Cognitive-behavioural training interventions for assisting foster carers in the management of difficult behaviour - PubMed (original) (raw)

Meta-Analysis

Cognitive-behavioural training interventions for assisting foster carers in the management of difficult behaviour

W Turner et al. Cochrane Database Syst Rev. 2007.

Abstract

Background: The provision of training for foster carers is now seen as an important factor contributing to the successful outcome of foster care placements. Since the late 1960s, foster carer training programs have proliferated, and few of the many published and unpublished training curricula have been systematically assessed and evaluated. The advent of cognitive-behavioural therapy (CBT) and the research evidence demonstrating its effectiveness as a psychotherapeutic treatment of choice, has prompted many working in the social care field to devise CBT-based training programmes. CBT approaches to foster care training derive from a 'skill-based' training format that also seeks to identify and correct problematic thinking patterns that are associated with dysfunctional behaviour by changing and/or challenging maladaptive thoughts and beliefs.

Objectives: To assess the effectiveness of cognitive-behavioural training interventions in improving a) looked-after children's behavioural/relationship problems, b) foster carers' psychological well-being and functioning, c) foster family functioning, d) foster agency outcomes.

Search strategy: We searched databases including: CENTRAL (Cochrane Library Issue 3, 2006), MEDLINE (January 1966 to September 2006), EMBASE (January 1980 to April 2004), CINAHL (January 1982 to April 2004), PsycINFO (January 1872 to April 2004), ASSIA (January 1987 to April 2004), LILACS (up to April 2004), ERIC (January 1965 to April 2004), Sociological Abstracts (January 1963 to April 2004), and the National Research Register 2004 (Issue 3). We contacted experts in the field concerning current research.

Selection criteria: All studies in which participants were foster parents/carers, and who were allocated by random or quasi-random methods to a CBT-based training intervention (in a group and/or one-to-one settings) versus a no-treatment or wait-list control, were selected.

Data collection and analysis: Data from the six eligible trials (total n = 463 ) were extracted and entered into RevMan. Results were synthesised and presented in both graphical (forest plots) and narrative form (where insufficient data were provided for effect size computations).

Main results: Training interventions evaluated to date appear to have very little effect on outcomes relating to looked-after children, assessed in relation to psychological functioning, extent of behavioural problems and interpersonal functioning. Results relating to foster carer(s) outcomes also show no evidence of effectiveness in measures of behavioural management skills, attitudes and psychological functioning. Analysis pertaining to fostering agency outcomes did not show any significant results.

Authors' conclusions: There is currently little evidence about the efficacy of CBT-based training intervention for foster carers. The need for further research in this area is highlighted.

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Conflict of interest statement

Two of the review authors (WT and GM) have undertaken a randomised controlled trial in the area of CBT for foster carers in the southwest of England (UK) (Macdonald 2004; Macdonald 2005).

Figures

1.1

1.1. Analysis

Comparison 1 Foster carer training vs. Control Group (Child psychological functioning), Outcome 1 Child Behaviour Checklist (CBCL‐ Externalising Scores).

1.2

1.2. Analysis

Comparison 1 Foster carer training vs. Control Group (Child psychological functioning), Outcome 2 Child Behaviour Checklist (CBCL‐ Internalising Scores).

1.3

1.3. Analysis

Comparison 1 Foster carer training vs. Control Group (Child psychological functioning), Outcome 3 Child Behaviour Checklist (CBCL‐Total Scores).

1.4

1.4. Analysis

Comparison 1 Foster carer training vs. Control Group (Child psychological functioning), Outcome 4 Self‐esteem (children).

1.5

1.5. Analysis

Comparison 1 Foster carer training vs. Control Group (Child psychological functioning), Outcome 5 Strengths & Difficulties Questionnaire (SDQ‐ completed by foster carers).

1.6

1.6. Analysis

Comparison 1 Foster carer training vs. Control Group (Child psychological functioning), Outcome 6 Strengths & Difficulties Questionnaire (SDQ‐completed by teachers).

1.7

1.7. Analysis

Comparison 1 Foster carer training vs. Control Group (Child psychological functioning), Outcome 7 Strengths & Difficulties Questionnaire (SDQ ‐ completed by foster children).

1.8

1.8. Analysis

Comparison 1 Foster carer training vs. Control Group (Child psychological functioning), Outcome 8 Strengths & Difficulties Questionnaire (ProSocial Scores).

1.9

1.9. Analysis

Comparison 1 Foster carer training vs. Control Group (Child psychological functioning), Outcome 9 Strengths & Difficulties Questionnaire (Total Scores).

1.10

1.10. Analysis

Comparison 1 Foster carer training vs. Control Group (Child psychological functioning), Outcome 10 Reactive Attachment Disorder Scale (RAD‐post training).

1.11

1.11. Analysis

Comparison 1 Foster carer training vs. Control Group (Child psychological functioning), Outcome 11 Reactive Attachment Disorder (RAD‐ 9 months post‐training).

2.1

2.1. Analysis

Comparison 2 Foster carer training vs. Control Group (Child behaviour), Outcome 1 Eyberg Child Behavior Inventory (ECBI‐Problem).

2.2

2.2. Analysis

Comparison 2 Foster carer training vs. Control Group (Child behaviour), Outcome 2 Eyberg Child Behaviour Inventory (ECBI‐Intensity).

3.1

3.1. Analysis

Comparison 3 Foster carer training vs. Control Group (Foster carer skills), Outcome 1 Knowledge of Behavioral Principles (KBPAC).

3.2

3.2. Analysis

Comparison 3 Foster carer training vs. Control Group (Foster carer skills), Outcome 2 Use of behavioural strategies.

3.3

3.3. Analysis

Comparison 3 Foster carer training vs. Control Group (Foster carer skills), Outcome 3 Parenting Scale (PS).

4.1

4.1. Analysis

Comparison 4 Foster carer training vs. Control Group (Foster carers' psychological functioning), Outcome 1 General Health Questionnaire (GHQ).

6.1

6.1. Analysis

Comparison 6 Foster carer Training vs. Control Group (Fostering agency outcomes), Outcome 1 Placement Stability (assessed post‐training).

6.2

6.2. Analysis

Comparison 6 Foster carer Training vs. Control Group (Fostering agency outcomes), Outcome 2 Placement stability (assessed 6 months after training).

7.1

7.1. Analysis

Comparison 7 Meta‐analysis ‐ looked‐after child psychological functioning, Outcome 1 Training participants assessment ( post training).

7.2

7.2. Analysis

Comparison 7 Meta‐analysis ‐ looked‐after child psychological functioning, Outcome 2 Training participants assessment (6‐9 month post training).

8.1

8.1. Analysis

Comparison 8 Meta‐analysis ‐ foster carers skills, Outcome 1 Various measures of skills & knowledge.

Update of

References

References to studies included in this review

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