Current status and evidence base of training for foster and treatment foster parents☆
Introduction
Child welfare services in the United States serve over 500,000 youth in out-of-home care at any point in time (AFCARS, 2005). The majority of these youth are served via some form of foster care. Youth who enter foster care are likely to have experienced some form of child abuse or neglect and/or other traumatic events (e.g., domestic violence, impaired caregiver, traumatic loss) (Hazen et al., 2004, Henry et al., 1991). It is well known that youth in foster care display a wide range and depth of behavioral, developmental, social, and educational problems (e.g., Farmer et al., 2001, Clausen et al., 1998, Sawyer and Dubowitz, 1994, Smucker et al., 1996).
Given the severity of foster children's trauma histories and resulting difficulties, it seems apparent that individuals who are becoming foster parents should receive solid training in the range of domains that will be necessary to successfully ‘parent’ these children during the time they reside in foster care. Such a position has a long history of wide endorsement and support (Christensen and Fine, 1979, Galaway et al., 1995, Ruff et al., 1990, Runyan and Fullerton, 1981). A recent study using data from Caring for Children in Child Welfare, a supplemental study to the National Survey of Child and Adolescent Well-being (NSCAW) designed to evaluate the impact of child welfare, Medicaid, state Child Health Insurance Plans (CHIP) programs and policies on service use indicates that there is tremendous variation in the training that foster parents receive (Hurlburt, Leslie, Barth, & Landsverk, in press).
In a recent companion article (Barth et al., 2005), we reviewed the evidence base for parent-training interventions that are currently being used or have potential to be used with families who come into contact with child welfare agencies because of allegations of abuse/neglect. This review identified a range of parent training approaches with varying levels of ‘evidence’ (Chambless and Ollendick, 2001, Hoagwood, 2003, Kratochwill and Stoiber, 2002). This review also pointed out the strong disjuncture between training for ‘biological’ parents and ‘substitute’ parents. Few of the identified approaches in the parent-training review had any evidence base with foster or substitute parents. Only in the last 3 years have any of the identified approaches (i.e., Parent–Child Interaction Therapy, The Incredible Years) been the subject of empirical investigation with a focus on foster parents (Linares et al., 2006, McNeil et al., 2005). Aside from these recent investigations, a search of training programs for foster parents identified a distinct set of training programs developed specifically for foster parents. Therefore, the current review and evaluation examines training specifically for foster parents.
Section snippets
Dimensions for examining foster parent training
The initial review of parent training focused specifically on interventions designed to help parents involved with child welfare develop increased competence in parenting maltreated children. This required efforts to understand how parent training fit within the child welfare services context, which includes consideration of information about case management and legal processes, as well as the usual training on dyadic care for children. As such, it quickly became evident that a review of
Note about foster care and treatment foster care
Foster care, as traditionally viewed, is an element of child welfare services that involves placement of a child in a substitute home environment when the child's parents are unable or unwilling to provide appropriate care. Foster care is intended to be a time-limited placement on the way to determining one of the following three permanency plan options: reunification with the biological parent, conversion of the foster home to a legally-permanent guardianship or adoption, or placement of the
Legal requirements
William Grimm (2003), from the National Center for Youth Law, recently published a thorough review of the legal requirements and status of foster parent training throughout the nation. Support for the general idea of foster parent training is contained in federal policy via the Foster Care Independence Act of 1999 (H.R. 3443). This legislation states that “before a child in foster care…is placed with prospective foster parents, the prospective foster parents will be prepared adequately with the
Professional standards
At present, professional standards for foster parent training have been operationalized via training curricula developed by professional organizations in the area of child welfare. Two curricula—Model Approach to Partnerships in Parenting Group Preparation and Selection of Foster and/or Adoptive Families (MAPP/GPS) and Foster Parent Resources for Information, Development, and Education (PRIDE)—are widely used and viewed as ‘gold standards’ for the field. MAPP, the older of the two, was
Professional standards for treatment foster care
In 1995 (updated in 2004) the Foster Family-Based Treatment Association (FFTA) published a set of Program Standards for Treatment Foster Care (Foster Family-Based Treatment Association, 1995, Foster Family-Based Treatment Association, 2004). These standards were developed via a series of meetings among directors and developers of leading programs in Treatment Foster Care. The Standards specify a wide range of dimensions, with Standards categorized into three broad areas: Standards related to
General dimensions of foster parent and treatment foster parent training
All of this focus on required training hours often ignores the central question of “training about what?” Given the complex roles that foster parents and treatment foster parents are asked to play (Rhodes et al., 2003, Wells and D'Angelo, 1994, Wells et al., 2004), it is not surprising that training often addresses a wide array of topics, and that different training approaches differentially emphasize these domains.
