Group-Based Foster Parent Training and Support Programs: A Meta-Analytic Review of the Evidence

Background: High rates of externalizing behavior problems present a risk for placement instability, negative academic outcomes, and increased mental health service needs for the more than a quarter-million children who enter foster care annually. However, the is little, if any, evidence  to suggest that the most widely used caregiver-training programs—such as MAPP/GPS and PRIDE—significantly reduce child problem behaviors or improve placement stability. In response, researchers have called for the increased use of evidence-based parent training and support programs in child welfare that can help foster and kin caregivers (caregivers) manage tough behaviors and promote placement stability.

Method: The current study is a systematic literature review and meta-analysis of the evidence-base for manualized, multisession foster and kinship caregiver training interventions targeting improvements in externalizing child behaviors. Two researchers independently extracted the data. Disagreements were resolved by consensus or by consulting a third party. The effect size measures (d_ppc2) for individual studies were estimated using pre and post means and standard deviations for the intervention and control or comparison groups. The individual study results were synthesized to estimate a total effect size.

Results: The final sample for the qualitative synthesis included 11 articles published between 2007 and 2016, seven of which contained sufficient information to be included in the meta-analysis. The studies included in this review evaluated four intervention models including the Incredible Years, Project KEEP, Middle School Success program and Cognitive Behavioral Parent training. All of the models drew from behavioral and social learning theories and were delivered in a group format.

All studies with comparison or control groups (n=9) saw a reduction in either reported child behaviors or behavior intensity favoring the treatment group. Similarly, all of the studies using a single group design (n=2) saw a reduction in either reported behaviors or behavior intensity. The quantitative synthesis (n=7) identified a significant small to medium total average effect size on externalizing child behaviors (ES_random = -.403, 95% CI = [-.523, -.282]). No studies reported an increase in child problem behaviors for the treatment group. In addition, among the groups that analyzed three or more measurement points, the treatment effect was maintained at follow-up.

Conclusion: Results from the current study support the findings from previous reviews that  group-based caregiver training programs are an effective method for reducing child problem behaviors. The analyses identified a small to medium effect on externalizing problem behaviors across the ethnically and nationally diverse samples represented in this review. There is evidence that the programs produce similar results for older and younger children as well as boys and girls. It is unclear whether the intervention effects on externalizing behavior are sustained over longer periods. Overall, the evidence suggests that group-based caregiver training is an effective method for reducing problem behaviors among children in out of home care. The studies reviewed here present manualized and replicable interventions designed to improve the level of training provided to caregivers and the level of care provided to the young people served by the foster care system.