The effectiveness of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) for young children with severe behavioral disturbances: study protocol for a randomized controlled trial (original) (raw)
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Journal of Child and Family Studies, 2017
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 quasiexperimental 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.
Application of Evidence-Based Therapies to Children in Foster Care: A Survey of Program Developers
2013
In New York City specifically, Lyons (2001) conducted a survey of the health and mental health needs of foster care children to address concerns about the adequacy of mental health interventions for children in this population. Lyons found that nearly one third of a sample drawn from New York City Administration for Children’s Services (New York City’s child protection services) was classified as having serious emotional disorders compared with 15% in the general population. Lyons also found that 74% of children living in kinship foster care, 73% of children living in regular foster family homes, and 88% of children living in congregate care had diagnosable emotional-behavioral problems. There is no doubt that foster care children in general and in New York City specifically are at high risk for current and long-term mental health problems. These high rates of mental health problems are understood in the context of the multiple risk factors associated with foster care placement. The...
Psychosocial Treatment of Children in Foster Care: A Review
Community Mental Health Journal, 2005
A substantial number of children in foster care exhibit psychiatric difficulties. Recent epidemiological and historical trends in foster care, clinical findings about the adjustment of children in foster care, and adult outcomes are reviewed, followed by a description of current approaches to treatment and extant empirical support. Available interventions for these children can be categorized as either symptom-focused or systemic, with empirical support for specific methods ranging from scant to substantial. Even with treatment, behavioral and emotional problems often persist into adulthood, resulting in poor functional outcomes. We suggest that self-regulation may be an important mediating factor in the appearance of emotional and behavioral disturbance in these children.
The Effectiveness of Individualized and Rehabilitative Therapies for Children in Foster Care
2017
The Effectiveness of Individualized and Rehabilitative Therapies for Children in Foster Care by Alma Pozo-Breen MS, Walden University, 2007 BS, Loma Linda University, 1998 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Counseling Psychology Walden University December 2017 Abstract Children placed in foster care face considerable stress and trauma related to being removed from their homes and subsequently living in a new environment. They may exhibit severe disruptive or antisocial behavior as a consequence. Clinicians and researchers often have not considered that these behaviors may be due to children’s underdeveloped cognitive control and response. Treatment approaches that offer more holistic perspectives on stress and the inclusion of individual and specialized therapies may help foster children to better control their responses and return to their biological families sooner. The purpose of this study was to focus on whet...
Journal of Social Issues, 2006
Children who enter foster care have usually experienced maltreatment as well as disruptions in relationships with primary caregivers. These children are at risk for a host of problematic outcomes. However, there are few evidence-based interventions that target foster children. This article presents preliminary data testing the effectiveness of an intervention, Attachment and Biobehavioral Catch-up, to target relationship formation in young children in the foster care system. Children were randomly assigned to the experimental intervention that was designed to enhance regulatory capabilities or to a control intervention. In both conditions, the foster parents received in-home training for 10 weekly sessions. Post-intervention measures were collected 1 month following the completion of the training. Outcome measures included children's diurnal production of cortisol (a stress hormone), and parent report of children's problem behaviors. Children in the experimental intervention group had lower cortisol values than children in the control interven-Q1 tion. Also, the experimental intervention parents reported fewer behavior problems . She studies the challenges facing young foster children and children who have been maltreated.
Children and Youth Services Review, 2014
Of 1 million cases of child maltreatment identified every year in the United States, one-fifth result in foster care. Many of these children suffer from significant emotional and behavioral conditions. Decision-makers must allocate highly constrained budgets to serve these children. Recent evidence suggests that Multidimensional Treatment Foster Care for Preschoolers can reduce negative outcomes for these children, but the relative benefits and costs of the program have not been evaluated. The objective of this study was to assess net benefit, over 24 months, of Multidimensional Treatment Foster Care for Preschoolers compared to regular foster care. Data were from a randomized controlled trial of 117 young children entering a new foster placement. A subsample exhibited placement instability (n = 52). Intervention services including parent training, lasted 9-12 months. Multidimensional Treatment Foster Care for Preschoolers significantly increased permanent placements for the placement instability sample. Average total cost for the new intervention sample was significantly less than for regular foster care
Predictors of treatment use among foster mothers in an attachment-based intervention program
Attachment & Human Development, 2012
The current study examined predictors of treatment use among 56 foster mothers who participated in an attachment-based intervention program for foster infants. Foster mothers' levels of treatment use were coded at early, middle, and late phases of the intervention program. Foster mothers' states of mind with regard to attachment predicted their understanding of the intervention session concepts. Specifically, autonomous foster mothers showed higher levels of understanding at the start of the intervention program, when compared with non-autonomous foster mothers. State of mind with regard to attachment also predicted foster mothers' levels of reflective functioning during the intervention sessions. Autonomous foster mothers showed higher levels of reflective functioning at early, middle, and late stages of the intervention program, when compared with non-autonomous foster mothers. The relevance of these findings for both treatment effectiveness and treatment delivery is discussed.
Longitudinal Therapeutic Outcomes for Foster Youth; Emotional Development and Symptomology
Compared to non-foster youth, children in foster care are at higher risk for emotional developmental delay and mental health problems due to their traumatic experiences. Foster youth not only experience severe maltreatment, but also face disruption and discontinuity while in foster care. Few studies research the impact of long-term therapeutic intervention, especially with the foster youth. We examined the impact of pro bono, long-term psychotherapy on emotional delay and psychiatric symptoms with foster children during three to four years of treatment. Annual semi-structured telephone interviews, with therapists about their foster youth patients, were conducted regarding therapists’ and patients’ demographics, patients’ emotional development, and psychiatric symptomologies. Therapists (n = 10) were predominately female (100%), White (90%), middle-aged (M = 52.8 years; SD = 10.1) psychologists (40%) or marriage and family therapists (40%) who had an average of 8.3 years (SD = 6.7) of licensed clinical experience. They reported on patients (n = 10) were predominately female (70%), Multiple Ethnicities (40%) or White (30%), school-aged (M = 9.0 years; SD = 5.5) foster youth who were in treatment on average for (M = 3.0) years; SD = .39). Therapists’ reports of psychological symptoms and emotional development were analyzed using repeated measures ANOVA. Across three years of treatment, therapists’ ratings showed significant reductions in anxiety, sleep problems, eating problems, violence/aggression, and relationship problems with family of origin. Of the ten, four patients terminated treatment and experienced additional significant reductions in depression, dissociative symptoms, and peer relationship problems. There was no significant change in emotional development. Additional exploratory analysis examined patterns in symptom reduction across treatment. Initial results showed treatment regressions between year two and three in symptoms including but not limited to depression, anxiety, and suicidality followed by improvements at exit in all but one symptom. This study highlights the complexity of treatment with children who have been exposed to multiple traumas. Despite limitations including small sample size, the potential for therapist reporting bias, and lack of comparison group and standardized measures, findings support the use of long-term psychotherapy. Future studies should address these limitations as well as include foster patient perspectives. Keywords: child maltreatment, foster youth, emotional development, psychiatric symptoms, long-term relationship-based psychotherapy