Intervention effects on foster parent stress: associations with child cortisol levels

Study protocol for a randomized controlled trial of supportive parents - coping kids (SPARCK)-a transdiagnostic and personalized parent training intervention to prevent childhood mental health problems

BACKGROUND

To meet the scientific and political call for effective prevention of child and youth mental health problems and associated long-term consequences, we have co-created, tested, and optimized a transdiagnostic preventive parent-training intervention, Supportive parents - coping kids (SPARCK), together with and for the municipal preventive frontline services. The target group of SPARCK is parents of children between 4 and 12 years who display symptoms of anxiety, depression, and/or behavioral problems, that is, indicated prevention. The intervention consists of components from various empirically supported interventions representing different theorical models on parent-child interactions and child behavior and psychopathology (i.e., behavioral management interventions, attachment theory, emotion socialization theory, cognitive-behavioral therapy, and family accommodation intervention). The content and target strategies of SPARCK are tailored to the needs of the families and children, and the manual suggests how the target strategies may be personalized and combined throughout the maximum 12 sessions of the intervention. The aim of this project is to investigate the effectiveness of SPARCK on child symptoms, parenting practices, and parent and child stress hormone levels, in addition to later use of specialized services compared with usual care (UC; eg. active comparison group).

METHODS

We describe a randomized controlled effectiveness trial in the frontline services of child welfare, health, school health and school psychological counselling services in 24 Norwegian municipalities. It is a two-armed parallel group randomized controlled effectiveness and superiority trial with 252 families randomly allocated to SPARCK or UC. Assessment of key variables will be conducted at pre-, post-, and six-month follow-up.

DISCUSSION

The current study will contribute with knowledge on potential effects of a preventive transdiagnostic parent-training intervention when compared with UC. Our primary objective is to innovate frontline services with a usable, flexible, and effective intervention for prevention of childhood mental health problems to promote equity in access to care for families and children across a heterogeneous service landscape characterized by variations in available resources, personnel, and end user symptomatology.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NTCT05800522.

Systematic Review of the Evaluation of Foster Care Programs

OBJETIVE

The aim of this study was to conduct an exhaustive synthesis to determine which instruments and variables are most appropriate to evaluate foster care programs (foster, kinship, and professional families). This evaluation includes the children, their foster families, their families of origin, professionals, and foster care technicians.

METHOD

The systematic review included randomized, quasi-randomized, longitudinal, and control group studies aimed at evaluating foster care interventions.

RESULTS

A total of 86 studies, 138 assessment instruments, 18 constructs, and 73 independent research teams were identified.

CONCLUSIONS

(1) although the object of the evaluations was the children, the informants were usually the people in charge of their care; therefore, effort should be made to involve the children in a more participatory way; (2) psychosocial functioning, behavior, and parenting are transversal elements in most evaluations, while quality of life and coping are not sufficiently well incorporated; (3) practical instruments (brief and easy to apply and correct) that are widely used and carry scientific guarantees should be prioritized to ensure the comparability and reliability of the conclusions; and (4) progress should be made in the study of evaluation models for all forms of foster care, including foster, extended, and specialized families.

Relationship between hair cortisol concentrations and cognitive functioning in adolescents with ADHD

Background: Our study aimed to explore whether the hair cortisol concentration (HCC), a measure of long-term cortisol output, is associated with poorer cognitive functioning in adolescents with attention deficit and hyperactivity disorder (ADHD). We further aimed to test the potential moderating effects of sex and childhood maltreatment.Methods: In this cross-sectional study, fifty-three adolescents with ADHD were studied. The ADHD Rating Scale (ADHD-RS) and Childhood Trauma Questionnaire (CTQ) were administered. Seven cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered, and two cognitive factors (attention and memory and executive functioning) were identified by confirmatory factor analysis. A 3-cm hair sample from the posterior vertex region of the head was obtained. HCCs were determined by a high-sensitivity enzyme immunoassay kit. Multiple linear regression analyses were used to explore the association between HCCs and either cognitive performance or ADHD severity while adjusting for sex, childhood maltreatment and the ADHD-RS total score.Results: Sex moderated the relationship between HCCs and attention/memory confirmatory factor analysis (CFA) scores, with better performance in boys with higher HCCs. HCCs were not associated with executive functioning or ADHD symptoms. Childhood maltreatment was associated with inattention symptoms in adolescents with ADHD.Conclusions: Our study suggests that HCCs are positively associated with attention and memory performance in adolescents with ADHD, with a moderating effect of sex (the relationship is strongest in boys).

Improving parenting, child attachment, and externalizing behaviors: Meta-analysis of the first 25 randomized controlled trials on the effects of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline

Improving parenting, child attachment, and externalizing behaviors: Meta-analysis of the first 25 randomized controlled trials on the effects of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). VIPP-SD combines support of parental sensitive responsiveness with coaching parents in sensitive limit setting. Here, we present meta-analyses of 25 RCTs conducted with more than 2,000 parents and caregivers. Parents or children had various risks. We examined its effectiveness in promoting parental cognitions and behavior regarding sensitive parenting and limit setting, in promoting secure child-parent attachment, and reducing externalizing child behavior. Web of Science, MEDLINE, PubMed, and recent reviews were searched for relevant trials (until May 10, 2021). Multilevel meta-analysis with META, METAFOR, and DMETAR in R took account of the 3-level structure of the datasets (studies, participants, measures). The meta-analyses showed substantial combined effect sizes for parenting behavior (r = .18) and attitudes (r = .16), and for child attachment security (r = .23), but not for child externalizing behavior (r = .07). In the subset of studies examining effects on both parenting and attachment, the association between effect sizes for parenting and for attachment amounted to r = .48. We consider the way in which VIPP-SD uses video-feedback an active intervention component. Whether VIPP-SD indeed stimulates secure attachment through enhanced positive parenting remains an outstanding question for further experimental study and individual participant data meta-analysis.

Adoption and trauma: Risks, recovery, and the lived experience of adoption

BACKGROUND

Although a very heterogeneous group, adopted persons may present developmental and mental health problems of varying severity. Pre-placement adversity and trauma have often been linked to these problems. It has been also suggested that adoption itself is a psychological trauma, predisposing the individual to emotional difficulties.

OBJECTIVES

This article examines the links between early adversity, trauma, and adoption. We begin by defining trauma and then describe the way in which pre-placement adversity can undermine neurobehavioral and interpersonal functioning, increasing the risk for long-term psychological difficulties. Next, we examine children's recovery when placed in a stable adoptive home. Finally, we explore adoption as a lived experience, highlighting contextual and developmental factors that facilitate the person's positive or negative attributions about being adopted, leading to varying patterns of emotional adjustment.

