KEEP proves it's worth keeping on across the US

The US spends $20 billion a year on foster care – an amount roughly equivalent to the GDP of Latvia or Uruguay, but experimental evidence on the impact of separating children from their families and placing them in substitute care settings is in short supply the world over.

It is reasonable to hypothesize that such an intervention will do harm to a small number of children, but clearly very difficult to put theory usefully to to the test – for example by randomly allocating children to foster or residential care conditions.

The challenges are particularly strong in the US where entry to State care has to be mandated by the courts. Any research design must be approved by the court and will require judges to use their powers sparingly.

Though still rare, randomly allocating support to foster parents is a more straightforward proposition, as Patricia Chamberlain, Research Scientist at the Oregon Social Learning Center (OSLC) has lately been able to demonstrate.

Her evaluation of the impact of enhanced training involved the random distribution of specialist help among 700 foster parents, a third of whom were relatives of the children they were looking after.

Just over half were offered a training program called KEEP (Keeping Foster Parents Trained and Supported). The program is a less intensive version of the training offered to foster parents as part of OSLC's Multidimensional Treatment Foster Care [1] (MTFC), one of 11 Blueprints Model Programs [2].

Training for foster parents is mandatory in the US, but quality and quantity are very variable. KEEP offers a basis for consistent training (there is a standard training manual), as well as supervision and support over a 16-week period. Parents are also rewarded for taking part.

KEEP focuses on behavior management methods. As with much of the OSLC’s work, the object is to increase parents’ “positive reinforcement” of their foster children. A good example is the “four-to-one rule” which encourages parents to tell their children how well they are doing four times for every one time they chide them or impose discipline.

The trial found an improvement in the behavior of the foster children. The effect was quite small. Foster children in families receiving the extra training displayed about four problem behaviors per day compared to about five in the control group.

The greatest impact and the greatest benefit from positive parenting strategies occurred among children displaying higher rates of behavior problems at the outset.

And as with any successful intervention there were flaws. Nearly two-fifths of the foster parents offered the training declined to participate.

If the training had the greatest impact on the most difficult children, should it be a universal service – one offered to all foster parents?

Chamberlain and colleagues say it should. Very few foster parents look after one foster child at a time. In the study sample, there was an average of 2.4 foster children to each foster family. And generally foster parents cared for a succession of children. Those in the Oregon sample had each sheltered an average of 13.4 children.

The odds on foster parents having to deal with high levels of problem behavior at some point are quite short, so it makes sense for the training to be available to all. And since training of some kind is mandatory in the US it also makes sense to use quality programs like KEEP.

[See also: How they KEEP foster care real in San Diego [3] and Getting moribund welfare systems out of jail the Oregon way [4].]

Reference
Chamberlain P, Price J, Leve L, Laurent H, Landsverk J and Reid J “Prevention of Behavior Problems for Children in Foster Care: Outcomes and Mediation Effects”, Prevention Science, available online pre-publication.