFC's developmental outcomes. We aimed to explore (1) whether foster parents' parenting conceptualizations are related differently to various CFC developmental outcome variables and (2) how characteristics of foster parents and CFC moderate these associations. Following the recommendations of the PRISMA statement, we searched four databases in 2017 (with an update in May 2020). Forty-three primary studies were coded manually. The interrater agreement was 92.1%. Parenting variables were specified as parenting behavior, style, and goals and were distinguished further into functional and dysfunctional parenting. CFC development was divided into adaptive (including cognitive) development and maladaptive development. Meta-analyses could be performed for foster parenting behavior and developmental outcomes, as well as for functional parenting goals and maladaptive socioemotional outcomes in CFC. Associations between functional parenting behavior and adaptive child development were positive and negative for maladaptive child development, respectively. For dysfunctional, parenting effects were in the opposite direction. All effects were small to moderate. Similar results were found descriptively in the associations of parenting style and child developmental outcomes. We found similar effect sizes and directions of the associations between parenting behavior in foster families and the child's developmental outcomes as those previously reported for biological families. These findings provide strong support for the significant role of parenting in foster families regarding children's development in foster care.

Research Participation of Minor Adolescents in Foster Care

STUDY OBJECTIVE

In this study we evaluated published studies about foster care to: (1) determine the types of data used; (2) describe the degree to which a sexual/reproductive health topic was addressed; and (3) describe the consent process.

DESIGN

Analysis of published literature.

SETTING

PubMed was searched using "foster care" for English articles published between January 1, 2017 and September 4, 2019.

PARTICIPANTS

None.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Articles were coded into 4 data source categories: primary, secondary, peripheral, or perspective data. Articles with a primary data source were coded for participant ages: only 9 years old and younger, 10- to 17-year-olds (minor adolescents), and only 18 years old and older. Articles using a secondary data source were coded for the source of the data registry. All articles were coded for presence of a sexual/reproductive health outcome. The primary data articles that included minor adolescents were coded for the study topic and consent process.

RESULTS

Of the 176 articles about foster care, 72/176 (41%) used primary data, 53/176 (30%) used secondary data, and 51/176 (29%) used peripheral/perspective data. Forty-eight of the primary data articles included minor adolescents. Secondary data sources included few national research surveys. Sexual/reproductive health outcomes were measured in 17 articles, 4 of which used primary data. The consent process for minor adolescents varied and had no consistent pattern across studies.

CONCLUSION

Research on best practices for consent processes and use of registries could be developed to increase research on sexual/reproductive health outcomes among adolescents in foster care.

Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes: Systematic review (CHIMES) protocol

INTRODUCTION

The mental health and well-being of children and young people who have been in care (ie, care-experienced) are a priority. There are a range of interventions aimed at addressing these outcomes, but the international evidence-base remains ambiguous. There is a paucity of methodologically robust systematic reviews of intervention effectiveness, with few considering the contextual conditions under which evaluations were conducted. This is important in understanding the potential transferability of the evidence-base across contexts. The present systematic review will adopt a complex systems perspective to synthesise evidence reporting evaluations of mental health and well-being interventions for care-experienced children and young people. It will address impact, equity, cost-effectiveness, context, implementation and acceptability. Stakeholder consultation will prioritise a programme theory, and associated intervention, that may progress to further development and evaluation in the UK.

METHODS AND ANALYSIS

We will search 16 bibliographic databases from 1990 to June 2020. Supplementary searching will include citation tracking, author recommendation, and identification of evidence clusters relevant to included evaluations. The eligible population is children and young people (aged ≤25 years) with experience of being in care. Outcomes are (1) mental, behavioural or neurodevelopmental disorders; (2) subjective well-being; (3) self-harm; suicidal ideation; suicide. Study quality will be appraised with methodologically appropriate tools. We will construct a taxonomy of programme theories and intervention types. Thematic synthesis will be used for qualitative data reporting context, implementation and acceptability. If appropriate, meta-analysis will be conducted with outcome and economic data. Convergent synthesis will be used to integrate syntheses of qualitative and quantitative data.

ETHICS AND DISSEMINATION

We have a comprehensive strategy for engagement with care-experienced children and young people, carers and social care professionals. Dissemination will include academic and non-academic publications and conference presentations. Ethical approval from Cardiff University's School of Social Sciences REC will be obtained if necessary.

PROSPERO REGISTRATION NUMBER

CRD42020177478.