CONCLUSIONS

Although pre-placement adversity increases adopted individuals' risk for maladjustment, the human brain and behavior are malleable, and placement in a nurturing adoptive home often facilitates recovery from early adversity, with significant heterogeneity in the extent of recovery within and across domains of functioning. While there is no evidence that early adoption is a trauma for the individual, ongoing negative life circumstances, attachment difficulties, and developmentally-mediated attributions about adoption can undermine the person's self-esteem, identity, relationships, and sense of well-being. Conclusions and suggestions for future research are offered.

Social Fear in US Infants: The Roles of Hair and Salivary Cortisol

Elevated social fear in infancy poses risk for later social maladjustment and psychopathology. Hair cortisol concentration (HCC), an index of cumulative cortisol exposure, and diurnal salivary cortisol slope, a biomarker of acute stress regulation, have been associated with social fear behaviors in childhood; however, no research has addressed their relations in infancy. Elucidating potential biomarkers of infant social fear behaviors, as well as environmental factors associated with these biomarkers, may grant insights into the ontogeny of fear behaviors that increase risk for internalizing and externalizing psychopathologies later in life. The current study used multiple linear regression to examine if infant HCC, infant diurnal cortisol slope, and income-to-needs ratios (ITN) were differentially associated with observed social fear responses to a Stranger Approach task at 12 months. Using a sample of 90 infants (M _age = 12.26m, SD = 0.81m, 50% female), results indicated that increased infant HCC was associated with increased distress vocalizations during the Stranger Approach task, while steeper diurnal cortisol slope was associated with fewer distress vocalizations. Ordinary least squares path analyses did not reveal group differences between economically strained and non-strained infants in how cortisol measures and social fear responses related. Findings underscore very early psychobiological correlates of fearfulness that may increase risk for fear-related disorders and adverse mental health symptomology across childhood.

Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review

Background

Adopted children and children placed in foster care are at increased risk of developing a range of mental health, behavioural, and psychosocial adjustment problems. Previous studies suggest that due to early experiences of separation and loss some children may have difficulties forming a secure attachment relationship with the adoptive/foster parents.

Objectives

The objectives of the present review were: (1) to assess the efficacy of attachment-based interventions on measures of favourable parent/child outcomes (attachment security, dyadic interaction, parent/child psychosocial adjustment, behavioural and mental health problems, and placement breakdown) within foster and adoptive families with children aged between 0 and 17 years. (2) to identify factors that appear to be associated with more effective outcomes and factors that modify intervention effectiveness (e.g., age of the child at placement and at intervention start, programme duration, programme focus).

Search Methods

Relevant studies were identified through electronic searches of bibliographic databases, governmental and grey literature repositories, hand search in specific targeted journals, citation tracking, contact to international experts and Internet search engines. The database searches were carried out to October 2020.

Selection Criteria

The interventions of interest were parenting interventions aimed at helping the foster/adopted children and their parents to form or sustain a secure attachment relationship. The interventions had to be at least partly informed by attachment theory.

Data Collection and Analysis

The total number of potentially relevant studies constituted 17.822 hits after duplicates were removed. A total of 44 studies (27 different populations) met the inclusion criteria and were critically appraised by the review authors. Due to critical study quality, missing numeric data and re-use of the same data, only 24 studies analysing 16 different populations could be used in the data synthesis (children, N = 1302; parents, N = 1344). Meta-analysis using both child and parent outcomes were conducted on each metric separately. All analyses were inverse variance weighted using random effects statistical models. Random effects weighted mean effect sizes were calculated using 95% confidence intervals (CIs). When possible, we conducted moderator analysis using meta-regression and single factor sub group moderator analysis. Sensitivity analysis were conducted across study design and domains of the risk of bias assessment.

Main Results

Ten studies analysed the effect of attachment-based interventions on the overall psychosocial adjustment of foster or adopted children as reported by their caregivers post intervention. Measures used include the Child Behaviour Checklist, The Strengths and Difficulties Questionnaire, Brief Infant-Toddler Social and Emotional Assessment (BITSEA) and Eyberg Child Behaviour Inventory. The random effects weighted standardised mean difference (SMD) favouring the intervention group was 0.37 (95% CI, 0.10-0.65) and statistically significant. Three studies analysed the effects of attachment-based interventions on the observed attachment security of foster and adopted children as measured by independent observation. Measures include the Strange Situation Procedure, Attachment Q-Set, and The Emotional Availability Clinical Screener. The random effects weighted SMD was 0.59 (95% CI, -0.40-1.57) and not statistically significant. Four studies analysed the effect of attachment-based interventions on positive child behaviour post intervention as measured by independent observation of video-taped interaction between the child and caregivers. Measures include Disruptive Behaviour Diagnostic Observation Schedule (DB-DOS) and Emotional Availability Scales). The random effects weighted SMD was 0.39 (95% CI, 0.14-0.64) and statistically significant. Ten studies analysed the effect of attachment-based interventions on positive parenting behaviour post intervention as measured by independent observation of video-taped interaction between the child and caregivers or coding of audio-taped recordings of parental speech. Measures include Adapted Ainsworth Scales for sensitivity and noninterference, Measurement of Empathy in Adult-Child Interaction, The Dyadic Parent-Child Interaction Coding System, Reflective functioning scale, and Emotional Availability Scales. The random effects weighted SMD was 1.56 (95% CI, 0.81-2.31) and statistically significant. Nine studies analysed the effect of attachment-based interventions on self-reported post intervention parenting stress (Parenting Stress Index). The random effects weighted SMD was 0.24 (95% CI, 0.03-0.46.) and statistically significant. Three studies analysed the effect of attachment-based interventions on parental post intervention self-reported depressive symptoms (Beck Depression Inventory). The random effects weighted SMD was 0.59 (95% CI, -0.08-1.25.) and not statistically significant. Follow-up analyses were carried out for the outcomes externalising behaviour, positive parenting, and parenting stress, but due to the low number of studies, results should be viewed with caution. Results of the single factor sub group moderator analysis suggest that it cannot be ruled out the effects differ depending on whether the interventions take place in the family home or in a clinical setting. However, it is unclear which location is associated with more positive effects as our findings differ between child and parent outcomes. Results of the sensitivity analysis showed no appreciable changes in the results following the removal of any of the studies in any of the analyses.

