Parenting Children Who Have Experienced Trauma, Grief and Loss: An Evaluation of Pathways to Permanence 2

Background: When children are removed from their families because they cannot safely live at home, they experience trauma, grief, and loss. It is essential that caregivers are prepared to care for these children in order to have a positive impact on placement stability and permanency outcomes. The National Quality Improvement Center for Adoption and Guardianship Support and Preservation collaborated with the Texas Department of Family Protective Services to test Pathways to Permanence 2 (“Pathways 2”), a seven session (21-hour) group-delivered interactive series that helps caregivers understand the impact of trauma and loss on child development.

Methods: A quasi-experimental design was used to evaluate the effectiveness of Pathways in one region of Texas. The sample included children in foster care in one region of Texas who did not have a permanency hearing scheduled within 60 days. Caregivers were asked to commit to the program and in return, were provided child care, meals and stipends for attendance. Caregivers were surveyed at two time points, once before participating in Pathways and again six months after completing Pathways. Additionally, a survey was distributed to families in a separate region to serve as the comparison group. Using administrative data, propensity score matching was used to control for significant differences at baseline between the intervention and comparison groups on total placements, living arrangement, and a child’s age. Paired sample t-tests were used examine differences in caregiver knowledge of grief and loss, child behavior problems, and caregiver strain within the intervention group (pre to post) and between the intervention group and matched comparison group.

Results:

A total of 85 families (110 caregivers) attended at least five sessions of Pathways 2 and completed the pre and post survey. A total of 79 of these families were matched to 79 of 117 (68%) comparison group families using administrative data; however, significant factors including child behavior and caregiver strain could not be controlled for at baseline.

Overall, caregivers who participated in Pathways 2 had a better understanding of grief and loss compared to the matched caregivers who received services as usual, t(74)=6.32, p<.001. Pathways 2 caregivers were more likely to agree that: loss is a part of life for children who do not live with their birth parents; children lose a part of their identity through adoption and permanence; and, children have lifelong connections to both their birth families and permanent families. Pathways 2 caregivers also significantly increased their own understanding of grief and loss from pre to post, t(102)=5.66, p<0.001.

Conclusion: Pathways 2 provided caregivers with a foundation to understand trauma, grief, and loss and empowered caregivers with new tools to help them parent their children in a way that addresses impaired-attachments and trauma. Further implementation and evaluation of this intervention is needed.