Non-Completion of Evidence-Based Parent Training: An Empirical Examination Among Families of Children in Foster Care

Purpose:  This study examines the reasons for and the obstacles related to treatment non-completion of an evidence-based parenting intervention for families of children in foster care. Despite growing recognition for practices that promote parental engagement (Kemp, Marcenko, Lyons & Kruzich, 2013), child welfare has historically experienced high dropout rates, ranging from 33% to 80% (Damashek, Doughty, Ware & Silovsky, 2011). Additionally, new evidence-based interventions (EBIs) are spreading into the field of child welfare, but they could fall short of achieving successful outcomes if treatment attrition is high. Needed also is research that tests that EBIs imported from other fields, such as mental health, are useful and effective in new settings and with different target populations (Testa & White, 2014). Although recognized as a problem, little information exists about the specific barriers to treatment completion experienced by families involved in the child welfare system and newly implemented EBIs. This study sought to build understanding about differences between completers and non-completers and the reasons for non-completion.

 Method:  The project setting was a statewide demonstration project funded under the federal Permanency Innovations Initiative which sought to reduce long-term foster care. This project site tested the Parent Management Training, Oregon Model (PMTO). The study sample comprised 283 families who were randomly assigned to the treatment condition. At the time of assignment, children met criteria for serious emotional disturbance and had been in foster care for fewer than 6 months. After consenting to services, families received a 6-month in-home parent training intervention from a Master’s level practitioner. Researchers collected and analyzed the practitioners’ summary of treatment discharge to examine reasons for and obstacles related to non-completion of an evidence-based parenting intervention. Analysis involved categorizing all reasons for treatment non-completion and verification of the analysis by practitioners. Additionally, bivariate analysis compared demographic and case characteristics between the families who did not complete the intervention (n=86) and those who did complete it (n=197). 

 Results:  About one-third (30.4%) of the families did not complete the parent training intervention.  Analyses revealed that approximately half of the families dropped out due to non-engagement reasons (e.g., no-shows, cancellations, not returning calls). Other reasons for non-completion included a poor fit between the families’ context and needs, and the intervention (e.g., required time commitment, parent’s work schedule, mismatched goals). The most common and formidable challenges for families to complete the intervention were parental substance abuse and parental mental illness. Furthermore, no significant differences were found on the demographic and case characteristics among completers and non-completers.

 Conclusion: This study contributes to the current knowledge by describing the reasons for and the barriers related to non-completion. It offers a real-world view on the complexities that contribute toward some families’ non-completion of treatment. Implications are discussed for enhancing parental participation and engagement in interventions offered by child welfare.