Stable Reunification: Long-Term Follow-up on a Randomized Study of a Parenting Intervention for Families of Children with Emotional and Behavioral Problems

Background/Purpose:

Family reunification is a preferred permanency goal for the vast majority of children entering foster care, and the target of most parenting interventions. While parenting interventions have shown positive effects on reunification rates (e.g., Brook, et al., 2012), few prospective and longitudinal studies are available to test whether these effects are sustained to prevent reentry. As an original site of the federal Permanency Innovations Initiative, this long-term follow-up study examined whether an evidence-based parenting intervention for families of children with serious emotional disturbance (SED) would improve stable reunification rates. Specifically, we asked: Do children with SED whose families reunified after receiving in-home Parent Management Training Oregon model (PMTO) experience more stable reunification (i.e., no reentry) than children with SED whose families received foster care services-as-usual (SAU)?

Methods:

Using a randomized consent design (Zelen, 1990), parents and their children (ages 3-16) were randomly assigned to PMTO (n=461) or SAU (n=457) after children were identified as SED and within 6 months of entering foster care. This study’s sample comprised families who reunified within 4-1/2 years (PMTO n=290; SAU n=255). Data on reentry were collected from the state’s child welfare administrative data, allowing observation for 2-1/2 to 7 years after reunification. Median days to reentry was estimated by Kaplan-Meier models. Next, Cox regression examined whether PMTO influenced reentry rates under intent-to-treat (ITT) analyses. Additional Cox regression analyses compared reentry among PMTO completers, PMTO non-completers, and the SAU group.

Results:

Among the study’s 545 children, 21.4% of PMTO group and 23.1% of SAU group reentered foster care within 7 years of reunification. ITT analyses indicated that PMTO was not significantly related to reentry as compared to SAU (HR=1.11, p=.573). However, follow-up analyses revealed reentry was significantly lower for PMTO completers (20.6%) compared to PMTO non-completers (22.7%) and SAU group (23.1%). As compared to completers, the odds of reentry were 3 times greater for non-completers (HR=3.01, p=.009) and more than 2 times greater for those receiving SAU (HR=2.28, p=.022). Further, the shortest time to reentry was estimated for the non-completers (M=1,778 days; SE=100.5), followed by the SAU group (M=1,918 days SE=63.7), and PMTO completers (M=1,921=days; SE=62.6).

Conclusions:

ITT results suggest that stable reunification did not differ significantly among families who reunified after PMTO and SAU. Additional analyses also showed reentry was significantly lower among PMTO completers. This study contributes to a larger body of literature on evidence-based parenting interventions, pointing to positive and lasting outcomes with birth families of children with SED. Importantly, the shorter time to reunification for PMTO families did not increase reentry rates. Given the modest but important difference in reentry rates for treatment completers, more research is needed to develop and test strategies that increase treatment completion and promote stable reunification. The study’s findings will be discussed, considering how services may be structured to enhance treatment completion for high-need populations of children in foster care and policies may support responsive, replicable, and sustainable interventions in real world child welfare settings.