1. Glenda G. Love, M.S., M.S.W. TED - PhD
Systematic Reviews in Social Work Dr. Joanne Yaffe SW 7113 – Summer 2011 May 26, 2011
Glenda G. Love, M.S., M.S.W.
TED - PhD

2. The Cochrane Collaboration
Behavioral and Cognitive Behavioral Training Interventions for Assisting Foster Carers in the Management of Difficult Behavior
The Cochrane Collaboration

3. Turner W, Macdonald G, Dennis JA
Turner W, Macdonald G, Dennis JA. Behavioral and cognitive behavioral training interventions for assisting foster carers in the management of difficult behavior. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: XS DOI: / CD pub3.
CITATATION

4. Difficult Behavior Experiments
Toddler: Teen
Difficult Behavior Experiments

5. Are behavioral and cognitive behavioral foster parent training programs effective in managing difficult foster child behavior?
Question

6. Search Strategy CENTRAL, Cochrane Library Issue 3, 2006
MEDLINE, January 1966 – September 2006
EMBASE, January 1980 – September 2006
CINAHL, January 1982 – September 2006
PsychINFO, January 1872 – September 2006
LILACS, up to September 2006
ERIC, January 1965 – September 2006
Sociological Abstracts, January 1963 – September 2006
National Research Register, 2006 (Issue 3)
Search Strategy

7. Key Words Foster care Foster parent Foster child
Cognitive Behavioral Training (CBT)
Intervention
Placement disruption
Therapy
Foster care stability
Key Words

8. Conceptualization and Operationalization
Training (IV)
Managing Difficult Child Behaviors (DV)
Behavioral
Cognitive Behavioral
Looked-after children’s behavioral/relationship problems
Foster carers psychological well-being and functioning
Foster family functioning
Foster agency outcomes
Conceptualization and Operationalization

9. What’s the Difference? Behavioral Cognitive Behavioral
Behavioral teaching and learning tends to focus on skills that will be acquired and used later
B.F. Skinner
Operant Conditioning
Reinforcement and punishment to modify voluntary behavior
Emphasize the role of cognition as a major determinant of behavior and mood
Aaron T. Beck
Change thoughts, attitudes, beliefs and assumptions
Combine behavioral and cognitive techniques
What’s the Difference?

10. Why is this study important?
To date, no systematic review of the effectiveness of ANY foster carer training approach has been undertaken.
Why is this study important?

11. Difficult Child BehaviorDV IV
Difficult Child Behavior
Training
Variables

12. Foster Carer Training Enhancing caring attitudes and skills
Reducing behavior problems in foster children
Improving relationships between foster carers and child welfare agencies
Decreasing foster carer attrition
Training for foster parents is seen as an important factor contributing to the successful outcome of foster care placements. Foster carer training is believed to be associated with…
Foster Carer Training

13. Lack of foster parent training is associated with failed placements
Premise

14. Two Types of FP Training
SKILL
Child Development Information
Child Management Techniques
SUPPORT
Information to assist foster carers in role assimilation
Support for the functioning of the foster family
Two Types of FP Training

15. Behavioral and Cognitive Behavioral approaches fall into the “skill-based” category

16. Selection Criteria Treatment No Treatment
Random or quasi- randomized studies
Comparing behavioral or cognitive-behavioral-based training intervention
Group or one-to-one settings
No-treatment
(or) Wait-list control for foster parent/carers
Selection Criteria

17. Methods

18. Types of Studies Random allocation Quasi-random allocation
CBT-based intervention
Treatment vs. no treatment (or wait-listed)
Types of Studies

19. Types of Participants Foster parents/carers
Either single or two-parent families
Looking after children ages 0-18 years
One study had children as the unit of study or participant
Types of Participants

20. Types of Interventions
Either group or individual
Behavioral or cognitive behavioral based
(or) described the use of interventions derived from CBT
Types of Interventions

21. Theoretical Underpinnings
Operant conditioning
Negative reinforcement
Classical
Pavlovian
Social learning theory
Modeling and rehearsal
Cognitive theories
Change thinking
Theoretical Underpinnings

22. Data Collection and Analysis
Two authors independently assessed trial quality and extracted data.
Data Collection and Analysis

23. Study Demographics N=463 in 6 trials Countries 2 U.S. 1 north Wales
1 south west Wales
1 England
Scotland
Study Demographics

24. 28 excluded studies
5 studies waiting assessment
Excluded and Waiting

25. Types of outcome measures

26. “Looked after child” outcomes
Psychological functioning (depression, PTSD, etc.)
Behavior problems at home and school (truancy, absences, failures and achievements)
Interpersonal functioning (relationship with peers and foster family)
“Looked after child” outcomes

27. “Foster Carer” outcomes
Measures of skills, knowledge and attitude
Psychological functioning
Foster family functioning
Foster parent/child relationship
“Foster Carer” outcomes

28. “Fostering Agency” outcomes
Placement stability based on the number of requests for any removal
(or) completion of allocated stay, or both.
“Fostering Agency” outcomes

29. Results of Study

30. Tables Table 1 Additional methods for future updates Table 2
Baseline characteristics of foster carers
Table 3
Baseline characteristics of children in foster care
Table 4
Methodological quality of included studies
Table 5
Characteristics of studies
Table 6
Characteristics of excluded studies
Table 7
Characteristics of studies awaiting assessment
Tables

31. Data and Analyses Foster carer vs. Control Group Table 1
Child psychological functioning
Table 2
Child behavior
Table 3
Foster carer skills
Table 4
Foster carers’ psychological functioning
Table 5
Not listed
Table 6
Fostering agency outcomes
Table 7
Meta-analysis – “looked after child” psychological functioning
Table 8
Meta-analysis – foster carer skills
Data and Analyses

32. Assessment Tools within Studies
Child Behavior Checklist (CBCL)
Self-esteem Scale (SES)
Strengths and Difficulties Questionnaire (SDQ)
Reactive Attachment Disorder Scale (RAD)
Child Behavior Inventory (CBI)
Knowledge of Behavioral Principles
Parenting Scale (PS)
General Health Questionnaire (GHQ)
Placement Stability
Assessment Tools within Studies

33. There is currently little evidence about the efficacy of behavioral or cognitive behavioral training intervention for foster carers.
Conclusions of Study

34. Competing Explanations
Underpowering (too few subjects) makes for less likelihood of finding significance, or Type II errors.
Foster carers have little direct influence on children’s past traumatic experiences
Need to couple CBT with child trauma treatment and child behavior treatment
Competing Explanations

35. Implications of Study Practice
CBT types of training evaluations to date appear to have very little effect on managing difficult behaviors of “looked-after” children
Implications of Study

36. Implications of Study Research
Need for further research on training effectiveness
More sensitive outcome measures and assessments
Adequately powered studies to detect effects
Attention paid to grouping participants and according to severity/type of challenging behaviors
CBT programs may need to be longer and more intensive
On-going foster carer training
Implications of Study

37. Questions/Impressions
Study seemed to change back and forth from “managing difficult behavior” to “placement stability”
Synthesis seemed like it was too broad and the articles chosen did not seem to necessarily focus on “managing difficult child behavior”
Participants included foster children and foster parents; maybe focus on children in a different review
Not sure the title accurately describes the research synthesis (Effectiveness of CBT foster parent training in managing “difficult child behaviors”)
Some tables in review tried to fit too much info in a column, making tables difficult to read and defeating purpose of tables
Q: intention-to-treat analysis (all rated “not met”) pg. 19
Questions/Impressions

38.
Brain Storm