Parenting intervention effects on reunification: A randomized trial of PMTO in foster care

Evidence-supported parenting interventions (ESPIs) have expanded into child welfare because a growing research base has demonstrated positive results among children with serious emotional and behavioral problems. Despite a clear federal policy emphasis on reunification, few randomized trials have tested ESPIs with biological families of children in foster care; even fewer studies have investigated the distal outcomes of ESPIs. The aim of the current study was to examine the effects of Parent Management Training, Oregon (PMTO) model on reunification. Children in foster care with emotional and behavioral problems were randomized to in-home PMTO (n=461) or services as usual (SAU) (n=457). Cox regression models tested whether children in the PMTO group achieved higher rates of reunification. We applied life tables data for integrals calculations to estimate days saved in foster care. Analyses were conducted as intent-totreat (ITT), and per protocol analysis (PPA). ITT results showed reunification rates were 6.9% higher for the PMTO group (62.7%) than the SAU group (55.8%) with 151 days saved per typical child. PPA indicated that intervention completion strengthened effects as PMTO completers’ reunification rates (69.5%) were 13.7% higher than the SAU group (55.8%), and were 15.3% higher than non-completers (54.2%). Days saved were also greater for completers as compared to the SAU group (299 days) and non-completers (358 days). Overall, findings suggest that an inhome parenting intervention positively affected reunification as delivered to biological parents of children and youth in foster care with serious emotional and behavioral problems. Implications and future considerations for research are discussed.U.S. Department of Health and Human Services, under grant number 90-CT-0152

A Future of Strength: The Strengths Perspective and Developing Social Workers

In the 30 years since the birth of the strengths perspective, it has experienced con- tinued celebration and been marked as a pivotal approach for promoting effective engagement with people in a variety of contexts. From parenting to leadership, human resources to education, and therapy to case management; the strengths per- spective has been studied and incorporated into professional practices both within and outside of the social work discipline (Aguinis, Gottfredson, & Joo, 2012; Lopez & Louis, 2009; Marty, Rapp, & Carlson, 2001; Sheely-Moore & Bratton, 2010). Howev- er, social workers initiated the genesis of the perspective (Rapp, 1998; Weick, Rapp, Sullivan, & Kisthardt, 1989) and, therefore, bear the mantle of the legacy, institu- tionalization, and continuation of practicing strengths-based work. Despite wide- spread adoption of the ideology of the strengths perspective, attention is needed to ensure its ongoing use and relevant application to social work. In 2018, more than 700,000 social workers were employed in the United States (Bu- reau of Labor Statistics, 2018). Job growth is steady for the profession and projected to increase by 11 percent by 2028 (Bureau of Labor Statistics, 2018). As the number of social work professionals increases, understanding and meeting the needs of developing social workers is paramount to the sustainment of strengths-based social work. The projected expansion of the profession also suggests that the methods and strategies for incorporating the strengths perspective into the education and practice of developing social work students may need rethinking. Strengths-based work is not business as usual. Saleebey (2013) explained that it is a direct departure from traditional social work practices, such as those that focus on psychopathol- ogy and deficit-driven treatment. Likewise, ensuring the passing of the torch may require a direct departure from traditional social work education. In aligning with the strengths perspective, social work professionals and educators have a respon- sibility to consciously collaborate in their efforts to assist developing social workers in establishing competencies, capabilities and confidence that will enable them to build their career upon a strengths-based foundation

“I Ran to Make a Point”: Predicting and Preventing Youth Runaway from Foster Care

