Holding a foster child’s mind in mind: study protocol for a cluster-randomized controlled trial of mentalization-based therapy (MBT) for foster families

BACKGROUND: Children in foster care are psychologically vulnerable and show more social, developmental, and behavioral problems than those living with their family of origin. Many foster parents struggle to care for these children, some of whom have experienced severe adversity. Research and theory suggest that developing a strong and supportive foster parent-child relationship is essential for foster children to become more well-adjusted and experience a decrease in behavioral problems and emotional maladjustment. Mentalization-based therapy (MBT) for foster families aims at increasing the reflective functioning of the foster parents, thus promoting the development of more secure and less disorganized child attachment representations, which is subsequently proposed as a factor that reduces behavioral problems and emotional maladjustment in children and promotes their overall well-being. METHODS: This is a prospective cluster-randomized controlled trial with two conditions: (1) the intervention group participating in MBT, and (2) the control group who receive usual care. Participants are 175 foster families with at least one foster child aged 4-17 years with emotional or behavioral problems. The intervention will be offered to foster families by 46 foster care consultants from 10 municipalities in Denmark. The foster care consultants will be randomized to MBT training (n = 23) or usual care (n = 23). The primary outcome is the psychosocial adjustment of the foster child measured by the Child Behavior Checklist (CBCL) as reported by foster parents. Secondary outcomes include child well-being, parental stress, parent mental health, parent reflective function and mind-mindedness, parent/child relations, child attachment representations, and placement breakdown. In order to explore implementation fidelity as well as practitioner experiences, we will administer questionnaires designed for this study and conduct qualitative research exploring the practice of the MBT therapists. DISCUSSION: This trial is the first experimental study of a family therapeutic intervention based on attachment theory for foster families within the Scandinavian context. This project will contribute with novel knowledge on attachment representations in foster children and the effects of an attachment-based intervention on essential outcomes for foster families and children. Trial registration ClinicalTrials.gov NCT05196724. Registered on January 19, 2022

Developing an Intervention to Enhance Parental Monitoring in Family Foster Care

Purpose: To fulfill their supervision and counseling responsibilities to foster parents, social workers need an effective way to indirectly monitor foster children's mental health and learning ability within a model of tripartite parenthood. This article describes how we are developing an intervention aimed at enhancing parental monitoring as a protective factor in family foster care. Methods: Focusing on the initial parts of Fraser et al.'s stepwise model for intervention development and drawing on ongoing research, we describe the main challenges faced in developing a program theory of parental monitoring. Results: The product is a manual that can transform the agenda of counseling meetings based on the following pre-requisites: appropriate standardized instruments, a common digital platform, training social workers, and being responsive to municipal differences. Conclusion: Our experience thus far allows us to be cautiously optimistic about strengthening parental monitoring in family foster care