Improving the lives of foster children through evidenced-based interventions

In the United States and England, the use of evidence-based interventions for children in foster care has the potential to decrease the widespread disparities in health and mental health outcomes, improve placement stability and increase the likelihood of children achieving permanency. Nevertheless, there have been few discussions about the systematic implementation of evidence-based practice to address different levels of need and risk in foster care. In this paper, we provide a framework for determining the types of programs needed for children with varied needs along a continuum that includes four categories of options: (1) screen and identify those who are functioning adequately in foster care versus those in need of supplemental services; (2) provide 'enhanced foster care' with additional resources for families and children; (3) implement interventions that target specific problems such as disruptive behavior or school functioning; and (4) implement intensive therapeutic foster-care programming. Examples of interventions in each category are provided, and implications for policy and practice are discussed.

Patterns and predictors of growth in divorced fathers' health status and substance use

Health status and substance use trajectories are described over 18 months for a county sample of 230 divorced fathers of young children aged 4 to 11. One third of the sample was clinically depressed. Health problems, drinking, and hard drug use were stable over time for the sample, whereas depression, smoking, and marijuana use exhibited overall mean reductions. Variance components revealed significant individual differences in average levels and trajectories for health and substance use outcomes. Controlling for fathers' antisociality, negative life events, and social support, fathering identity predicted reductions in health-related problems and marijuana use. Father involvement reduced drinking and marijuana use. Antisociality was the strongest risk factor for health and substance use outcomes. Implications for application of a generative fathering perspective in practice and preventive interventions are discussed.

Bridging the divide: openness in adoption and postadoption psychosocial adjustment among birth and adoptive parents

Using 323 matched parties of birth mothers and adoptive parents, this study examined the association between the degree of adoption openness (e.g., contact and knowledge between parties) and birth and adoptive parents' postadoption adjustment shortly after the adoption placement (6 to 9 months). Data from birth fathers (N = 112), an understudied sample, were also explored. Openness was assessed by multiple informants. Results indicated that openness was significantly related to satisfaction with adoption process among adoptive parents and birth mothers. Increased openness was positively associated with birth mothers' postplacement adjustment, as indexed by birth mothers' self-reports and the interviewers' impression of birth mothers' adjustment. Birth fathers' report of openness was associated with their greater satisfaction with the adoption process and better postadoption adjustment.

Prevention of behavior problems for children in foster care: outcomes and mediation effects

Parent training for foster parents is mandated by federal law and supported by state statues in nearly all states; however, little is known about the efficacy of that training, and recent reviews underscore that the most widely used curricula in the child welfare system (CWS) have virtually no empirical support (Grimm, Youth Law News, April-June:3-29, 2003). On the other hand, numerous theoretically based, developmentally sensitive parent training interventions have been found to be effective in experimental clinical and prevention intervention trials (e.g., Kazdin and Wassell, Journal of the American Academy of Child and Adolescent Psychiatry, 39:414-420, 2000; McMahon and Forehand, Helping the noncompliant child, Guilford Press, New York, USA, 2003; Patterson and Forgatch, Parents and adolescents: I. Living together, Castalia Publishing, Eugene, OR, USA, 1987; Webster-Stratton et al., Journal of Clinical Child Pyschology Psychiatry, 42:943-952, 2001). One of these, Multidimensional Treatment Foster Care (MTFC; Chamberlain, Treating chronic juvenile offenders: Advances made through the Oregon Multidimensional Treatment Foster Care model, American Psychological Association, Washington, DC, USA, 2003), has been used with foster parents of youth referred from juvenile justice. The effectiveness of a universal intervention, KEEP (Keeping Foster Parents Trained and Supported) based on MTFC (but less intensive) was tested in a universal randomized trial with 700 foster and kinship parents in the San Diego County CWS. The goal of the intervention was to reduce child problem behaviors through strengthening foster parents' skills. The trial was designed to examine effects on both child behavior and parenting practices, allowing for specific assessment of the extent to which improvements in child behavior were mediated by the parenting practices targeted in the intervention. Child behavior problems were reduced significantly more in the intervention condition than in the control condition, and specific parenting practices were found to mediate these reductions, especially for high-risk children in foster families reporting more than six behavior problems per day at baseline.