Youth who run away from foster care experience danger to health and safety and increased risk of adverse child welfare outcomes. By applying a concurrent mixed-methods approach, this study aimed to develop a deeper understanding of runaway risk that used a person-centered lens and amplified youth voices. Collectively, this approach can inform service innovations to support youth placed in out-of-home care. Working with a foster care agency in Kansas, data sources comprised administrative data for youth ages 12 + in care, and interview data with 20 youth, 12 + in care. Quantitative analyses involved latent class analysis followed by multinomial logistic regression to investigate whether the population of youth in care was comprised of subpopulations with differential runaway risk and whether subpopulations would predict runaway behaviors. Qualitative analyses applied modified analytic inductive thematic analysis to explore critical life experiences that may act as risk or protective factors of running away from care. Results revealed four sub-populations which were characterized by their previous family and system experiences. Additionally, class membership, gender, number of siblings, and age were statistically significant predictors of runway behaviors. Youth interviews revealed five key themes on life experiences that mitigate or exacerbate youths’ runaway behaviors. Recommendations resulting from this study were provided in three key areas: (1) improving family visitation and maintaining youth connections with self-identified family and non-relative kin; (2) supporting service approaches for youth that honor and amplify their voices, choices, and family connections; and (3) improving placement quality and individualization of services

Predictors of foster care exits to permanency: A competing risks analysis of reunification, guardianship, and adoption

Although foster care is intended to be temporary, and policy explicitly requires permanency outcomes, many children experience lengthy stays and exit foster care without a permanent family. This study sought to identify which child and placement characteristics were important predictors of exit to three types of permanency outcomes: reunification, guardianship, and adoption. A sample of 3351 children who entered foster care in 2006 was observed for 30 to 42 months. Permanency outcomes were analyzed using competing risks survival analysis. Children exited foster care to different types of permanency at different rates and frequencies. Reunification occurred most quickly and frequently. Guardianship was second in terms of median duration but third in frequency. Adoption was the second most common exit but had the longest median duration. One in four children remained in foster care or exited without permanency. While patterns varied by type of permanency, three major categories of important predictors were identified: 1) demographic characteristics of age at entry and race, 2) clinical needs related to children's disabilities and mental health problems, and 3) continuity and connections represented by kin placements, sibling placements, early stability, and absence of runaway events. Implications for practice, policy, and research are discussed.Child welfare Foster care Permanency Reunification Guardianship Adoption

A case example of the ACYF’s Well-being framework: The Kansas Intensive Permanency Project

This series of papers, Integrating Safety, Permanency and Well-Being in Child Welfare, describes how a more fully integrated and developmentally specific approach in child welfare could improve both child and system level outcomes. The papers were developed to further the national dialogue on how to more effectively integrate an emphasis on well-being into the goal of achieving safety, permanency and well-being for every child. The third paper, A Case Example of the Administration on Children, Youth and Families’ Well-Being Framework: KIPP (Akin, Bryson, McDonald, and Wilson), presents a case study of the Kansas Intensive Permanency Project and describes how it has implemented many of the core aspects of a well-being framework. These papers are an invitation for further thinking, discussion and action regarding the integration of well-being into the work of child welfare. Rather than being a prescriptive end point, the papers build developmentally on the Administration on Children, Youth and Families’ 2012 information memorandum Promoting Social and Emotional Well-Being for Children and Youth Receiving Child Welfare Services and encourage new and innovative next steps on the journey to support healthy development and well-bein

Randomized trial of PMTO in foster care: 12-month child well-being, parenting, and caregiver functioning outcomes

Evidence-supported parenting interventions (ESPIs) increasingly are used in child welfare to improve child well-being and parenting. However, little evidence exists on the effectiveness of ESPIs with biological families of children in foster care with serious behavioral health problems. To address this gap in the literature, we examined the outcomes of in-home Parent Management Training Oregon model (PMTO). PMTO was evaluated in a randomized trial in which 918 children were assigned to PMTO or services as usual with assessment at baseline, 6 months, and 12 months. Outcome domains included child social-emotional well-being, parenting, and caregiver functioning. Our results show PMTO demonstrated linear improvements in children's social-emotional functioning, problem behaviors, and social skills. Although results for parenting were inconclusive, two of four caregiver functioning outcomes (parent mental health and readiness for reunification) were significantly improved. Overall, these findings suggest PMTO and similar ESPIs may hold promise for promoting better outcomes for biological families of children in foster care with behavioral health problems

