Does Age Matter for Reentry after Reunification? a Ten-Year Longitudinal Exploration from an RCT on Pmto for Families of Children in Foster Care

Background: Scholars have found children’s quicker reunification from foster care has been associated with higher rates of foster care reentry. Evidence supported interventions (ESPIs) in child welfare are more commonly being used; however, there approaches must balance prioritizing timely reunification with lowering reentry rates over time. While reunification is a goal, the use of ESPIs with biological families in child welfare settings is not common; in addition, we have even less information about how child developmental stage may alter reentry risk over time. Our 10-year longitudinal study seeks to understand distal outcomes of reunification stability with consideration for developmental effects among a group of families who participated in a randomized controlled study of the Parent Management Training-Oregon (PMTO) Model and experienced successful reunification.

Method: This study design involved a randomized controlled trial. Children, ages 3 to 16 at baseline, and their biological families were enrolled in the study within 6 months of entering foster care over a two-year period (September 2012-September 2014) in a midwestern state. The original study enrolled 918 children (PMTO, n = 461; SAU, n = 457). Of these, 542 children reunified with their biological families. We used administrative data over 10 years to identify reentry risk for this population of families where children were reunified. Data were analyzed with Stata 17.0. The effect of PMTO on reentry was examined through Cox regression models using intent to treat (ITT) and per protocol analyses (PPA). To investigate developmental effects, we conducted additional analyses where we stratified by age groups aligning with variation in intervention content.

Results: We observed no statistically significant effects using the ITT approach when the data was stratified by two age groups: (a) children ages 3 to 11 years and (b) children 12 to 17 years. PPA Models for children 12-17 years at baseline indicates PMTO non-completers had a significantly higher foster care re-entry hazard rate (HR = 2.98, 95% CI [1.30, 6.15], p = .008) and the SAU comparison group also had significantly higher foster care re-entry hazard rate (HR = 2.84, 95% CI [1.31, 6.15], p = .008) when compared to PMTO completers. In contrast, we did not observe any differences between groups for children who were 3 to 11 years old at baseline.

Implications: These findings suggest ESPIs, such as PMTO, may have promising outcomes for lowering risk of reentry into foster care for adolescent populations, specifically, when biological parents complete the intervention protocol. Future research should explore what specific developmental factors contribute to stable reunification for children 12 and older. For example, PMTO includes the use of contingent rewards for desired behavior, which speaks to the functional development of the midbrain reward system in adolescence may be primed to be responsive to reward-guided habits. Additionally, PMTO includes a focus on positive parental involvement and problem solving to decrease conflict between adolescents and their caregivers while supporting the parent in supporting autonomy and resilience of their teenage children.