Authors' Conclusions

Parenting interventions based on attachment theory increase positive parent/child interactional behaviours, decrease parenting stress, and increase the overall psychosocial adjustment of children in foster and adoptive families postintervention. Due to the low number of studies evidence regarding the effects of attachment-based parenting interventions on attachment security and disorganised attachment in foster and adopted children was inconclusive. Theoretically, it is possible that child attachment security and/or attachment disorganisation cannot change within the relatively short period of time that parenting interventions typically last. It is possible that if postintervention improvements in parenting behaviours are sustained over time, it may lead to possible improvement in child attachment security and a decrease in child disorganised attachment. Thus, more longitudinal research is needed. Furthermore, evidence regarding the long-term effects of attachment-based parenting interventions on any outcomes was inconclusive due to too few studies, but findings suggest that attachment-based interventions increase positive parenting behaviour at follow-up points 3-6 months after the intervention. No study included in the present review provided a measure of placement stability or breakdown as an outcome, which could be used in the meta-analysis. This further emphasises the need for future longitudinal research in prevention of placement breakdown.

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.

Pilot randomized controlled trial of an attachment- and trauma-focused intervention for kinship caregivers

BACKGROUND

Kinship care placements are increasing in many Western countries, however families in kinship care are underserved partly due to the lack of evidence-based interventions addressing their unique needs.

OBJECTIVE

We conducted a pilot randomized controlled trial (RCT) to examine research feasibility and the acceptability, fidelity, and preliminary outcomes of an attachment- and trauma-focused intervention for kinship caregivers in Australia.

PARTICIPANTS AND SETTING

Participants included 26 kinship caregivers (M_age = 55.00 years; 54% grandparents) with youth (M_age = 10.58 years; 38% female), and 19 practitioners from child protection, out-of-home care and other services.

METHOD

Kinship caregivers were randomized to Connect for Kinship Parents (Connect-KP) or care-as-usual (CAU), and completed assessments at baseline, post-intervention, and 6-month follow-up. Placement changes were evaluated at 6-month follow-up. A subset of practitioners received both training and supervision in implementing Connect-KP, and their videorecorded sessions were coded for fidelity.

RESULTS

Practitioners rated the training highly and demonstrated excellent fidelity to program content and process. Results supported the research feasibility and all kinship caregivers reported high levels of program satisfaction and had very high attendance and completion rates. Direction of effects favored Connect-KP vs. CAU for all nine caregiver and youth outcomes, with the largest effects observed for significant reductions in caregiver strain, caregiver psychological aggression, and youth affect suppression following intervention. At 6-month follow-up, more youth from CAU (15%) vs. Connect-KP (0%) experienced an unplanned placement change.

CONCLUSIONS

Our findings show promise of Connect-KP as a potentially effective intervention that can be successfully implemented in child welfare services, and provide impetus for a larger-scale RCT.

Replication and extension of a family-based training program to improve cognitive abilities in young children

Childhood socioeconomic status (SES) is associated with persistent academic achievement gaps, which necessitates evidence-based, scalable interventions to improve children's outcomes. The present study reports results from a replication and extension of a family-based training program previously found to improve cognitive development in lower-SES preschoolers (Neville et al., 2013). One hundred and one primarily low-SES families with 107 children aged 4-7 years were randomly assigned to the intervention or passive control group. Intent-to-treat regression models revealed that children whose families were assigned to the intervention group did not exhibit significant benefit on composite measures of nonverbal IQ, executive functioning, or language skills, though post-hoc analyses suggested marginal improvement on the fluid reasoning subcomponent of nonverbal IQ. Treatment-on-treated models revealed a significant positive effect of intervention attendance on fluid reasoning and a negative effect on vocabulary. We discuss potential causes for the non-replication, including differences in the sample composition, size, and assessment choices. Results suggest the need to more broadly assess scalable interventions with varying populations and ensure appropriate cultural and geographical adaptations to achieve maximum benefits for children from diverse backgrounds.

Physiological Stress Response Reactivity Mediates the Link Between Emotional Abuse and Youth Internalizing Problems

Youth who are raised in emotionally abusive families are more likely to have poor mental health outcomes such as depression and anxiety. However, the mechanisms of this association are unclear. The present study utilized a longitudinal sample of low-SES youth (N = 101, M_ageT1 = 10.24) to examine stress response reactivity (i.e. vagal withdrawal, sympathetic activation, and hypothalamic-pituitary-adrenal [HPA] axis activation) as mediators between emotional abuse and prospective youth internalizing symptoms. Results indicated that blunted HPA reactivity to a laboratory social stress task mediated the association between emotional abuse and youth internalizing symptoms. Emotional abuse was also associated with blunted parasympathetic nervous system activity (i.e. less vagal withdrawal than average). In sum, emotional abuse is a potent risk factor for youth internalizing symptoms, and this link may be mediated via dysregulation in physiological stress response systems. Primary prevention of childhood emotional abuse and secondary prevention programs that target self-regulation skills may reduce rates of youth internalizing symptoms and disorders.

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.

Hyper- and hypo-cortisol functioning in post-institutionalized adolescents: The role of severity of neglect and context

Understanding the developmental timing of stress exposure may help inform mechanisms underlying how stress "gets under the skin" and influences the stress response system, including the HPA axis and its end-product cortisol. Early adversity may be particularly detrimental; however, it is difficult to disentangle the timing of adversity from its cumulative burden because there is typically high continuity between early and later adversity. Moreover, context and the different stressors inherent in various contexts may interact with stress exposure to influence psychophysiological functioning. To address this issue, we examined adolescents who had been reared in institutions and suffered neglect or social deprivation ranging from approximately six months to several years of life prior to adoption into U.S. homes. We focused on the stress hormone cortisol because it can reflect continued regulatory problems in youth, even years after youth transition to typical homes. We examined cortisol morning levels and diurnal rhythms across multiple contexts (home, school, lab) on 5 separate days in 41 post-institutionalized youth and 78 comparison youth. Employing hierarchical linear modeling, we found that when assessed in the lab, post-institutionalized (PI) youth displayed lower morning cortisol levels and flatter diurnal slopes than the control youth. Yet at home, PI youth displayed higher morning cortisol levels than the control youth. In addition to group effects, we also examined severity of early adversity and found that PI kids who had endured the most severe early adversity displayed lower home cortisol levels than controls. No significant predictors of diurnal cortisol on school days were identified. These data fit with the notion that the HPA axis is impacted by early adversity, even years after adoption, and with emerging theories that postulate that stress physiology calibrates within youth to help them adapt to their context. In the case of severe early adversity, the cost of such adaptation may not be desirable. It also highlights the important role of context when assessing HPA axis activity, particularly in post-institutionalized youth.