Randomized trial of PMTO in foster care: 12-month child well-being, parenting, and caregiver functioning outcomes

Evidence-supported parenting interventions (ESPIs) increasingly are used in child welfare to improve child well-being and parenting. However, little evidence exists on the effectiveness of ESPIs with biological families of children in foster care with serious behavioral health problems. To address this gap in the literature, we examined the outcomes of in-home Parent Management Training Oregon model (PMTO). PMTO was evaluated in a randomized trial in which 918 children were assigned to PMTO or services as usual with assessment at baseline, 6 months, and 12 months. Outcome domains included child social-emotional well-being, parenting, and caregiver functioning. Our results show PMTO demonstrated linear improvements in children's social-emotional functioning, problem behaviors, and social skills. Although results for parenting were inconclusive, two of four caregiver functioning outcomes (parent mental health and readiness for reunification) were significantly improved. Overall, these findings suggest PMTO and similar ESPIs may hold promise for promoting better outcomes for biological families of children in foster care with behavioral health problems

Randomized study of PMTO in foster care: Six-month parent outcomes

Objective:  This study examined the effects of Parent Management Training, Oregon (PMTO) model on parenting effectiveness and caregiver functioning. Method:  Children in foster care with emotional and behavioral problems were randomized to PMTO (n = 461) or services as usual (n = 457) in a nonblinded study design. Using an intent-to-treat approach, analysis of covariance models tested the intervention's overall effect and time interactions for parenting and caregiver functioning. Additional analyses were conducted to identify significant predictors of outcomes. Results:  PMTO did not significantly affect parenting practices; however, positive effects were observed on caregiver functioning in mental health (odds ratio [OR] = 2.01), substance use (OR = 1.67), social supports (OR = 2.37), and readiness for reunification (OR = 1.64). While no time interactions were detected, several child, parent, and case characteristics were associated with improvements in 6-month outcomes. Conclusion:  This study extends evidence on PMTO to biological families of children in foster care, including those with older youth

Randomized trial of PMTO in foster care:12-month child well-being, parenting, and caregiver functioning outcomes

Evidence-supported parenting interventions (ESPIs) increasingly are used in child welfare to improve child well-being and parenting. However, little evidence exists on the effectiveness of ESPIs with biological families of children in foster care with serious behavioral health problems. To address this gap in the literature, we examined the outcomes of in-home Parent Management Training Oregon model (PMTO). PMTO was evaluated in a randomized trial in which 918 children were assigned to PMTO or services as usual with assessment at baseline, 6 months, and 12 months. Outcome domains included child social-emotional well-being, parenting, and caregiver functioning. Our results show PMTO demonstrated linear improvements in children's social-emotional functioning, problem behaviors, and social skills. Although results for parenting were inconclusive, two of four caregiver functioning outcomes (parent mental health and readiness for reunification) were significantly improved. Overall, these findings suggest PMTO and similar ESPIs may hold promise for promoting better outcomes for biological families of children in foster care with behavioral health problems

Randomized Trial of PMTO in Foster Care: Six-Month Child Well-Being Outcomes

Objective: This study tested the effectiveness of Parent Management Training, Oregon (PMTO) model on child social–emotional well-being. Methods: Using a randomized controlled design and three measures of social–emotional well-being, the study investigated effectiveness of PMTO with families of children in foster care with serious emotional disturbance (SED). Participants included children (3–16 years) and parents who were randomly assigned to PMTO (n = 461) or services as usual (n = 457). Study condition was known to participants and assessors. Six months after baseline, analysis of covariance models examined the intervention’s overall effect and time interactions using intent-to-treat analysis. Follow-up analyses identified salient predictors of well-being. Results: PMTO demonstrated small but significant positive effects on three primary outcomes: social–emotional functioning (Cohen’s d = .31), problem behaviors (Cohen’s d = .09), and prosocial skills (Cohen’s d = .09). Conclusion: Results suggest that PMTO was effective at improving short-term social–emotional well-being in a high-risk population of children with SED