Fostering Mental Health for Children in Foster Care: A Randomized Controlled Trial

Background and Purpose: The 2018 Family First Prevention Services Act calls for the use of evidence-based, trauma-informed services with youth involved in the child welfare system. While referrals to evidence-based programs (EBPs) may be increasing for families involved in the child welfare system, many of these programs were not developed or tested in real-world contexts, thereby reducing their ability to engage and retain children and families who are facing challenges across multiple systems. A systematic review of interventions for children in foster care delineated the multiple inequities in providing effective mental health services for children in care. For these reasons, many well-known EBPs aimed at reducing trauma have not been rigorously tested in foster care populations, and their ability to engage and retain youth and their caregivers in is unknown. In addition, few program have examined potential moderators of program efficacy. Fostering Healthy Futures (FHF) is a preventive intervention for preadolescent children who have experienced maltreatment and placement in out-of-home care. It consists of individualized mentoring and weekly skills groups for 30 weeks.

Methods: This study examines the program engagement and mental health outcomes of the FHF program. Participants included 426 children recently placed in out-of-home care who were randomized to intervention or control conditions. The study examined program engagement as well as FHF’s effects on key mental health outcomes measured 6-10 months post-intervention: a multi-informant (child, caregiver, teacher) index of mental health problems, youth-reported posttraumatic stress symptoms (including dissociation), youth-reported quality of life, and caregiver- and youth-reported use of mental health treatment (including psychotropic medications). Analyses then examined whether the following baseline variables moderated the impact of FHF on outcomes: gender, race/ethnicity, type of placement (foster vs kinship care), intellectual functioning, adverse childhood experiences, and mental health functioning.

Results: There were high rates of program initiation, retention, and engagement; 95% of those randomized to FHF started the program, 92% completed it, and over 85% of the mentoring visits and skills groups were attended. The FHF program demonstrated significant impact in reducing mental health symptomatology (Cohen’s ds ranging from .20-.29), especially trauma symptoms, and mental health service utilization (OR = .62). These program effects were consistent across almost all subgroups, suggesting that FHF confers benefit for diverse children.

Conclusions and Implications: Preventing the negative impact of maltreatment on children's mental health requires interventions to be contextually-sensitive, grounded in theory and research, and effective in reaching and retaining children and families. Results indicate that the FHF program is highly acceptable and engaging to diverse children and families and that it can positively impact trauma and its sequelae, thereby reducing inequity among this vulnerable population. As the child welfare system embraces new evidence-based programs and reduces structural barriers to funding and implementing innovative programming, we hope more contextually-sensitive and growth-promoting strategies to address mental health problems in vulnerable populations will be implemented.