Longitudinal changes in amygdala, hippocampus and cortisol development following early caregiving adversity

Although decades of research have shown associations between early caregiving adversity, stress physiology and limbic brain volume (e.g., amygdala, hippocampus), the developmental trajectories of these phenotypes are not well characterized. In the current study, we used an accelerated longitudinal design to assess the development of stress physiology, amygdala, and hippocampal volume following early institutional care. Previously Institutionalized (PI; N = 93) and comparison (COMP; N = 161) youth (ages 4–20 years old) completed 1–3 waves of data collection, each spaced approximately 2 years apart, for diurnal cortisol (N = 239) and structural MRI (N = 156). We observed a developmental shift in morning cortisol in the PI group, with blunted levels in childhood and heightened levels in late adolescence. PI history was associated with reduced hippocampal volume and reduced growth rate of the amygdala, resulting in smaller volumes by adolescence. Amygdala and hippocampal volumes were also prospectively associated with future morning cortisol in both groups. These results indicate that adversity-related physiological and neural phenotypes are not stationary during development but instead exhibit dynamic and interdependent changes from early childhood to early adulthood.

Methylation of the glucocorticoid receptor promoter in children: Links with parents as teachers, early life stress, and behavior problems

The present study examined the effect of early life stress (ELS) on the glucocorticoid receptor gene (NR3C1) methylation, the associations between NR3C1 methylation and behavior problems, and the effect of the program Parents as Teachers (PAT) on NR3C1 methylation. Participants included 132 children, 72 assigned to the PAT intervention group and 60 to the PAT control group. Children were aged 3 years, and were living in psychosocially at-risk families. We assessed NR3C1 methylation of the NGFI-A binding regions of exon 1F via sodium bisulfite sequencing from saliva DNA. Results indicated that (a) children living in families receiving PAT had decreased methylation at one single cytosine–guanine dinucleotides (CpG) site; (b) current maternal depressive symptoms and parental disagreement were predictive of increased methylation of mean NGFI-A and three single CpG sites; and (c) increased methylation of mean NGFI-A and one single CpG site was significantly associated with increased internalizing and externalizing symptoms. In addition, mean NGFI-A was a mediator of the association between parental disagreement and a child's affective problems. These results suggest that PAT may contribute to preventing NR3C1 methylation in preschool children living in psychosocially at-risk situations, and confirm previous findings on the associations between ELS, NR3C1 methylation, and behavior problems.

A Narrative Review of the Needs of Children in Foster and Kinship Care: Informing a Research Agenda

As a result of maltreatment, children in care can present with a range of complex needs and challenges. In addition to direct clinical care commonly provided by paediatricians, psychiatrists, and clinical psychologists, the provision of knowledge and skills to foster and kinship carers have become modes of support common in responding to these needs and challenges. A narrative review of key systematic reviews and empirical research was conducted to assess the effectiveness of existing foster carer interventions. Results indicated a range of methodological characteristics that limit our ability to develop a sound, research-driven, evidence base. As a result, we remain limited in our knowledge about which treatments are effective, for which symptoms they are effective, and for which population subgroups they are most likely to be effective. This review provides a summary of identified needs and challenges in the delivery of foster carer interventions. It provides an account of current treatment components and offers a platform for the development and progression of a programme of research in an effort to advance knowledge in the area.

Parenting intervention outcomes for kinship caregivers and child: A systematic review

BACKGROUND

Kinship foster caregivers often face serious challenges but lack adequate parenting capacities and resources. The importance of parenting interventions for kinship foster caregivers has been recognized, and researchers have assessed the effect of various parenting interventions on the caregivers and children. However, no systematic review has been conducted to summarize findings related to parenting interventions targeting kinship care.

OBJECTIVES

This study systematically summarizes the effect of parenting interventions on kinship foster caregivers and their cared for children, and examines the intervention strategies and research methods used in order to provide a context in which to better understand effects of interventions.

METHODS

From six academic databases, 28 studies were identified for review. A data template was used to extract the following information from each study: intervention targets, research design, settings, intervention description, outcome measures, and main results for each study.

RESULTS

Various parenting interventions targeting kinship foster care families have been developed to improve parenting capacities and reduce parental stress. Most of the interventions had a positive impact on the outcomes of both caregivers and children, although the assessed outcomes often differed across studies. Parenting interventions improve caregivers' parenting competency, reduce parental stress, and advance child wellbeing. However, some interventions appear less promising in achieving targeted goals.

DISCUSSION

The findings suggest that promoting evidence-based parenting interventions with a special focus on kinship care is important for child welfare. Future directions for research are also discussed in this study.

Effects of parenting interventions on child and caregiver cortisol levels: systematic review and meta-analysis

BACKGROUND

Nurturing care, in which children are raised in engaging and safe environments, may reduce child stress and shape hypothalamic-pituitary-adrenal axis functioning. Hence, parent-training programs may impact child cortisol levels, as well as behavioral, social and health outcomes. We conducted a systematic review of the impact of parent-training interventions on children's and caregivers' cortisol levels, and meta-analyzed the results.

METHODS

In January 2020, searches in PubMed, LILACS, ERIC, Web of Science, Scielo, Scopus, PsycNET and POPLINE databases were conducted, and two independent researchers screened the results for eligible studies - randomized trials that assessed the impact of parent-training interventions on child or caregiver cortisol levels. Random effects were used to pool the estimates, separately for children and caregivers, and for children's morning and evening cortisol levels, as well as change across the day.

RESULTS

A total of 27 eligible studies were found. Data from 19 studies were extracted and included in the meta-analyses, with 18 estimates of child cortisol levels and 5 estimates for caregiver cortisol levels. The pooled effect size (standardized mean difference) for the effects of parent training programs on morning child cortisol was 0.01 (95%CI: - 0.14 to 0.16; I2: 47.5%), and for caregivers it was 0.04 (95%CI: - 0.22 to 0.30; I2: 0.0%). Similar null results were observed for child evening cortisol and for the slope between morning and evening child cortisol. No evidence of publication bias was found.

CONCLUSION

Existing evidence shows no effect of parent-training interventions on child or caregiver post-intervention cortisol. Researchers are encouraged to adopt standardized protocols to improve evaluation standards, to test for intervention effects on psychosocial outcomes that are theorized to mediate the effects on biomarkers, and to use additional biomarkers for chronic stress.

Tarabulsy. Contacts parent-enfant en contexte de placement : liens entre la sensibilité du parent d’accueil et les réactions des enfants à la suite des contacts

Cadre de la recherche : Au Québec, la Loi sur la protection de la jeunesse encourage le maintien des contacts entre les enfants placés en famille d’accueil et leurs parents biologiques. Or, il n’existe pas de consensus empirique quant aux conséquences de ces contacts sur les enfants placés.

