Pmto for Children in Foster Care with Serious Mental Health Problems: Follow-up Results from a Randomized Controlled Trial

Background/Purpose:

Parent training has been identified as a viable strategy to improve outcomes among children in foster care, particularly those with serious emotional disturbance (SED) (e.g., Barth et al., 2009). Yet, evidence is mainly established for foster parents or biological parents with custody of children, and is limited for biological parents whose children are in out-of-home care. As part of the federal Permanency Innovations Initiative, this study investigated parent training for families of children with SED in foster care. Following studies on short-term outcomes, this study investigated child and parent outcomes at follow-up (12-months post-baseline). We asked:

Do children with SED who received Parent Management Training Oregon model (PMTO) improve their social-emotional well-being at follow-up more than children with SED who receive foster care services-as-usual (SAU)?

Do parents of children with SED who received PMTO improve their parenting and caregiver function at follow-up more than parents of children with SED who receive foster care SAU?

Method:

Using a randomized consent trial (Zelen, 1990), children identified as SED were 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. Assessments were administered at baseline, 6-months, and 12-months. Child social-emotional well-being comprised child functioning, measured by the Child and Adolescent Functional Assessment Scale (CAFAS) (Hodges, 2004), and problem behaviors and social skills, measured by the Social Skills Improvement System (SSIS) (Gresham & Elliott, 1990). Parenting was measured by the five subscales of the Family Interaction Task (FIT) (encouragement, positive involvement, problem-solving, discipline, monitoring), and caregiver functioning was measured by four subscales of the North Carolina Family Assessment Scale (NCFAS) (social supports, mental health, substance use, readiness-for-reunification) (name & name, year). Using intent-to-treat analyses and multiple imputation for missing data, ANCOVA models examined the intervention’s effect on child and parent outcomes. Follow-up analyses considered dosage effects.

Results:

Analyses of child and parent characteristics showed that the study groups were comparable at baseline. Across the child outcomes, the intervention demonstrated statistically significant and small to medium effects (R² for:  functioning=.04; problem behaviors=.15; social skills=.17.). Similarly, PMTO showed small to medium effects in improvements for all but one domain of parenting (monitoring) (R² for: encouragement=.04, positive involvement=.10, problem-solving=.10, discipline=.26) and two domains of caregiver functioning (R² for: mental health=.05, substance use=.16). When dosage was considered, PMTO was effective for all child and all but one of the parent outcomes (monitoring).

Conclusions:

Combined with earlier studies, results suggest PMTO improves short and intermediate outcomes of child well-being, parenting, and caregiver functioning. These findings are important because they reflect outcomes assessed by workers (CAFAS, NCFAS), parents (SSIS), and independent raters (FIT). In addition to observing several consistent results across informants, this study adds to evidence on parent training interventions because few studies have tested their effectiveness with biological parents, especially among a broad age-range of children (ages 3-16). Additional studies are needed to further test effectiveness of parent training on distal outcomes (e.g., lasting permanency) and in other state’s foster care systems, and examine treatment completion.