This proposal is a continuation of an NIMH funded study entitled the Cascading Dissemination of a Foster Parent Intervention (MH60195, Patti Chamberlain, PI). Designed as a modified version of Multidimensional Treatment Foster Care (MTFC), the intervention (entitled Keep - Keeping Foster Parents Trained and Supported) focused on reducing the behavior problems of children between the ages of 5 to 12 who are in regular foster care. The results of this effectiveness trial revealed that the intervention was effective in reducing levels of child behavior problems, increasing parental use targeted parenting strategies, increasing the number of positive exits from the home (e.g., reunifications with biological parents, adoptions), and mitigating placement disruptions (e.g., removing a child at the request of a foster parent) for children with a history of multiple placements changes. As a result, the Child Welfare Services division of the San Diego County Health and Human Services Agency (HHSA) began implementation of the KEEP intervention through a private mental health services contractor (Social Advocates for Youth San Diego - SAY). The primary goal of the current proposal is to utilize this opportunity as a real-world platform for addressing three key questions that need to be answered prior to wide-scale implementation of the KEEP intervention. First, do the effects of the KEEP parent training generalize (concurrently) to other children currently in foster and kin intervention homes and lead to reductions in overall levels of behavior problems? Second, does the KEEP intervention continue to have effects after the completion of the intervention and generalize (temporally) to new children who enter the homes of these families at a later point in time? Finally, as the KEEP intervention is being implemented by a community agency in a real-world system of care, can the intervention be delivered and maintained in a manner that preserves the goals and quality of the intervention? Children in foster care, between the ages of 5 and 12 will be randomly assigned to one of two conditions - the KEEP intervention or a """"""""services as usual"""""""" condition. In the KEEP intervention condition, foster and kin caregivers will participate in 16 weekly group meetings. Outcomes to be assessed include child problem behavior (of the focal child and other children in the household), child functioning, parental stress, family functioning, use of mental health services, child placement changes (e.g., reunification with biological parents, move to another foster home), and foster parent retention rates. In addition, for a year following the completion of the intervention, new children entering the home of foster/kin caregiver will be included in the assessments, along with the impact of these additional children on parental stress and family functioning. Finally, several dimensions of intervention fidelity (e.g., facilitator adherence and group engagement) will be assessed and examined in relation to child, family, and system outcomes.
Project Narrative Implementation of evidence-based interventions into community settings has become a public health priority. The primary goal of the proposed study is to examine the fidelity and generalization of parenting effects of the KEEP foster parent training intervention as it is being delivered within a child welfare system of care by a community mental health provider. The KEEP intervention is designed to reduce child behavior problems, decrease the need for mental health services, and reduce placement disruptions among children in foster care. The findings from this investigation have the potential to contribute to preparation for wide scale implementation of the KEEP intervention and have the potential to influence the mental health needs of children in foster care both within and outside the San Diego region.
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