Objectifs : Notre étude vise à examiner les liens entre la sensibilité du parent d’accueil et les réactions des enfants à la suite de ces contacts, en considérant trois facteurs potentiellement confondants soit la sécurité d’attachement, l’âge au moment du premier placement et la fréquence des contacts.

Méthodologie : Il s’agit d’une étude quantitative réalisée auprès de 51 enfants placés âgés de 12 à 45 mois. Une entrevue individuelle auprès du parent biologique nous permet de documenter la fréquence des contacts réalisés auprès de l’enfant. Les réactions de l’enfant, à la suite des contacts, sont rapportées par le parent d’accueil. La sensibilité parentale et la sécurité d’attachement sont observées lors d’une visite au domicile du parent d’accueil. 

Résultats : La plupart des enfants affichent au moins une réaction négative à la suite des contacts. Les réactions négatives rapportées sont associées significativement à l’insensibilité du parent d’accueil. 

Conclusions : Notre étude suggère que la sensibilité du parent d’accueil peut être un facteur favorable à de meilleures transitions à la suite des contacts.

Contribution : Cet article contribue à la réflexion sur la tenue des contacts suivant une mesure de placement et sur les réactions manifestées par les enfants à la suite de ces contacts.

Levers and barriers to success in the use of translational neuroscience for the prevention and treatment of mental health and promotion of well-being across the lifespan

Neuroscientific tools and approaches such as neuroimaging, measures of neuroendocrine and psychoneuroimmune activity, and peripheral physiology are increasingly used in clinical science and health psychology research. We define translational neuroscience (TN) as a systematic, theory-driven approach that aims to develop and leverage basic and clinical neuroscientific knowledge to aid the development and optimization of clinical and public health interventions. There is considerable potential across basic and clinical science fields for this approach to provide insights into mental and physical health pathology that had previously been inaccessible. For example, TN might hold the potential to enhance diagnostic specificity, better recognize increased vulnerability in at-risk populations, and augment intervention efficacy. Despite this potential, there has been limited consideration of the advantages and limitations of such an approach. In this article, we articulate extant challenges in defining TN and propose a unifying conceptualization. We illustrate how TN can inform the application of neuroscientific tools to realistically guide clinical research and inform intervention design. We outline specific leverage points of the TN approach and barriers to progress. Ten principles of TN are presented to guide and shape the emerging field. We close by articulating ongoing issues facing TN research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Utilising Genetically-Informed Research Designs to Better Understand Family Processes and Child Development: Implications for Adoption and Foster Care Focused Interventions

Understanding the interplay between genetic factors and family environmental processes (e.g., inter-parental relationship quality, positive versus negative parenting practices) and children's mental health (e.g., anxiety, depression, conduct problems, ADHD) in the contexts of adoption and foster-care research and practice is critical for effective prevention and intervention programme development. Whilst evidence highlights the importance of family environmental processes for the mental health and well-being of children in adoption and foster care, there is relatively limited evidence of effective interventions specifically for these families. Additionally, family-based interventions not specific to the context of adoption and foster-care typically show small to medium effects, and even where interventions are efficacious, not all children benefit. One explanation for why interventions may not work well for some is that responses to intervention may be influenced by an individual's genetic make-up. This paper summarises how genetically-informed research designs can help disentangle genetic from environmental processes underlying psychopathology outcomes for children, and how this evidence can provide improved insights into the development of more effective preventative intervention targets for adoption and foster-care families. We discuss current difficulties in translating behavioural genetics research to prevention science, and provide recommendations to bridge the gap between behavioural genetics research and prevention science, with lessons for adoption and foster-care research and practice.

Acute stress impairs children's sustained attention with increased vulnerability for children of mothers reporting higher parenting stress

Despite evidence that acute stress impairs attention in adults, there has been minimal research in children. Here, the effects of acute stress on Go/No-go performance were examined in young children (M age = 5.41 years). Given the critical role of the parent-child relationship to children's self-regulatory development, the extent to which parenting stress predicts children's cognitive vulnerability to acute stress and autonomic reactivity was also investigated. A between-groups design (n = 58 stress, n = 26 control) was used with oversampling of the stressor-exposed children to examine individual differences. The Parenting Stress Index and subscales were employed as a measure of parenting stress. Acute stress impaired children's sustained attention, but not inhibitory control. Higher parenting stress was associated with vulnerability to attentional impairment. Parenting distress was also positively associated with sympathetic reactivity to acute stress, but neither sympathetic nor parasympathetic reactivity was associated with attentional impairment. A conceptual model of pathways through which repetitive acute stress may contribute to self-regulatory difficulties is presented, including the potential buffering role of caregivers.

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.

Early adversity, child neglect, and stress neurobiology: From observations of impact to empirical evaluations of mechanisms

Research on the effects of early life adversity, and in particular on the absence of responsive caregiving, has shown long-term impacts on well-being and development. These investigations have been conducted both in human populations and in animal models. The work has demonstrated that neglect experienced in the early years can affect not only behavior but also neurobiological functioning. In particular, studies of children in the foster care system show convergence with research on children adopted following institutional rearing in terms of dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which produces the neuroendocrine hormone cortisol. The characteristic pattern that has been most commonly observed involves diminished diurnal cortisol production, particularly in terms of low levels of cortisol upon awakening. Notably, however, a number of evidence-based interventions for infant, toddler, and preschool-aged foster children have been shown to produce more typical patterns of cortisol production, in combination with improved behavioral, socioemotional, and foster care placement outcomes. In this paper, we review the literature on the effects of early disruptions in care on biobehavioral development, and summarize the results of the interventions for young foster children.

Placement disruption in foster care: Children's behavior, foster parent support, and parenting experiences

BACKGROUND

The majority of children in foster care 24 months or longer experience three or more placements. Children's behavior problems are a primary contributor to multiple moves, but little is known about how behavior problems and other stressors lead to disruptions. This study focused on foster parents' experiences of parenting a child at risk for moves using the determinants of parenting model (Belsky, 1984) to identify potential correlates of difficult parenting experiences and placement disruption.

OBJECTIVE

To identify factors associated with difficult parenting experiences and placement disruption.

PARTICIPANTS

Foster parents (N = 139) caring for children age 8-14 in long term foster care with a history of two or more moves were randomly selected in a large Midwestern state in the U.S.

METHODS

Participants completed a 90-minute telephone interview (86% response rate). Placement moves were tracked prospectively for two years. Parenting experiences and disruption were analyzed using multiple and logistic regression.

RESULTS

Results support aspects of the determinants of parenting model. Behavior problems, children's risk to others, low support, and stress were significantly associated with more difficult parenting experiences (βs = .28, .22, .18, .19, respectively, ps < .05), and more difficult parenting experiences strongly predicted placement disruption (p < .01). Risk to others also predicted disruption before including parenting experiences, with this association becoming nonsignificant after including parenting experiences. Unexpectedly, African American foster parents had a higher risk for disruption, despite more positive parenting experiences.

