Research That Matters (January 17 - 20, 2008)

Purpose: Youth with a history of maltreatment and foster care placement are at risk for a host of mental health, behavioral, and social problems, resulting in adverse life-course outcomes of great public health significance. Fostering Healthy Futures (FHF) is a NIMH-funded RCT of an innovative preventive intervention designed to promote prosocial development, and to reduce problem behaviors, for 9-11-year-old children who have been maltreated and placed in out-of-home care.

Methods: Through a 9-month intervention that includes screening assessments, one-on-one mentoring, and skills groups, FHF targets cognitive, social and behavioral domains in order to build competencies, improve mental health functioning and quality of life, and reduce problem behaviors (e.g. delinquency, substance use, sexual risk behaviors, self-destructive behaviors) and adverse life-course outcomes (e.g. arrests, school dropout, restrictive placements). The intervention consists of 3 components: 1) evaluations of children's functioning, including a screen for mental health, cognitive, and academic problems, 2) one-on-one mentoring/advocacy, and 3) weekly therapeutic skills groups implemented over a 9-month period. All eligible children receive the evaluation and subsequently half of the children are randomized to the intensive intervention. Mentoring/advocacy is provided by graduate students in social work who meet weekly for 3-4 hours with their mentees and interface with other important adult influences in the children's lives (e.g. parents, therapists). They work to ensure that youth receive appropriate services in all domains and serve as support for youth as they face challenges within various systems. Building on youths' strengths, mentors help them identify and engage in meaningful extracurricular activities intended to promote their self-esteem, help foster their association with prosocial peers and adults, and augment their future orientation. Therapeutic skills groups are implemented over 30 weeks and combine traditional cognitive-behavioral skill group activities with process-oriented material. Participants are assessed at baseline, post-intervention and at 6-month follow-up, using reports from youth, their foster parents, biological parents, and teachers.

Results: In this paper we will present: 1) a basic overview of the FHF program, focusing on how the program was specifically designed to meet the needs of preadolescent youth in foster care; 2) program feasibility and uptake, including recruitment and retention rates (currently 92% and 94% respectively), 3) participant characteristics, including demographic information, cognitive functioning, academic achievement, and mental health functioning; and, 4) preliminary quantitative outcomes. The FHF pilot study has demonstrated positive preliminary effects on youths' social functioning, attitudes, coping skills, behavioral regulation, and extracurricular involvement (ds from .23-1.17). It has also demonstrated positive effects on more distal outcomes, including problem behaviors, competencies, number of restrictive placements, and life satisfaction (ds from .23-.88).

Implications: FHF has demonstrated positive preliminary effects in a range of areas with a high-risk population for whom there are few evidence-based interventions. The goal of this research is to design more efficacious interventions, thereby reducing disability, morbidity, and mortality, not only for youth in foster care, but for all high-risk youth.