Effects of a foster parent training intervention on placement changes of children in foster care

Placement disruptions undermine efforts of child welfare agencies to promote safety, permanency, and child well-being. Child behavior problems significantly contribute to placement changes. The aims of this investigation were to examine the impact of a foster parent training and support intervention (KEEP) on placement changes and to determine whether the intervention mitigates placement disruption risks associated with children's placement histories. The sample included 700 families with children between ages 5 and 12 years, from a variety of ethnic backgrounds. Families were randomly assigned to the intervention or control condition. The number of prior placements was predictive of negative exits from current foster placements. The intervention increased chances of a positive exit (e.g., parent/child reunification) and mitigated the risk-enhancing effect of a history of multiple placements. Incorporating intervention approaches based on a parent management training model into child welfare services may improve placement outcomes for children in foster care.

A Randomized Evaluation of Multidimensional Treatment Foster Care: Effects on School Attendance and Homework Completion in Juvenile Justice Girls

Despite growing evidence that child welfare youth are at increased risk for juvenile delinquency, little is known about gender-specific processes and effective treatment programs for girls. Multidimensional Treatment Foster Care (MTFC), an empirically validated intervention for child welfare and juvenile justice populations, has demonstrated efficacy in reducing arrest rates in delinquent boys and girls. In this study, the efficacy of MTFC on school attendance and homework completion was examined in juvenile justice girls who were referred to out-of-home care (N = 81). Results from this randomized intervention trial suggest that MTFC was more effective than group care in increasing girls' school attendance and homework completion while in treatment and at 12 months postbaseline. In addition, the previously reported effect of MTFC on reducing girls' days in locked settings was mediated by homework completion while girls were enrolled in the intervention setting. Implications for policy and practice are described.

Multidimensional treatment foster care for girls in the juvenile justice system: 2-year follow-up of a randomized clinical trial

This study is a 2-year follow-up of girls with serious and chronic delinquency who were enrolled in a randomized clinical trial conducted from 1997 to 2002 comparing multidimensional treatment foster care (MTFC) and group care (N = 81). Girls were referred by juvenile court judges and had an average of over 11 criminal referrals when they entered the study. A latent variable analysis of covariance model controlling for initial status demonstrated maintenance of effects for MTFC in preventing delinquency at the 2-year assessment, as measured by days in locked settings, number of criminal referrals, and self-reported delinquency. A latent variable growth model focusing on variance in individual trajectories across the course of the study also demonstrated the efficacy of MTFC. Older girls exhibited less delinquency over time relative to younger girls in both conditions. Implications for gender-sensitive programming for youths referred from juvenile justice are discussed.

Consensus report on impulsive aggression as a symptom across diagnostic categories in child psychiatry: implications for medication studies

OBJECTIVE

To determine whether impulsive aggression (IA) is a meaningful clinical construct and to ascertain whether it is sufficiently similar across diagnostic categories, such that parallel studies across disorders might constitute appropriate evidence for pursuing indications. If so, how should IA be assessed, pharmacological studies designed, and ethical issues addressed?

METHOD

Experts from key stakeholder communities, including academic clinicians, researchers, practicing clinicians, U.S. Food and Drug Administration, National Institute of Mental Health, industry sponsors, and patient and family advocates, met for a 2-day consensus conference on November 4 and 5, 2004. After evaluating summary presentations on current research evidence, participants were assigned to three workgroups, examined core issues, and generated consensus guidelines in their areas. Workgroup recommendations were discussed by the whole group to reach consensus, and then further iterated and condensed into this report postconference by the authors.

RESULTS

Conference participants agreed that IA is a substantial public health and clinical concern, constitutes a key therapeutic target across multiple disorders, and can be measured with sufficient precision that pharmacological studies are warranted. Additional areas of consensus concerned types of measures, optimal study designs, and ethical imperatives.

CONCLUSION

Derived from scientific evidence and clinical experience, these consensus-driven recommendations can guide the design of future studies.