CONCLUSIONS

These findings support attending to foster parents' parenting experiences, children's risk to others, social support and stress to better support placements of children at risk for disruption.

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.

Rethinking Addiction

Addiction is a complex and challenging condition with many contributing factors. Although addictive behaviors appear to be individual choices, behavior alterations cannot be addressed successfully without considering characteristics of the physical and social environments in which individuals live, work, and play. Exposure to chronic psychosocial stressors and the physiological response of individuals to their external environment activates the brain's neuroendocrine hypothalamic-pituitary-adrenal axis, with profound conditioning effects on behavior. This brief synopsis describes the social determinants of health; examines the interconnectedness of the psychosocial environment, behavior, and subsequent health outcomes; discusses the environment's critical influence on brain plasticity, adaptation and functioning; and explores additional factors that complicate adolescent addiction. Because the environment is both a determinant of behavior and an opportunity for intervention, in the context of addictions, it is important to incorporate these factors in the analysis of risk and design of early interventions for prevention and amelioration of addiction.

General Cognitive Ability as an Early Indicator of Problem Behavior Among Toddlers in Foster Care

OBJECTIVE

Children who have experienced maltreatment and subsequent placement in foster care are at increased risk of problem behavior. Increased knowledge of the development of problem behavior in this population, particularly during toddlerhood, can greatly inform preventive intervention efforts. This study examined variability in problem behavior among toddlers entering new foster care placements and identified related child and parenting characteristics.

METHODS

Ninety-one toddlers in foster care (mean = 2.26 years) and their caregivers completed an initial assessment and were reassessed 6 months later. A child's general cognitive ability was assessed via performance on a standardized developmental measure, and child problem behavior, parenting stress, frequency of family routines, and harsh discipline were assessed via caregiver report.

RESULTS

Upon entering a new foster care placement and 6 months after placement, respectively, 38% and 25% of the toddlers were within the borderline clinical or clinical range in terms of problem behavior when assessed using the Child Behavior Checklist. There was not a significant difference in problem behavior over this 6-month period, suggesting that problem behavior was quite stable among the toddlers as a group. However, general cognitive ability was a significant predictor of individual differences in change in problem behavior, with toddlers with lower general cognitive ability displaying increased problem behavior over this period.

CONCLUSION

An increased number of toddlers in foster care displayed clinically significant levels of problem behavior, further demonstrating that these children are an extremely high-risk group. The association between general cognitive ability and change in problem behavior highlights the importance of early developmental screenings, which may help identify children at greatest risk of problem behavior and most in need of preventive intervention efforts.

Recollections of positive early caregiving relate to sympathetic nervous system activation and chronic inflammation in subsequent generations

To understand links between early experience and biomarkers of peripheral physiology in adulthood, this study examined associations between quality of early caregiving and markers of sympathetic activation and chronic inflammation in a sample of 52 low-income mothers and their preschool-aged children. Mothers reported on levels of positive caregiving experienced during childhood using the Structural Analysis of Social Behavior-Intrex. Mother and child sympathetic activation was indexed via pre-ejection period (PEP) at rest, during a dyadic social engagement task, and for children, while interacting with an unfamiliar adult. C-reactive protein (CRP) was collected using whole blood spots to assess levels of low-grade chronic inflammation. Results showed that mothers who reported experiencing more warm guidance and support for autonomy in early childhood displayed lower resting sympathetic nervous system activation (i.e., longer PEP) and lower chronic inflammation (i.e., CRP levels). Further, lower maternal chronic inflammation levels were associated with lower sympathetic activation (i.e., longer PEP) in their children at rest, and during social interactions with mother and a female stranger.

Leveraging translational neuroscience to inform early intervention and addiction prevention for children exposed to early life stress

Substance use and addiction are disproportionately experienced by individuals with a history of exposure to early life stress (ELS), such as maltreatment, domestic violence and parent psychopathology. Unfortunately, extant interventions have mixed effectiveness at improving outcome trajectories for ELS-exposed children, who are often underserved by evidenced-based programs. Here, we employ a translational neuroscience framework to delineate how neuroscience can deepen our understanding of ELS-linked alterations in children's function to inform the development of more targeted, effective early intervention and addiction prevention programs. Candidate neural pathways altered by ELS and linked to addiction are described across sensory, affective, motivational, and executive function domains. Next, we provide an example of the application of translational neuroscience principles in a family of early interventions (i.e. Multidimensional Treatment Foster Care – Preschool, Kids in Transition to School) focused on improving self-regulation in ELS-exposed children. Future directions and areas of unmet need in intervention research detail the significant potential of translational neuroscience to advance interventionists' ability to support positive adjustment in ELS-exposed children and prevent harmful addiction outcomes.

MEASUREMENT ISSUES IN HOME-VISITING RESEARCH WITHIN TRIBAL COMMUNITIES: CHALLENGES AND STRATEGIES

In this article, Tribal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grantees share strategies they have developed and adopted to address the most common barriers to effective measurement (and thus to effective evaluation) encountered in the course of implementation and evaluation of their home-visiting programs. We identify key challenges in measuring outcomes in Tribal MIECHV Programs and provide practical examples of various strategies used to address these challenges within diverse American Indian and Alaska Native cultural and contextual settings. Notably, high-quality community engagement is a consistent thread throughout these strategies and fundamental to successful measurement in these communities. These strategies and practices reflect the experiences and innovative solutions of practitioners working on the ground to deliver and evaluate intervention programs to tribal communities. They may serve as models for getting high-quality data to inform intervention while working within the constraints and requirements of program funding. The utility of these practical solutions extends beyond the Tribal MIECHV grantees and offers the potential to inform a broad array of intervention evaluation efforts in tribal and other community contexts.

USING SINGLE-CASE DESIGNS TO EVALUATE COMPONENTS OF TRIBAL HOME-VISITATION PROGRAMS

Single-case designs are typically used in classroom and clinical settings to assess the behavioral impacts of an intervention with an individual child. Using two illustrative case studies, this article describes the extension of this model to home-visitation programs serving tribal communities and examines the lessons learned throughout the process of adapting this approach. Our experience suggests that the benefits of using this design outweigh the associated challenges and allows researchers to expand the use of single-case designs to previously unexplored settings. Specifically, some of the benefits discussed include allowing for evaluative rigor in contexts with small samples, allowing everyone who qualifies to immediately participate, providing visual representations of the outcome-making the results more tangible and accessible to a broader audience, and allowing for a deep level of cultural sensitivity. The article also provides some general guidelines to address the practical challenges one may face when attempting to use single-case designs in novel ways within nonschool settings.

