Leslie D. Leve

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.

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.

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 childrens 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.

Practitioner Review: Children in Foster Care--Vulnerabilities and Evidence-Based Interventions that Promote Resilience Processes.

BACKGROUND An increasing number of children are placed in foster care (i.e., a kin or nonkin family home other than the biological parent) due to experiences of physical, sexual, emotional, or psychological abuse, and/or neglect. Children in foster care are at increased risk for a host of negative outcomes encompassing emotional, behavioral, neurobiological, and social realms. METHODS Areas of risk and vulnerability among foster children are described, including emotional and behavioral deficits, impaired neurobiological development, and social relationship deficits. Evidence suggesting the significance of family placement changes and prenatal exposure to substances as contributing mechanisms is presented. Based on a systematic search of the PsycINFO database (to March 2012), eight efficacious evidence-based interventions for foster families are summarized. FINDINGS Although the development of evidence-based interventions that improve outcomes for foster children has lagged behind the delivery of interventions in other service sectors (e.g., mental health and educational sectors), several interventions across childhood and adolescence offer promise. Service system constraints offer both challenges and opportunities for more routine implementation of evidence-based interventions. CONCLUSIONS Given the increased likelihood of poor outcomes for foster children, increased efforts to understand the pathways to vulnerability and to implement interventions shown to be effective in remediating risks and improving outcomes for this population are indicated. Evaluation of efficacious interventions in countries outside of the United States is also needed.

Coercive family processes: A replication and extension of Patterson’s coercion model

Patterson hypothesized that aggressive behavior develops in families when parents use coercion as the primary mode for controlling their children. The model has been tested with boys and older children. In this paper, through confirmatory factor analysis, we examine how well the coercion model generalizes to 5-year-old children (boys and girls). Our results suggest that the model fits the data similarly for boys and girls. Few sex differences in child antisocial behavior were found on observed or parent-rated measures, nor were differences found in observed parent aversive responses to child behavior. This implies that similar coercion processes apply to both boys and girls. Aggr. Behav. 27:14–25, 2001.

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.

Multidimensional treatment foster care as a preventive intervention to promote resiliency among youth in the child welfare system.

Demographic trends indicate that a growing segment of families is exposed to adversity such as poverty, drug use problems, caregiver transitions, and domestic violence. Although these risk processes and the accompanying poor outcomes for children have been well studied, little is known about why some children develop resilience in the face of such adversity, particularly when it is severe enough to invoke child welfare involvement. This paper describes a program of research involving families in the child welfare system. Using a resiliency framework, evidence from 4 randomized clinical trials that included components of the Multidimensional Treatment Foster Care program is presented. Future directions and next steps are proposed.

Teacher Ratings of Externalizing Behavior at School Entry for Boys and Girls: Similar Early Predictors and Different Correlates

In a test of Pattersons 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.

Practitioner Review: Children in foster care - vulnerabilities and evidence-based interventions that promote resilience processes.

BACKGROUND An increasing number of children are placed in foster care (i.e., a kin or nonkin family home other than the biological parent) due to experiences of physical, sexual, emotional, or psychological abuse, and/or neglect. Children in foster care are at increased risk for a host of negative outcomes encompassing emotional, behavioral, neurobiological, and social realms. METHODS Areas of risk and vulnerability among foster children are described, including emotional and behavioral deficits, impaired neurobiological development, and social relationship deficits. Evidence suggesting the significance of family placement changes and prenatal exposure to substances as contributing mechanisms is presented. Based on a systematic search of the PsycINFO database (to March 2012), eight efficacious evidence-based interventions for foster families are summarized. FINDINGS Although the development of evidence-based interventions that improve outcomes for foster children has lagged behind the delivery of interventions in other service sectors (e.g., mental health and educational sectors), several interventions across childhood and adolescence offer promise. Service system constraints offer both challenges and opportunities for more routine implementation of evidence-based interventions. CONCLUSIONS Given the increased likelihood of poor outcomes for foster children, increased efforts to understand the pathways to vulnerability and to implement interventions shown to be effective in remediating risks and improving outcomes for this population are indicated. Evaluation of efficacious interventions in countries outside of the United States is also needed.

Genetic expression outside the skin: Clues to mechanisms of Genotype × Environment interaction

The rapidly moving study of Gene x Environment interaction (G x E) needs interim conceptual tools to track progress, integrate findings, and apply this knowledge to preventive intervention. We define two closely related concepts: the social mediation of the expression of genetic influences and the interaction between the entire genotype and the social environment (G x E). G x E, the primary focus of this report, assesses individual differences in the full genotype using twin, sibling, and adoption designs and, for the most part, employs fine-grained analyses of relational processes in the social environment. In comparison, studies of Allele x Environment interaction assess the influence on development of one or more measured polymorphisms as modified by environmental factors. G x E studies build on work showing how the social environment responds to genetic influences and how genetic influences shape the social environment. Recent G x E research has yielded new insight into variations in the sensitivity of the social environment to genotypic influences and provides clues to the specificity and timing of these environmental responses that can be leveraged to inform preventive interventions aimed at reducing genetic risk for problem behavior.