A Randomized Effectiveness Trial of Evidence-Based Parent Training for Children with Serious Mental Health Problems: Six Month Child Well-Being Outcomes

Background/Purpose:

Child emotional and behavioral problems are known to poorly influence outcomes of children in foster care, such as placement stability and permanency (e.g., Chamberlain et al, 2006). In recent years, the child welfare field has expanded services to include interventions that might address the concerns of this subpopulation. As part of a federal demonstration to improve outcomes of targeted groups of children who experience the most serious barriers to permanency, this study tested an evidence-based parent training intervention for families of children with serious emotional disturbance (SED). Specifically, we evaluated: Do children with SED who received in-home Parent Management Training Oregon model (PMTO) improve their social-emotional well-being at six-months more than children with SED who receive usual foster care services?

Method:

Using a pretest-posttest randomized consent trial (Zelen, 1990), children identified as SED within six months of entering foster care were randomly assigned to PMTO (N=461) or to a services-as-usual comparison group (N=457). Intervention group families received up to 6 months (M=23 weeks) of in-home PMTO with a master’s level clinician. Child social-emotional well-being comprised three constructs (functioning, problem behaviors, social skills) that were measured by the Child and Adolescent Functional Assessment Scale (CAFAS) (Hodges, 2004) and the Social Skills Improvement System (SSIS) (Gresham & Elliott, 1990) at baseline and 6-month post-baseline. All analyses were conducted as intent-to-treat; multiple imputation was used for missing data; and, effect sizes were calculated. ANCOVA models examined the intervention’s overall effect and time interactions. Additionally, follow-up analyses (conditional and moderated ANCOVAs) identified salient predictors of social-emotional well-being.

Results:

Comparability of study groups was established by showing that child and parent characteristics and social-emotional functioning were similar at baseline (p=.23). Across all three outcomes, the intervention demonstrated small but significant positive effects (Cohen’s d for functioning=.31; problem behaviors=.17; social skills=.19). Tests of time interactions indicated that changes in social-emotional functioning (but not problem behaviors or social skills) were significantly greater across time for the intervention group (Δβ=.15). Secondary analyses revealed several predictors of social-emotional well-being while controlling for baseline assessments and treatment condition. Statistically significant predictors included: a) for higher functioning: younger parent age and placement stability; b) for fewer problem behaviors: older child age, being white, being non-Latino, and placement stability; c) for more social skills: younger parent age, being white, and no prior foster care removals.

Conclusions:

Results suggest that in-home PMTO was associated with improvements in short-term social-emotional well-being among children with SED. Overall, the intervention positively influenced functioning, problem behaviors, and social skills at six months post-baseline. In addition to these positive main effects, our findings point to characteristics that may diminish treatment effects. This study adds to a growing literature on whether evidence-based parenting interventions are effective in real-world foster care settings. Future research must also consider long-term outcomes (e.g., lasting permanency). The study’s findings will be discussed within the context of the need for targeting services to children most at-risk of long-term foster care and developing responsive, replicable, and sustainable evidence-based interventions for this high-need population of children.