Treatment Implementation and Parenting Practices in Treatment Foster Care

Background and Purpose: Community-based and home-based interventions, which are often multi-focal and have active ingredients that include a wide range of factors, create complexities for assessing intervention implementation/fidelity and outcomes. Treatment Foster Care (TFC) is an example of such an intervention. It is often viewed as a behaviorally-oriented adult-directed intervention. However, TFC contains many elements and may target a wide range of parenting behaviors along with more narrowly focused behavioral principles to improve youth outcomes.  This study investigates the multifaceted nature of the treatment parent (TP) role, exploring the treatment practices and parenting behaviors used by TPs and how these may systematically vary by characteristics of treatment parents and youth.  

Methods: Data come from a larger study of Together Facing the Challenge (TFTC), an empirically-supported approach to TFC (Farmer, et al., 2010). The study sample included 247 youth and their TPs in a southeastern state. Current data come from baseline interviews with TPs (before intervention).  Data include measures of implementation of behavioral interventions (e.g., effective consequences, consistency of praise and consequences) and parenting practices (e.g., quality of adult-child relationship, supervision, perspective taking/empathy building, communication, conflict, joint activities, etc.). Youth had a mean age of 13 years (s.d., 3.8), 45% were female, 57% were African American. Treatment parents’ age ranged from 22-77 (mean=48) years. Ninety percent of primary care providers were female, 59% were married, 67% had education beyond high school (19% were college graduates), and 74% were African American.

Results:  Data show tremendous variation in treatment and parenting practices employed by TPs. Treatment parents’ self-views showed that 34% viewed themselves primarily as a “parent” while only 2% viewed themselves primarily as a treatment professional. Results suggest that both child and TP factors were related to the treatment and parenting practices used in the home. For example, child’s age (older) was related to less time together, decreased positive affect by the TP, and less consistent use of both praise and consistent consequences.  African American TPs were more likely to view themselves primarily as parents than as professionals. This sense of the parental role was, in turn, positively related to TP’s likelihood of using perspective-taking skills and of having positive affect with the youth. Married TPs showed a range of differences: more time with the youth, less conflict, fewer communication difficulties, and more consistent use of both praise and consequences than TPs who were not married.

Conclusions and Implications: TFC parents play complex roles as both parent substitutes and front-line treatment providers. Results from this study suggest that TP’s self-views of their roles vary considerably, and that these differences are related to different approaches in working with youth. They also suggest that the treatment and parenting practices used by TPs vary by youth characteristics, demographic factors, and marital status. These results suggest the need to include a broad range of factors in studies that examine intervention implementation and outcomes. They also suggest that recognizing different styles/approaches may be critical to tailor interventions and trainings to various youth and treatment families.