Virtual parent-child visitation in support of family reunification in the time of COVID-19

When children are removed from their birth parents and placed in foster care, child welfare policy and practice prioritizes family reunification in permanency planning. Of the many services offered to families in support of reunification, parent-child visitation is one of the most important. The purposes of visitation are to maintain and support the parent-child relationship, facilitate improved parenting skills, and offer social workers opportunities to gauge the family’s progress in meeting reunification goals. Whether supervised or unsupervised, parent-child visitations most often involve face-to-face contact between family members. During periods of sheltering in place in response to COVID-19, however, face-to-face visits have been largely curtailed. In their place, child welfare agencies have begun using virtual visitation through various technology platforms such as smartphones, FaceTime, Zoom, WhatsApp, Facebook Messenger and Skype, often facilitated by foster parents. A number of questions have arisen, however, about the effectiveness of virtual visitations and how best to use them as a means of supporting reunification goals. In the present article, we examine existing data on how children respond to virtual communication with parents and extended family and what practical issues and training needs are encountered when implementing virtual visits in juvenile dependency cases.

A meta-analytic review of parenting interventions in foster care and adoption

Foster and adoptive parents often face challenges while taking care of children who, due to their adverse early life experiences, are at risk of developing insecure attachment relationships, behavior problems, and stress dysregulation. Several intervention programs have been developed to help foster and adoptive parents to overcome these challenges. In the current study, a series of eight meta-analyses were performed to examine the effectiveness of these intervention programs on four parent outcomes (sensitive parenting, k = 11, N = 684; dysfunctional discipline, k = 4, N = 239; parenting knowledge and attitudes, k = 7, N = 535; parenting stress, k = 18, N = 1,306), three child outcomes (attachment security, k = 6, N = 395; behavior problems, k = 33, N = 2,661; diurnal cortisol levels, k = 3, N = 261), and placement disruption (k = 7, N = 1,100). Results show positive effects for the four parent outcomes and child behavior problems, but not for attachment security, child diurnal cortisol levels, or placement disruption. Indirect effects on child outcomes may be delayed, and therefore long-term follow-up studies are needed to examine the effects of parenting interventions on children.

Understanding and Parenting Children's Noncompliant Behavior: The Efficacy of an Online Training Workshop for Resource Parents

The current study examined the effectiveness of an online training program on parenting children's noncompliant behavior. Eighty-two resource parents (foster, adoptive, and kinship) were recruited through Foster Parent College-an online training website-and randomly assigned to a treatment or wait-list control group. Parents in the treatment group participated in an online interactive workshop on noncompliant child behavior. Online assessments occurred before and after a 1-week intervention, and again 3 months later. Group differences at posttest were significant for parents' reports of children's positive behavior and parent knowledge related to children's noncompliant behavior. Only parents in the treatment group showed significant improvement from pre- to posttest on several other outcome measures of parenting noncompliant behavior. Satisfaction with the online workshop at posttest was very high. Results at the 3-month follow-up assessment showed significant group differences only for parents' knowledge about children's noncompliant behavior. Feedback on the workshop remained positive, with treatment group parents indicating that they felt the workshop had beneficially impacted their parenting and their children's behavior.

Longitudinal Relationships Between Foster Children’s Mental Health Problems and Parental Stress in Foster Mothers and Fathers

Abstract. This paper focuses on the longitudinal relationships between foster children’s mental health problems and parental stress across a 1-year interval with three measurements. A sample of 94 foster children and a comparison group of 157 biological children and their families participated in this study. The age of the children was between 2 and 7 years. At the initial assessment, the foster children had been in their foster families since 2–24 months. Based on Child Behavior Checklist (CBCL) scores, the results indicated increased internalizing and externalizing mental health problems in the foster children group. Both mental health scores remained rather stable across the longitudinal assessments in foster as well as in biological children. Internalizing as well as externalizing scores were substantially correlated with parental stress in both samples. Moreover, changes in mental health scores were associated with changes in parental stress. However, cross-lagged panel analyses showed no clear pattern of temporal relationships between children’s mental health scores and parental stress. Implications as well as strengths and limitations of the current study are addressed in the Discussion section.

Resilience in young children involved with child protective services

Child maltreatment increases the risk of poor developmental outcomes. However, some children display resilience, meaning they are high-functioning despite their adverse experiences. To date, few research studies have examined protective factors among very young maltreated children. Yet, domains of resilience, and the protective factors that promote resilience among maltreated children, are likely to differ by developmental stage. Drawing on ecological systems theory and life course theory, we examined how protective factors at multiple ecological levels across early childhood were related to social and cognitive resilience among very young children involved with child protective services. The results demonstrated that the buffering effects of protective factors varied by social or cognitive resilience and the cumulative effects of protective factors were more consistently related to later resilience than protective factors at specific time points. In addition, the influence of specific protective factors on resilience slightly varied by initial in-home or out-of-home placement. These findings have important policy and research implications for promoting optimal development among children involved in child protective services.