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Efficacy of a Flemish foster parent intervention for foster children aged 3 to 12 with externalizing problems


Aim. Several international studies have shown that many foster children (25 to 60%; Vanschoonlandt, Vanderfaeillie, Van Holen, De Maeyer, & Robberechts 2013) have externalizing problems. These externalizing problems are a risk for the success of the foster placement. They are the most important predictor of a breakdown (Oosterman, Schuengel, Slot, Bullens, & Doreleijers 2007) and are associated with more parenting stress and less effective parenting behavior in foster parents (Vanderfaeillie, Van Holen, Trogh, & Andries 2012). It is, therefore, important to prevent such negative consequences of foster children's externalizing problems. The aim of this study was to evaluate if a foster parent intervention, for foster children aged 3 to 12, is efficacious in reducing breakdowns, foster children's behavioral problems, and foster mothers' parenting stress and in altering foster mothers' parenting behavior.

Internationally, roughly two approaches can be distinguished regarding the development of foster parent interventions. On the one hand, parent training programs, which have proven to be efficacious in a general population (i.e., evidence-based programs), have been implemented in foster care. Usually these interventions are evaluated in methodologically sound evaluation studies, but the effects are often disappointing (Turner, Macdonald, & Dennis 2007). On the other hand, interventions, especially developed for foster parents, have been implemented, taking the specific needs of foster children (mainly from an attachment perspective) into account. Such interventions are often positively evaluated by foster parents, but there is a lack of methodologically sound research concerning the efficacy of these interventions. Since both approaches have their strengths and could complement each other, both were integrated in the development of the Flemish foster parent intervention (Vanschoonlandt, Vanderfaeillie, Van Holen, & De Maeyer 2012).

The theoretically sound social interaction perspective on the development of children's externalizing problems was the core theoretical basis of the intervention. For a further elaboration of how these skills should be addressed, research about key ingredients of effective interventions was consulted. In addition, literature on the specific needs of foster children (from an attachment perspective) was reviewed to adjust the foster parent intervention to these specific needs. The intervention is offered by an experienced and specially trained foster care worker (i.e., the trainer) who offers the intervention in addition to the regular casework by the regular foster care worker. The intervention starts with a joint intake with the trainer, the foster care worker, and the foster parents. Next, the trainer works individually with the foster parents during eight home visits. During these home visits several mandatory modules (positive involvement, praising, structure, effective commands, reward program, effective limit setting, avoiding problems, solving problems, autonomy & monitoring, and a look at the future), as well as some facultative modules (ignoring, logic consequence/loss of privilege, avoiding escalations, and evaluating own parenting behavior) are discussed. During this individual trajectory, also three monthly group sessions are organized. The intervention takes about three and a half months and ends with a joint session, where the foster care worker is present again, aiming at giving him an overview of what has changed in the foster family during the intervention. As a follow-up, a group session is organized one month after this final individual session.

Method. The efficacy of this foster parent intervention (with respect to breakdown, foster children's behavioral problems, and foster parents' parenting stress and parenting behavior) was evaluated in a randomized controlled trial. Sixty-three foster families were allocated to an intervention (n = 30) or control group (i.e., care-as-usual; n = 33). The treatment integrity in the intervention group was assessed using self-reports of the trainers. Moreover, foster mothers' self-report questionnaires were administered at T0 (before the start of the intervention) and T1 (at the end of the intervention; 3.5 months after T0). This questionnaire consisted of a Child Behavior Checklist (Cbcl) to measure foster children's behavioral problems and local standardized measures for parenting stress (Nijmegen Questionnaire for the Parenting Situation) and parenting behavior (Ghent Parental Behavior Scale). To examine group differences in change from pretest to posttest, Ancovas were used for the different outcome variables (T1-data) with the T0-data as covariate. Also the effect sizes for the different outcome variables were calculated.

Findings. An evaluation of the treatment integrity showed that the intervention was implemented as intended. Only the group sessions seemed difficult to organize. Results showed that the intervention was efficacious. Whereas no breakdowns occurred in the intervention group, three foster children in the control group experienced a (temporary) breakdown because of their behavioral problems. The Ancovas showed significant (p < .05) results for foster mothers' parenting stress (which decreased more in the intervention group), foster mothers' use of positive parenting (which increased more in the intervention group) and harsh punishment (which decreased in the intervention group and increased in the control group). The analyses of effect sizes showed medium effects on these domains (d = .52 to .54). The effects on foster children's behavioral problems were not statistically significant. An analysis of the effect sizes, did, however, show small (d = .26) to medium (d = .45) effects for foster children's externalizing and internalizing problems.

Conclusions. This study showed that it was feasible to implement a foster parent intervention for foster children, aged 3 to 12, with externalizing problems in Flanders. Offering the intervention by an experienced foster care worker, in addition to the regular casework, seemed a useful approach for recruiting foster parents. Moreover, the intervention had positive short-term effects on foster children's behavioral problems and foster mothers' parenting stress and parenting behavior and might be useful to prevent breakdown for these foster children. Probably the intensity of the foster parent intervention and the sound theoretical base of the intervention were responsible for the satisfying results. Although more research is needed concerning the long-term effects, and mediating, and moderating variables, this study already showed that a foster parent intervention might be an efficacious way to promote the effectiveness of foster care for children with externalizing problems. Moreover, an adaptation of evidence-based programs to the specific needs of foster children and foster parents might be a successful approach in the development of a foster parent intervention.

Key references

Oosterman, M., Schuengel, C., Slot, W.N., Bullens, R.A.R. and Doreleijers, T.A.H. (2007). Disruptions in foster care: A review and meta-analysis. Children and Youth Services Review, 29, 53-76.

Turner, W., Macdonald, G. and Dennis, J.A. (2007). Behavioural and cognitive behavioural training interventions for assisting foster carers in the management of difficult behaviour. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD003760.pub3.

Vanderfaeillie, J., Van Holen, F., Trogh, L. and Andries, C. (2012). The impact of foster children's behavioural problems on Flemish foster mothers' parenting behaviour. Child and Family Social Work, 17, 34-42.

Vanschoonlandt, F., Vanderfaeillie, J., Van Holen, F. and De Maeyer, S. (2012). Development of an intervention for foster parents of young foster children with externalizing behavior: Theoretical basis and program description. Clinical Child and Family Psychology Review, 15, 330-344.

Vanschoonlandt, F., Vanderfaeillie, J., Van Holen, F., De Maeyer, S. and Robberechts, M. (2013). Externalizing problems in young foster children: Prevalence rates, predictors and service use. Children and Youth Services Review, 35, 716-724.

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