Cascading Dissemination of a Foster Parent Intervention

Study Overview
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Brief Summary
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The primary goal of this study is to test the effectiveness of KEEP (Keeping Foster Parents Supported and Trained), an intervention intended to increase supports and consultation to foster parents, and to evaluate the transferability of the proposed intervention from Oregon to the foster care system in San Diego.

Detailed Description
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Children in the foster care system are growing in number, are at high risk for psychological problems, and are increasingly challenging to their foster parents. Foster parents who are trying to provide care and nurturing to these children are often doing so without benefit or meaningful or relevant consultation on developmental and mental health issues. The study tests the effectiveness of an intervention intended to increase supports and consultation to foster parents. A major aim of this study was to test the transferability of the proposed intervention from Oregon to the foster care system in San Diego in 3 regions of Health and Human Services. A cascading dissemination model will be employed, where the original developers train and supervise staff in San Diego to implement the intervention, and in the second iteration of the of the intervention, the involvement of the original developers lessened. The intervention is designed to provide foster parents with general support and specific parent management training (PMT), a well-documented and effective intervention approach. In a previous efficacy trial, PMT had positive effects with foster parents in three areas: 1) reduction of child symptoms, 2) lower rates of disruption in foster care (changes in placements for negative reasons), and 3) fewer foster parents in the PMT condition dropped out of providing foster care. Outcomes will be evaluated at multiple levels, including child symptoms, functional behavior, environments, consumer perspectives, and system using a multi-method/multi-agent strategy. Implementation fidelity will be assessed, as will contextual factors, including the organizational climate and social isolation/insularity of the foster parents. It is hypothesized that, compared to controls, foster parents in the intervention group will improve on parenting skills, feel more supported, and have less stress, which in turn will result in more positive child outcomes, including fewer reported child symptoms and higher levels of child functional behavior in three domains (i.e., home, school, with peers). Improvements in foster parent outcomes and child outcomes are both hypothesized to predict system-level outcomes, including child use of mental health services, foster parent retention, and placement disruptions. Contextual factors are expected to impact foster parent outcomes directly and child and system outcomes indirectly, through implementation fidelity.

Official Title
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Cascading Dissemination of a Foster Parent Intervention

Conditions
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Child Welfare, Foster Home Care

Intervention / Treatment
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* Behavioral: Parent Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Any child between ages 5 and 12 years in relative or non-relative foster care Exclusion Criteria: Only medically fragile children

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Parent Training<br>16 weeks of parent training in a group context with 5 to 10 relative and non-relative foster caregivers | Behavioral: Parent Training<br>* 16 weeks of of parent training led by a trained group facilitator<br>* Other names: Parent Management Training;|
| No Intervention: Services as Usual<br>Foster care services as usual | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in placement disruptions rates for foster placements | Using child welfare system placement records, rates of disruptions for pre and post time frames are calculated. | 18 months post baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in child behavior problems as assessed by the Parent Daily Report (PDR) | The PDR is a brief telephone interview that collects data the number problem behaviors that occurred in the previous 24 hours. This measure is repeated three times at each wave. | Baseline, 6 months-, 12 months-, and 18 months post baseline | 
| Change in rates of reunification with Biological Family as assessed by child welfare system placement records | Using child welfare system placement records, rates of reunification between baseline and 18 months are calculated. | Baseline through 18 months post baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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child behavior, parent training