Elsevier

Child Abuse & Neglect

Volume 38, Issue 9, September 2014, Pages 1508-1520
Child Abuse & Neglect

Engaging foster parents in treatment: A randomized trial of supplementing Trauma-focused Cognitive Behavioral Therapy with evidence-based engagement strategies

https://doi.org/10.1016/j.chiabu.2014.03.020Get rights and content

Abstract

The goal of this study was to examine the impact of supplementing Trauma-focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2006) with evidence-based engagement strategies on foster parent and foster youth engagement in treatment, given challenges engaging foster parents in treatment. A randomized controlled trial of TF-CBT standard delivery compared to TF-CBT plus evidence-based engagement strategies was conducted with 47 children and adolescents in foster care and one of their foster parents. Attendance, engagement, and clinical outcomes were assessed 1 month into treatment, end of treatment, and 3 months post-treatment. Youth and foster parents who received TF-CBT plus evidence-based engagement strategies were more likely to be retained in treatment through four sessions and were less likely to drop out of treatment prematurely. The engagement strategies did not appear to have an effect on the number of canceled or no-show sessions or on treatment satisfaction. Clinical outcomes did not differ by study condition, but exploratory analyses suggest that youth had significant improvements with treatment. Strategies that specifically target engagement may hold promise for increasing access to evidence-based treatments and for increasing likelihood of treatment completion.

Section snippets

Study overview

Data come from a small-scale RCT of standard delivery TF-CBT compared to TF-CBT plus evidence-based engagement strategies. The study was conducted in a large metropolitan area in Washington (WA) State between 2008 and 2011. Institutional Review Board approval was obtained from the Washington State IRB.

Child and adolescent participants

Participants were 47 children and adolescents between the ages of 6 and 15 and one of their foster parents (see Table 1). Foster parents included traditional foster parents (i.e., non-relative),

Preliminary analyses

The study involves nested data (i.e., time within clients, clients within therapists, therapists within agencies). To examine the impact of nesting, we examined intraclass correlation coefficients (ICCs) at the therapist and agency levels, both of which were very low (.0001–.0009) for all major outcomes by parent and child report. Additionally, comparisons of model goodness-of-fit among two- (i.e., without therapist or agency effects), three-, and four-level models were not statistically

Discussion

In this small study, a brief engagement intervention made a significant difference in improving treatment retention and completion for children and their foster parents involved in TF-CBT. Those who received the engagement intervention were significantly more likely to receive an active dose of TF-CBT (i.e., attend four or more sessions) and were less likely to have a premature treatment exit. Across the two conditions, however, no differences were found in attendance at the first scheduled

Acknowledgements

We thank the study therapists for their dedication to serving children and families in Washington State and willingness to participate in this collaboration. We also thank Elizabeth M.Z. Farmer for her mentorship and advisement on the project and Kate L. Conover and Julia Revillion Cox for their assistance with study implementation.

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    This publication was made possible by funding from grant number R34 MH079910 (Dorsey, PI), awarded from the National Institute of Mental Health (NIMH).

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