Peer Relations at School Entry: Sex Differences in the Outcomes of Foster Care

Converging research indicates that foster children with maltreatment histories have more behavior problems and poorer peer relations than biologically reared, nonmaltreated youth. However, little is known about whether such deficits in peer relations work independently or as a result of increased behavior problems, and whether outcomes for foster children differ by sex. To address these questions, multiagent methods were used to assess peer relations at school entry among maltreated foster children and a comparison sample of low-income, nonmaltreated, biologically reared children (N = 121). Controlling for caregiver-reported behavior problems prior to school entry, results from a multigroup SEM analysis suggested that there were significant relationships between foster care status and poor peer relations at school entry and between foster care status and the level of behavior problems prior to school entry for girls only. These Sex × Foster care status interactions suggest the need for gender-sensitive interventions with maltreated foster children.

Adolescent girls' offending and health-risking sexual behavior: the predictive role of trauma

Several studies have highlighted high levels of risk for girls who have been exposed to traumatic experiences, but little is known about the exact relationship between traumatic experiences and problems with delinquency and health-risking sexual behavior (e.g., precipitory and/or exacerbatory roles). However, numerous short- and long-term detrimental effects have been linked to trauma, delinquency, and health-risking sexual behavior. The utility of diagnostic and experiential trauma measures in predicting the greatest risk for poor outcomes for delinquent girls was examined in this study. Results indicate that the experiential measures of trauma (cumulative and composite trauma scores) significantly predicted adolescent offending and adolescent health-risking sexual behavior, whereas the diagnostic measures of trauma (full and partial diagnostic criteria) did not.

Intervention outcomes for girls referred from juvenile justice: effects on delinquency

An increasing number of girls are entering the juvenile justice system. However, intervention programs for delinquent girls have not been examined empirically. The authors examined the 12-month outcomes of a randomized intervention trial for girls with chronic delinquency (N = 81). Girls were randomly assigned into an experimental condition (Multidimensional Treatment Foster Care; MTFC) or a control condition (group care; GC). Analyses of covariance indicated that MTFC youth had a significantly greater reduction in the number of days spent in locked settings and in caregiver-reported delinquency and had 42% fewer criminal referrals than GC youth (a trend) at the 12-month follow-up. Implications for reducing girls' chronic delinquency are discussed.

Deviant Peer Affiliation and Problem Behavior: A Test of Genetic and Environmental Influences

This study uses a multitrait, multimethod (MTMM) approach to investigate the genetic and environmental etiologies of childhood deviant peer affiliation (DPA) and problem behavior (PROB). The variability of genetic and environmental estimates by agent and method is also examined. A total of 77 monozygotic and 72 dizygotic twin pairs and each twin's close friend were assessed. The informants included parents, teachers, and twins, and the methods involved questionnaire reports and coder ratings of videotaped dyadic interactions between each twin and their close friend. Twin intraclass correlations and univariate models attributed DPA and PROB to genetic, and shared and nonshared environmental effects. Parameter estimates differed by rater and method, however. Results accentuate the imperative to attend to method effects inherent in MTMM behavioral geneticresearch.

Preventing Behavior Problems and Health-risking Behaviors in Girls in Foster Care

Transition into middle school presents complex challenges, including exposure to a larger peer group, increased expectations for time management and self-monitoring, renegotiation of rules with parents, and pubertal changes. For children in foster care, this transition is complicated by their maltreatment histories, living situation changes, and difficulty explaining their background to peers and teachers. This vulnerability is especially pronounced for girls in foster care, who have often experienced sexual abuse and are at risk for associating with older antisocial males. Failures in middle school can initiate processes with cascading negative effects, including delinquency, substance abuse, mental health problems, and health-risking sexual behaviors. An intervention is described to prevent these problems along with a research design aimed at testing the intervention efficacy underlying mechanisms of change.

