Scaling Evidence-Based Interventions: Challenges, Outcomes, and Lessons Learned

Background and purpose:

Numerous studies have found that children and adolescents in foster care have relatively more and more serious behavioral and emotional problems than are found in the comparable populations who are not in care. Their psychological, social, and emotional disorders are made worse by the experience of placement instability; up to 50% of children in care disrupt within the first year of care. This instability has been shown to exacerbate mental health problems and lead to a plethora of negative long term outcomes including delinquency, drug use, and homelessness to name a few. Further, the disruption experience tends to be self-perpetuating (initial disruptions are likely to lead to further disruptions) deeming those caught in this cycle as being “hard to place”. KEEP (keeping foster and kinship parents supported and trained) was designed to break the cycle of disruption by giving foster and kinship parents the skills and confidence to handle common challenging child problems by using theoretically grounded, evidence-based parenting skills.  In this presentation we will discuss the scale-up of KEEP as part of system-wide foster parent reform efforts in New York City and Tennessee

Methods:

Pre-implementation, implementation, and sustainability methods for working to scale-up KEEP within two child welfare system-initiated foster care reform contexts will be described.  Additionally, methods for an observation-based strategy for continuous monitoring of intervention fidelity and real-time coaching will be demonstrated. 

Results:

Preliminary outcomes on placement stability and on length of stay in care will be presented along with data on intervention fidelity and change in fidelity over time.  Child/adolescent outcomes on decreases in behavioral and emotional problems will also be presented along with preliminary data on the generalization of parenting skills across children placed within KEEP-trained foster homes.  Specifically, analysis of outcome data, using a difference-in-difference framework, shows that time in care was reduced to a significant degree.

Conclusions and Implications:

KEEP can be implemented effectively given the buy-in of child welfare system leaders at the policy, administrative, and fiscal levels.  Moreover, outcomes for children improved when children are placed with KEEP trained foster parents.  Sustainability of the KEEP model absent an intense level of involvement of intervention developers has been demonstrated, making KEEP a feasible model for improving outcomes for children and adolescents in child welfare systems.