CASCADING DISSEMINATION OF A FOSTER PARENT INTERVENTION

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Children in the foster care system are growing in number, are at high risk for psychological problems, and are increasingly challenging to their foster parents. Foster parents who are trying to provide care and nurturing to these children are often doing so without benefit of meaningful or relevant consultation on developmental and mental health issues. The proposed study would test the effectiveness of an intervention intended to increase supports and consultation to foster parents. A major aim of this study is to test the transferability of the proposed intervention from Oregon to the foster care system in San Diego in six regions of Health and Human Services. A cascading dissemination model is proposed where, the original developers will train and supervise staff in San Diego to implement the intervention, and in the second iteration of the implementation, the involvement of the original developers will lessen. The intervention is designed to provide foster parents with general support and specific parent management training (PMT), a well- documented and effective intervention approach. PMT has been shown to produce positive outcomes in numerous clinical trials with diverse populations of youngsters from preschoolers to adolescents. In addition, in a previous efficacy trial, PMT had positive effects with foster parents in three areas: (1) reduction of child symptoms, (2) lower rates of disruptions in foster care (changes in placements for negative reasons), and (3) fewer foster parents in the PMT condition dropped out of providing foster care. Outcomes will be evaluated at multiple levels, including child symptoms, functional behavior, environments, consumer perspectives, and system using a multi- method/multi-agent strategy. Implementation fidelity will be assessed, as will contextual factors, including the organizational climate and social isolation/insularity of the foster parents. It is hypothesized that, compared to controls, foster parents in the intervention group will improve on parenting skills, feel more supported, and have less stress which will in turn result in more positive child outcomes, including fewer reported child symptoms and higher levels of child functional behavior in three domains (i.e, home, school, with peers). Improvements in foster parent outcomes and child outcomes are both hypothesized to predict system-level outcomes, including child use of mental health services, foster parent retention, and placement disruptions. Contextual factors are expected to impact foster parent outcomes directly and child and system outcomes indirectly, through implementation fidelity.