As will be shown in the review of the evidence base below, there are a wide
Evidence base for foster parent and treatment foster parent training
Training for foster parents is currently mandated by federal law and supported by state statutes in nearly all states. A recent review, however, suggested substantial problems with the current status of training (Grimm, 2003). As noted above, approximately half of the states have mandated use of one of the two leading training curricula for foster parents—MAPP or PRIDE. Before it is possible to more fully understand and evaluate the adequacy of current training, a review of the empirical base
Training for treatment foster care
There is currently little data on training for treatment foster parents. As noted above, the majority of ‘evidence’ for treatment foster care comes from Chamberlain's group. Data from this body of work shows that treatment foster parents adhere to a distinct paradigm of treatment and implement treatment that is substantially different than that in other treatment placements (i.e., group homes; Chamberlain, Ray, & Moore, 1996). As noted above, Chamberlain's MTFC model includes both preliminary
Conclusions
At present, there is remarkably little empirical evidence for the type of training that foster parents receive. MAPP and PRIDE, the two most widely used training curricula, have virtually no empirical support. A variety of other training curricula, approaches, and concepts have been evaluated. Many of these appear to have some pretest–posttest impact, but few have employed a rigorous research design, sufficient sample size, or a wide range of outcome measures. Much of the research was conducted
Current activities and future directions
This lack of an empirical foundation, coupled with concerns about the quality of care for youth in out-of-home placements, and strongly held beliefs about the importance of foster parent training (from advocates, policy makers, and providers), have come together to encourage a range of current activities to advance knowledge about effective training for foster and treatment foster parents.
Some of the most positive findings for foster parent training as a vehicle for improving outcomes for youth
Discussion
There is widespread rhetorical and philosophical support for providing training to foster parents, but little empirical support for the utility of the most common programs provided. Current policy in nearly every state requires that foster parents receive pre-service training and most states require some ongoing in-service training. In approximately half of the states, a specific curriculum is specified by statute, and nearly all specified programs are MAPP or PRIDE. The evidence base for both
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National training and development curriculum training program impact on placement, permanency, and stability
2024, Child Abuse and NeglectFrequency of family mealtimes in foster and kinship families
2023, Children and Youth Services ReviewTrajectories of adolescent psychopathology among youth who were maltreated and placed in out-of-home care
2022, Child Abuse and NeglectProximal outcomes of Connecting, an evidence-based, family-focused prevention program for caregivers of adolescents in foster care
2021, Children and Youth Services ReviewBetter outcomes for children in treatment foster care through improved stakeholder training and increased parent-school collaboration
2020, Children and Youth Services ReviewAssessing caregiver usability of the National Training and Development Curriculum for Foster and Adoptive Parents
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The authors were members of the Child and Adolescent Intervention Research Network (CAIRN: R24 MH067377 ), which is a collaborative effort between the Child and Adolescent Services Research Group (CASRC) at Children's Hospital-San Diego; the Oregon Social Learning Center; the University of North Carolina, School of Social Work; the Services Effectiveness Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; the Department of Psychiatry at the University of Pittsburgh; and the Children's Research Institute at Ohio State University. The work was also supported by a grant from NIMH (Farmer, MH57448).