METHODOLOGICAL CONSIDERATIONS FOR HOME-VISITING RESEARCH IN TRIBAL COMMUNITIES

Drawing on previous studies and the collective experience of conducting rigorous evaluations as part of the Tribal Maternal, Infant, and Early Childhood Home Visiting grants, we outline methodological considerations that will inform future research in tribal communities, particularly in the area of home visiting. The methodological issues we discuss are study design choices, measurement and data collection, and including community members in all aspects of the research.

Family conflict, chaos, and negative life events predict cortisol activity in low-income children

Childhood poverty is hypothesized to increase risk for mental and physical health problems at least in part through dysregulation of the hypothalamic-pituitary-adrenal axis. However, less is known about the specific psychosocial stressors associated with cortisol reactivity and regulation for children living in poverty. The current study investigates negative life events, household chaos, and family conflict in preschool and middle childhood as potential predictors of cortisol regulation in low-income 7-10 year olds (N = 242; M age = 7.9 years). Participants were assessed in preschool and participated in a follow-up assessment in middle childhood, during which diurnal free cortisol and free cortisol reactivity to the Trier Social Stress Test for Children (TSST-C) were assessed. Household chaos during preschool predicted a more blunted diurnal cortisol slope in middle childhood. Greater negative life events during preschool and greater concurrent family conflict were associated with increased free cortisol reactivity in middle childhood.

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.

Cognitive control moderates parenting stress effects on children's diurnal cortisol

This study investigated associations between parenting stress in parents and self-reported stress in children with children's diurnal cortisol secretion and whether these associations are moderated by known stress-regulating capacities, namely child cognitive control. Salivary cortisol concentrations were assessed from awakening to evening on two weekend days from 53 6-to-7-year-old children. Children completed a cognitive control task and a self-report stress questionnaire with an experimenter, while parents completed a parenting stress inventory. Hierarchical, linear mixed effects models revealed that higher parenting stress was associated with overall reduced cortisol secretion in children, and this effect was moderated by cognitive control. Specifically, parenting stress was associated with reduced diurnal cortisol levels in children with lower cognitive control ability and not in children with higher cognitive control ability. There were no effects of self-reported stress in children on their cortisol secretion, presumably because 6-to-7-year-old children cannot yet self-report on stress experiences. Our results suggest that higher cognitive control skills may buffer the effects of parenting stress in parents on their children's stress regulation in middle childhood. This could indicate that training cognitive control skills in early life could be a target to prevent stress-related disorders.

Foster children's behavioral development and foster parent stress: testing a transactional model

The goal of this three-wave longitudinal study was to analyze foster parent stress and foster children's internalizing and externalizing behaviors in a transactional framework. Participants in this study were 237 children in foster care in the Netherlands with, mostly, long placement durations (M = 56.86 months, SD = 49.10 months). We examined concurrent, prospective unidirectional and bidirectional relations between foster children's behavior and foster parent stress by using cross-lagged structural equation modeling and examined whether the results were stable across different subgroups of foster children. In contrast to our hypothesis, we found no bidirectional relations. There were unidirectional prospective pathways from foster children's internalizing and externalizing problems to foster parent stress, but no significant prospective pathways from foster parent stress to foster children's internalizing and externalizing problems. The results were fairly stable across different subgroups of foster children. The lack of bidirectional relations was unexpected given the presence of transactional relations in biological parent-child dyads. Foster parents seem not to influence their foster children when it comes to regulating problem behavior. Therefore, the question is whether foster parents can, in more general terms, help their foster children benefit from their improved home environment.

Adherence to Diurnal Cortisol Sampling Among Mother-Child Dyads From Maltreating and Nonmaltreating Families

There has been increasing interest in evaluating whether interventions for child maltreatment can improve and/or prevent child physiological dysregulation via measurement of diurnal cortisol. The assessment of diurnal cortisol typically involves the home-based collection of saliva multiple times per day, bringing forth important methodological considerations regarding adherence to collection instructions. To date, there has been no data regarding adherence to home collection of diurnal cortisol among maltreating families. The current study provides data on adherence to in-home sampling of salivary cortisol among 166 maltreating and demographically similar nonmaltreating mother-child dyads using electronic monitoring devices (Medication Event Monitoring System caps). Mothers collected saliva samples on themselves and their children 3 times per day (waking, midday, and evening) for 2 consecutive days. Analyses reveal that although maltreating families were more likely to be nonadherent to the collection protocol on their initial attempt, with additional support and resampling, maltreating and nonmaltreating families were comparable on most measures of adherence. Suggestions for best practices, including the use of electronic monitoring devices, for diurnal cortisol collection with maltreating families are provided.

The efficacy of conjoint behavioral consultation in the home setting: Outcomes and mechanisms in rural communities

This study reports the results of a randomized controlled trial examining the effect of Conjoint Behavioral Consultation (CBC), a family-school partnership intervention, on children's behaviors, parents' skills, and parent-teacher relationships in rural community and town settings. Participants were 267 children, 267 parents, and 152 teachers in 45 Midwestern schools. Using an Intent to Treat approach and data analyzed within a multilevel modeling framework, CBC yielded promising results for some but not all outcomes. Specifically, children participating in CBC experienced decreases in daily reports of aggressiveness, noncompliance, and temper tantrums; and increases in parent-reported adaptive skills and social skills at a significantly greater pace than those in a control group. Other outcomes (e.g., parent reports of internalizing and externalizing behaviors) suggested a nonsignificant effect at post-test. CBC parents reported using more effective parenting strategies, gaining more competence in their problem-solving practices, and feeling more efficacious for helping their child succeed in school than parents in the control group. Parents participating in CBC also reported significant improvements in the parent-teacher relationship, and the parent-teacher relationship mediated the effect of CBC on children's adaptive skills. Implications for practice in rural communities, study limitations, and directions for future research are discussed.

Social-learning parenting intervention research in the era of translational neuroscience

In the decades since social learning parenting interventions emerged, many evidence-based programs have been implemented at scale in community settings, and much research is now focusing on ways to maintain fidelity and impact during the implementation process. Notably, a considerable amount of theoretical confluence has occurred in parenting interventions from social learning, attachment, and other theoretical perspectives, with parent coaching as an example of this new generation of relational interventions. In addition, research examining the neurobiological effects of early adverse experiences is providing insight into key mediating and moderating mechanisms underlying the effectiveness of social learning parenting interventions, and new strategies for tailoring interventions to the needs of specific populations are being developed, making interventions more efficient, precise, and effective.

