A Randomized Controlled Trial of Parent Management Training Oregon Model in Foster Care: Reunification Outcomes

Background/Purpose:

Since Maas and Engler’s (1959) seminal work on “foster care drift,” lengthy stays in foster care have been viewed as a failure of the child welfare system. Long stays in foster care are associated with reduced permanency, stability, and child well-being. As part of the federal Permanency Innovations Initiative, this study investigated whether an evidence-based parenting intervention for families of children with serious emotional disturbance (SED) would improve reunification rates, and thereby reduce foster care stays. Specifically, we asked:  Do children with SED whose families received in-home Parent Management Training Oregon model (PMTO) reunify at higher rates and experience shorter stays than children with SED whose families received foster care services-as-usual (SAU)?

 

Method:

Using a randomized consent design (Zelen, 1990), children (ages 3-16) in foster care in a Midwestern state were identified as SED within 6 months of entering foster care, and randomly assigned to PMTO (n=461) or SAU (n=457). The PMTO group received up to 6 months (M=23 weeks) of in-home PMTO with a master’s level clinician. The study’s primary data source was the state’s child welfare administrative data, which allowed an observation period of 24 to 54 months.  Using intent-to-treat (ITT) analyses, Cox regression examined whether PMTO increased reunification rates and reduced time to reunification. Follow-up Cox regression analyses compared reunification among treatment completers, treatment non-completers, and the SAU group. Finally, Kaplan-Meier models calculated median days to reunification.

Results:

Analyses of parent and child characteristics showed PMTO and SAU groups were comparable at baseline. Cox regression with ITT indicated PMTO was not significantly related to time to reunification as compared to SAU (HR=1.14, p=.14). However, follow-up analyses revealed significant differences between SAU and treatment completers (HR=1.25, p<.05). Treatment non-completers’ time to reunification was not different than SAU (HR=.91, p=.72). Further, the highest reunification rates and shortest median time to reunification were observed for the PMTO completers (67.6% reunified; Median=440 days), followed by the SAU group (53.8% reunified; Median=610 days), and PMTO non-completers (52.2% reunified; Median=679 days).

Conclusions:

Results suggest that, although PMTO was not associated with a significant effect in the ITT analyses, it was related to higher rates and shorter time to reunification among treatment completers. This study contributes to the literature on evidence-based parenting interventions in real-world foster care settings by showing that positive outcomes may be achieved with biological families of children with SED. These results are important because most prior research has supported use of parent training with a narrower age range of children, foster parents, or biological parents with custody of their children. Thus, this study extends evidence to biological parents whose children were in foster care as well as to a broad age range of children with SED. Future research should investigate whether parent training reduces re-entry into foster care (i.e., lasting permanency) as well as strategies for promoting treatment completion. The study’s findings will be discussed in regards to targeting services and developing responsive, replicable, and sustainable evidence-based interventions for a high-need population of children in foster care.