Child Welfare

Children’s Stability and Well-Being Study (CSAW): Evaluating an Evidence-based Intervention Project

Official Title: The Children's Stability & Well-Being Study: An Evaluation of a Therapeutic Parenting Intervention for Caregivers of Children in Foster Care
Research Lead: David M. Rubin, M.D., M.S.C.E.
Study Team: Susan Dougherty, Ph.D., Joanne Wood, M.D., M.S.H.P., Denise Actie, M.S.W., Sarah Zlotnik, M.S.W., M.S.P.H., Marsha Gerdes, Ph.D.
Supported by: Annie E. Casey Foundation
Dates: January 2009-December 2012

Background

Many children in foster care have significant mental health issues. However, they often do not receive adequate behavioral health services. Moreover, the training foster parents receive often does not do enough to help caregivers feel prepared for managing children with significantly challenging behaviors or complex trauma histories. As a result, children in foster care may frequently change placement due to caregiver stress and placement disruption. The child welfare system needs to provide more promising evidence-based therapeutic interventions and training programs that can address the behavioral health needs of children in foster care and support foster parents and caseworkers.

Aims

• Develop and test two evidence-based caregiver interventions in two selected foster care agencies in Philadelphia.
  
  • Child Adult Relationship Enhancement (CARE)—a six hour group training module provided to all kinship and foster caregivers and agency caseworker
  • Parent Child Interaction Therapy (PCIT) –a 12-20 session intensive mental health intervention provided to caregiver-child dyads at risk for placement disruption related to reported child behavior problems and/or associated caregiver stress
• Demonstrate that the evidence-based parenting interventions achieve the following:
  • Reduce behavior problems in foster children
  • Mitigate foster parent stress
  • Decrease placement moves due to behavioral problems
  • Decrease the need for moves to treatment foster care
  • Use the train-the-trainer model and develop a sustainable intervention.

Methods

Study type: Four-year pilot intervention study
Participants: Approximately 100 children ages 2-8 years in foster or kinship care placements within two foster care agencies in Philadelphia

Progress

The initial planning phase is complete, and the project intervention has been launched. Two lead clinicians have been hired via a mental health agency selected for collaboration on this project. These clinicians are collocated on-site at the two participating foster care agencies to provide easier access to care. To date, all staff within the foster care units at each of these foster care agencies have completed CARE trainings and caregiver trainings are currently underway.

Policy Focus

To improve access to evidence-based mental health services for children in the child welfare system by:

• Collocating mental health services within the child welfare system
• Addressing barriers of consent for mental health services for children in the foster care system
• Creating sustainable mechanisms for billing of evidence-based mental health services
• Streamlining the referral process for mental health services for children in the child welfare system
• Delivering evidence-based mental health services with high fidelity and organizational support in an urban community-based setting

Additional Resources

• National Children Trauma Stress Network (November 2010). http://www.nctsn.org/nccts/nav.do?pid=hom_main
• PCIT International (2010). http://www.pcit.org/