Effects of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) for Young Foster Children with Severe Behavioral Disturbances

Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) has thus far only been tested for diminishing behavior problems in the US. This study tested relative efficacy of MTFC-P on multiple outcomes against treatment as usual in the Netherlands (TAU; Study I), and regular foster care (Study II). The sample included 55 children that received MTFC-P, 23 children received TAU and 30 children from regular foster care (RFC). Changes in behavioral and relationship functioning, trauma symptoms, hypothalamic-adrenal-pituitary (HPA-) axis functioning, and caregiving stress were assessed via questionnaires, interviews, and salivary cortisol. Outcomes of Study I were evaluated using a randomized controlled design and quasi-experimental design, outcomes of Study II according to non-equivalent group comparison. No evidence was found for relative efficacy of MTFC-P over TAU. A treatment effect was found on trauma symptoms, in favor of TAU. Outcomes of Study II revealed that whereas caregiving stress and secure base distortions were significantly more severe at baseline in MTFC-P compared to RFC, post treatment differences were no longer significant. However, percentages of symptoms of disinhibited attachment and attachment disorder were nearly equal between groups at baseline, while post treatment percentages indicated significantly more symptoms in MTFC. In addition, results revealed a significant difference in the severity of externalizing problems post treatment, in favor of RFC. The results obtained within this study indicate that children in MTFC-P and usual treatment foster care in the Dutch context improved similarly, thus not showing the same advantages that MTFC-P has demonstrated in the US. Results should be interpreted with caution due to lower than planned power. Findings underscore the challenges of testing novel treatments across contexts with highly different child welfare provisions.

The Oregon Model of Behavior Family Therapy: From Intervention Design to Promoting Large-Scale System Change

This paper reviews the evolution of the Oregon model of family behavior therapy over the past four decades. Inspired by basic research on family interaction and innovation in behavior change theory, a set of intervention strategies were developed that were effective for reducing multiple forms of problem behavior in children (e.g., Patterson, Chamberlain, & Reid, 1982). Over the ensuing decades, the behavior family therapy principles were applied and adapted to promote children's adjustment to address family formation and adaptation (Family Check-Up model), family disruption and maladaptation (Parent Management Training-Oregon model), and family attenuation and dissolution (Treatment Foster Care-Oregon model). We provide a brief overview of each intervention model and summarize randomized trials of intervention effectiveness. We review evidence on the viability of effective implementation, as well as barriers and solutions to adopting these evidence-based practices. We conclude by proposing an integrated family support system for the three models applied to the goal of reducing the prevalence of severe problem behavior, addiction, and mental problems for children and families, as well as reducing the need for costly and largely ineffective residential placements.

Effects of PMTO in Foster Families with Children with Behavior Problems: A Randomized Controlled Trial

The present randomized controlled trial examined the effectiveness of Parent Management Training Oregon for foster parents with foster children (aged 4-12) with severe externalizing behavior problems in long-term foster care arrangements. Foster children's behavior problems are challenging for foster parents and increase the risk of placement breakdown. There is little evidence for the effectiveness of established interventions to improve child and parent functioning in foster families. The goal of Parent Management Training Oregon, a relatively long and intensive (6-9 months, with weekly sessions) parent management training, is to reduce children's problem behavior through improvement of parenting practices. We specifically investigated whether Parent Management Training Oregon is effective to reduce foster parenting stress. A significant effect of Parent Management Training Oregon, compared to Care as Usual was expected on reduced parenting stress improved parenting practices, and on reduced child behavior problems. Multi-informant (foster mothers, foster fathers, and teachers) data were used from 86 foster families (46 Parent Management Training Oregon, 40 Care as Usual) using a pre-posttest design. Multilevel analyses based on the intention to treat principle (retention rate 73 %) showed that Parent Management Training Oregon, compared to Care as Usual, reduced general levels of parenting stress as well as child related stress and parent-related stress (small to medium effect sizes). The clinical significance of this effect was, however, limited. Compared to a decrease in the Care as Usual group, Parent Management Training Oregon helped foster mothers to maintain parental warmth (small effect size). There were no other effects of Parent Management Training Oregon on self-reported parenting behaviors. Child behavior problems were reduced in both conditions, indicating no additive effects of Parent Management Training Oregon to Care as Usual on child functioning. The potential implication of reduced foster parenting stress for placement stability is discussed.

Translational Neuroscience as a Tool for Intervention Development in the Context of High-Adversity Families

The use of theory-driven models to develop and evaluate family-based intervention programs has a long history in psychology. Some of the first evidence-based parenting programs to address child problem behavior, developed in the 1970s, were grounded in causal models derived from longitudinal developmental research. The same translational strategies can also be applied to designing programs that leverage emerging scientific knowledge about the effects of early adverse experiences on neurobiological systems to reduce risk and promote well-being. By specifying not only behavioral targets but also affected underlying neural systems, interventions can become more precise and efficient. This chapter describes the development of a program of research focusing on an intervention for young children in foster care. The intervention emerged from social learning theory research and employs a translational neuroscience approach. The conceptual model guiding the research, which incorporates behavioral domains as well as stress-regulatory neural systems, is described. Finally, future directions for translational neuroscience in family-based intervention research are considered.

Differential sensitization of parenting on early adolescent cortisol: Moderation by profiles of maternal stress

The hypothalamic-pituitary-adrenal (HPA) axis is a critical component of the body's stress-response neurobiological system, and its development and functioning are shaped by the social environment. Much of our understanding of the effects of the caregiving environment on the HPA axis is based on (a) parenting in young children and (b) individual maternal stressors, such as depression. Yet, less is known about how parenting behaviors and maternal stressors interact to influence child cortisol regulation, particularly in older children. With an ethnically diverse sample of 199 mothers and their early adolescent children (M=11.00years; 54% female), a profile analytic approach was used to investigate how multiple phenotypes of maternal stress co-occur and moderate the relation between parenting behaviors and youths' diurnal cortisol rhythms. Latent profile analysis yielded 4 profiles: current parenting stress, concurrent parenting and childhood stress, childhood stress, and low stress. For mothers with the concurrent parenting and childhood stress profile, inconsistent discipline, poor parental supervision, and harsh caregiving behaviors each were related to flattened diurnal cortisol rhythms in their adolescents. For mothers with the current parenting stress and childhood stress profiles, their use of inconsistent discipline was associated with flattened diurnal cortisol rhythms in their adolescents. For mothers with the low stress profile, none of the parenting behaviors was related to their adolescents' cortisol regulation. Findings suggest that based on mothers' stress profile, parenting behaviors are differentially related to youths' diurnal cortisol rhythms. Implications for parenting interventions are discussed.