Childhood temperament and family environment as predictors of internalizing and externalizing trajectories from ages 5 to 17

Childhood temperament and family environment have been shown to predict internalizing and externalizing behavior; however, less is known about how temperament and family environment interact to predict changes in problem behavior. We conducted latent growth curve modeling on a sample assessed at ages 5, 7, 10, 14, and 17 (N = 337). Externalizing behavior decreased over time for both sexes, and internalizing behavior increased over time for girls only. Two childhood variables (fear/shyness and maternal depression) predicted boys' and girls' age-17 internalizing behavior, harsh discipline uniquely predicted boys' age-17 internalizing behavior, and maternal depression and lower family income uniquely predicted increases in girls' internalizing behavior. For externalizing behavior, an array of temperament, family environment, and Temperament x Family Environment variables predicted age-17 behavior for both sexes. Sex differences were present in the prediction of externalizing slopes, with maternal depression predicting increases in boys' externalizing behavior only when impulsivity was low, and harsh discipline predicting increases in girls' externalizing behavior only when impulsivity was high or when fear/shyness was low.

Clarifying parent-child reciprocities during early childhood: the early childhood coercion model

Consistent with existing theory, the quality of parent-child interactions during early childhood affects children's social relationships and behavioral adjustment during middle childhood and adolescence. Harsh parenting and a propensity toward emotional overarousal interact very early in life to affect risk for later conduct problems. Less empirical work has evaluated the emergence of early childhood coercive parent-child reciprocities. The proposed early childhood coercion model describes the processes by which coercive parent-child reciprocities emerge. Specifically, the interaction between parenting and infants' propensities toward reactivity influences the development of emotion regulation in children and disciplinary styles in parents. Highly reactive children are expected to experience more difficulty learning to regulate emotions and to evoke harsher parenting. Through a process of mutual reinforcement, harsh parenting, negative emotional reactivity, and poor emotion regulation become coercive parent-child reciprocities during early childhood. The emergence of coercive parent-child interactions further diminishes children's emotional regulatory capacities and affects the formation of peer relationships during kindergarten.

Environmental and genetic variance in children's observed and reported maladaptive behavior

The genetic and environmental contributions to children's maladaptive behavior are assessed in a sample of 154 twin pairs (77 MZ twin pairs and 77 DZ twin pairs), who range in age from 6 to 11 years. To bridge the strengths of behavioral genetic methods and environmental assessment techniques, we use a multimethod, multimeasure approach to data collection, and analyze the data using behavioral genetic modeling techniques. Results indicate that genetic variation accounts for a majority of the variance in parent-reported child maladaptive behavior (average = 62%). One parent-report measure also suggests a smaller, significant contribution of shared environmental variance. In contrast to the parental ratings, the observational coding and global impressions of parent-twin interactive behavior suggest that shared environment is the primary source of variance accounting for parent and child maladaptive behavior. This is due, in part, to the direct influence one's interactive partner has on the expression of maladaptive behavior in an interactive setting. When controlling for the co-participant's behavior, genetic variation increases and shared environmental variation decreases.

Teacher ratings of externalizing behavior at school entry for boys and girls: similar early predictors and different correlates

In a test of Patterson's Coercion Theory with young children, 156 children (82 boys and 74 girls) were studied to assess the extent to which parenting and child variables, assessed at 18 months, would predict teacher ratings of externalizing child behaviors at age 5. Child playgroup behavior, parent coercion during home observations, and marital status each emerged as predictors, whereas child temperament, attachment classification, and gender did not. At age 5, the correlates of externalizing behaviors differed for boys and girls. Boys rated higher on externalizing behaviors by the teachers presented many problems in the home and school, whereas externalizing girls did not. In fact, girls rated higher on externalizing behaviors performed better on an intelligence test, yet the girls perceived themselves as less competent.

Genetics of aggressive and violent behavior

This article develops the topic of the genetics of aggressive and violent behavior from three directions. Firstly, evidence from twin, family, and adoption studies will establish the case for the importance of genetically transmitted factors in the genesis of aggressivity from childhood through adulthood. Secondly, evidence from adoption studies will be presented to show that some environmental conditions interact with genetic factors in such a way as to suggest that the development of aggressivity requires that both genetic and environmental factors be present. Thirdly, additional and direct evidence of genetic factors in aggressivity is presented from the perspective of molecular genetics, where underlying biochemical mechanisms associated with aggressivity have been found to be caused by specific genes in animal models with confirmation of similar physiologic mechanisms in humans.