Behavioral Interventions for Foster Youth: A Systematic Review

Background and Purpose: Approximately 500,000 children live in foster care on a given day. Many of these children and youth have behavior problems that may contribute to placement instability (Newton, Litrownik & Landsverk, 2000), which is associated with negative mental health outcomes (James, Landsverk, Slymen & Leslie, 2004). Interventions targeting negative externalizing behaviors have been developed but it is currently unclear which of these is most effective. This review examines the characteristics of these interventions to answer the following research questions: 1) What types of interventions are used to decrease negative behaviors for youth (ages 2-17) in foster care? 2) Are interventions that target caregivers more effective than those that directly target the child? 3) Does the length of the intervention improve the effectiveness?

Methods: A systematic review of peer-reviewed journals in seven databases was conducted with the publication dates limited to 2006-2011. Studies had to be conducted in the United States or Western Europe and include a comparison group of youth in foster care. The methodological quality of studies was assessed as described in the conference abstract. Outcomes were compared across studies accounting for methodological quality. The primary outcome was improvement in child behaviors measured by standardized instruments.

Results: The search of the electronic databases and review for inclusion criteria produced a total of 14 interventions. Nine of the interventions focused on the caretaker; five targeted the child directly. Thirteen of the studies measured child behavior; ten found a statistically significant improvement on at least one measure. Six studies measured the caretaker's behavior, and two had statistically significant results. Of the interventions with high methodological rigor and a significant improvement in behavior, five of the seven targeted caretakers. The interventions varied in length and were grouped into three categories: less than two months, two-four months, more than four months. Interventions that lasted longer than two months (n=10) generally had stronger results than those that lasted less than two months. Interventions between two and four months in length were more likely to be targeted at foster parents and were just as effective as those longer than four months, which included some interventions which included some targeted at youth. Only one intervention less than two months demonstrated a significant improvement in child behavior.

Conclusions and implications: This review found that interventions that targeted the caretaker or the child demonstrated significant improvement in foster youth's behavior. Promising interventions for foster parents can be implemented in a relatively short period of time without tremendous expenditure of resources. Feasibility is particularly important in the child welfare system and an enhanced training program for foster parents may be a more efficient use of resources than a lengthy one-on-one mentoring program for teens. This review had limitations that reduced the generalizability of the interventions.