Promoting Infant Mental Health in Foster Care

Study Overview
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Brief Summary
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This study will evaluate the effectiveness of the Promoting First Relationships (PFR) program versus an Early Education Support (EES) program in promoting infant well-being, preventing emotional and behavioral problems, countering developmental delay, and reducing placement instability in young foster care children.

Detailed Description
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Infants who enter foster care are at risk for developing multiple social and emotional problems later in life. These behavioral issues often result in foster children being placed with multiple different families during their childhoods. In turn, an unstable family life can lead to serious conduct disorders and mental health problems. The infants' loss of their first attachment relationship heightens the risks for developing these problems, even if the quality of care was poor prior to removal. Infants' reactions to this loss, combined with other vulnerabilities, complicate the development of new secure attachments to their foster care families. Garnering a secure attachment relationship between foster parents and foster infants may reduce the infant's risk for developing problematic mental health and conduct issues. PFR is a family therapy intervention focused on aiding foster care parents to cultivate secure attachments with their foster infants. This study will evaluate the effectiveness of the PFR program versus an EES program in promoting attachment security and infant well-being, preventing emotional and behavioral problems, countering developmental delay, and reducing placement instability in young foster care children. Participants in this single-blind study will be randomly assigned to receive either PFR or EES. Both interventions will be administered by a trained staff member of a community agency. Participants assigned to PFR will receive ten weekly home visits that will focus on promoting the development of a secure attachment between foster parents and infants. EES will consist of three monthly home visits, during which infants will be assessed and referred for additional care if necessary. EES participants will not receive any training. Outcomes will be assessed at 1, 6, and 12 months post-intervention for all participants.

Official Title
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Promoting Infant Mental Health in Foster Care

Conditions
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Child Development, Child Behavior Disorders, Reactive Attachment Disorder

Intervention / Treatment
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* Behavioral: Promoting First Relationships Program
* Behavioral: Early Education Support Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Transitioned into foster care, currently within foster care, or from foster care in past three months prior to study entry in Pierce County, WA Primary caregiver is foster care provider, kin caregiver, or biological parent Exclusion Criteria: Foster care provider is not English-speaking

Ages Eligible for Study
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Minimum Age: 10 Months
Maximum Age: 24 Months

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: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Promoting first relationships group | Behavioral: Promoting First Relationships Program<br>* Participants assigned to PFR will receive ten weekly home visits that will focus on promoting the development of a secure attachment between foster parents and infants.<br>* Other names: PFR;|
| Active Comparator: 2<br>Early education support group | Behavioral: Early Education Support Program<br>* EES will consist of three monthly home visits, during which infants will be assessed and referred for additional care if necessary. EES participants will not receive any training.<br>* Other names: EES;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Toddler Attachment Sort-45 |  | Measured at Months 1, 6, and 12 post-treatment | 
| Nursing Child Assessment Satellite Training (NCAST) Teaching Scale |  | Measured at Months 1, 6, and 12 post-treatment | 
| Indicator of Parent-Child Interaction (IPCI) |  | Measured at Months 1, 6, and 12 post-treatment | 
| Brief Infant-Toddler Social Emotional Assessment |  | Measured at Months 1, 6, and 12 post-treatment | 
| Bayley Scales of Infant Development, 3rd Edition Screening Test |  | Measured at baseline and Month 6 post-treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Parenting Stress Index/Short Form |  | Measured at Months 1, 6, and 12 post-treatment | 
| Patient Health Questionnaire (PHQ-9) |  | Measured at Months 1, 6, and 12 post-treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Toddlers, Attachment, Maltreatment, Foster Care, Infants