Does Pmto Moderate the Change of Child and Family Functioning within Families with Children in Foster Care with Serious Mental Health Problems: A Latent Profile Transition Analysis

Background

Children in foster care with serious emotional disturbance (SED) are at high risk of staying in long-term foster care (Becci, Bryson, McDonald, & Walker, 2012). As part of the federal Permanency Innovation Initiative, a Midwestern state implemented Parent Management Training-Oregon Model (PMTO) for families of children with SED placed in foster care. The intervention demonstrated statistically significant but small effects in changing child’s problem behaviors (PB), social skills (SS) and parenting practices (Becci, Lang, McDonald, Yan & Little, 2016; Becci et al., 2017). It is hypothesized that families with different family and child characteristics react to PMTO in different ways. This study examined the change among families at different levels of child and family functioning (C&FF) through the intervention. We asked:

Is there any difference in changing C&FF over time for PMTO families, compared with families who receive foster care services-as-usual (SAU)? If so, how does PMTO families change?

Method:

The sample consists of 918 families with children identified a SED and placed in foster care in the state. These families were randomly assigned to PMTO (n=461) or SAU (N=457; Zelen, 1990). The Child and Adolescent Functional Assessment Scale, Social Skills Improvement System, and the North Carolina Family Assessment Scale were administered at baseline and 6 months. A 3-step Latent Profile Transition Analysis (LPTA) examined the moderation effect of PMTO vs. SAU on C&FF changes across time (Asparouhov & Muthen, 2013).

Results:

Model fit indices showed that four- and six-class models accurately represent class membership at intake and 6-month follow-up respectively. Classes that measure different C&FF are defined as followed: 1) At intake, Class-1 (n=159) with low child functioning (CF), and low readiness for family reunification; Class-2 (n=276) with low CF but high child SS, and low family functioning (FF); Class-3 (n=150) with low CF but high FF; Class-4 (n=331) with high CF, and relatively high FF.

2) At 6-month follow-up, Class-1 (n=113) with high CF but low child SS, and high FF; Class-2 (n=96) with low CF but high child SS, and low FF; Class-3 (n=127) with medium CF and low FF; Class-4 (n=193) with low CF, but low problem behavior (PB), and low FF; Class-5 (n=208) with high CF, and high FF; and, Class-6 (n=179) with high CF and high FF.

Results of the final step of LPTA showed that PMTO participants in Class-2 at T1 are more likely to enter Class-2 at T2 than SAU counterparts. PMTO participants in Class-3 at T1 are less likely to enter Class-3 at T2 than SAU counterparts. PMTO participants in Class-1 and Class-4 at intake are more likely to move to Class-5 and Class-6 at T2, than SAU counterparts.   

Conclusions:

This study demonstrates the effectiveness of PMTO in helping high C&FF families or families with low CF, but high FF move to/stay in high functioning classes. However, results did not support PMTO in supporting families with low C&FF to improve. Well-designed family assessment tools are needed to identify the families for whom PMTO best addresses their needs.