Community Implementation of KEEP: Fidelity & Generalization of Parenting Effects

KEEP 的社区实施：Fidelity

• 批准号: 8081740
• 负责人: JOSEPH Michael PRICE
• 金额: $ 63.65万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-07-24 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8081740
• 关键词: Address; Adherence; Adoption; Advocate; Age; Biological; Caregivers; Caring; Child; Child Behavior; Child Welfare; Communities; Contractor; County; Diffusion; Dimensions; Discipline; Educational Curriculum; Educational Intervention; Effectiveness; Ensure; Evidence based intervention; Family; Fostering; Funding; Future; Generations; Goals; Group Meetings; Group Processes; Health; Health Personnel; Home environment; Household; Human; Human Resources; Intervention; Intervention Studies; Investigation; Lead; Learning; Measures; Mediating; Mediator of activation protein; Mental Health; Mental Health Services; Modeling; National Institute of Mental Health; Nature; Outcome; Parenting behavior; Parents; Phase; Population; Preparation; Price; Problem behavior; Provider; Psychological reinforcement; Psychopathology; Randomized; Recording of previous events; Research; Resources; Risk; Schools; Services; Siblings; Stress; Supervision; System; Testing; Time; Training; Training Support; Youth; base; behavior change; care systems; child mental health service; community setting; cost; design; effectiveness trial; externalizing behavior; follow-up; foster care; foster home; foster parent; group intervention; implementation trial; intervention effect; programs; public health priorities; public health relevance; response; skills; social

DESCRIPTION (provided by applicant): This proposal is a continuation of an NIMH funded study entitled the Cascading Dissemination of a Foster Parent Intervention (MH60195, Patti Chamberlain, PI). Designed as a modified version of Multidimensional Treatment Foster Care (MTFC), the intervention (entitled Keep - Keeping Foster Parents Trained and Supported) focused on reducing the behavior problems of children between the ages of 5 to 12 who are in regular foster care. The results of this effectiveness trial revealed that the intervention was effective in reducing levels of child behavior problems, increasing parental use targeted parenting strategies, increasing the number of positive exits from the home (e.g., reunifications with biological parents, adoptions), and mitigating placement disruptions (e.g., removing a child at the request of a foster parent) for children with a history of multiple placements changes. As a result, the Child Welfare Services division of the San Diego County Health and Human Services Agency (HHSA) began implementation of the KEEP intervention through a private mental health services contractor (Social Advocates for Youth San Diego - SAY). The primary goal of the current proposal is to utilize this opportunity as a real-world platform for addressing three key questions that need to be answered prior to wide-scale implementation of the KEEP intervention. First, do the effects of the KEEP parent training generalize (concurrently) to other children currently in foster and kin intervention homes and lead to reductions in overall levels of behavior problems? Second, does the KEEP intervention continue to have effects after the completion of the intervention and generalize (temporally) to new children who enter the homes of these families at a later point in time? Finally, as the KEEP intervention is being implemented by a community agency in a real-world system of care, can the intervention be delivered and maintained in a manner that preserves the goals and quality of the intervention? Children in foster care, between the ages of 5 and 12 will be randomly assigned to one of two conditions - the KEEP intervention or a "services as usual" condition. In the KEEP intervention condition, foster and kin caregivers will participate in 16 weekly group meetings. Outcomes to be assessed include child problem behavior (of the focal child and other children in the household), child functioning, parental stress, family functioning, use of mental health services, child placement changes (e.g., reunification with biological parents, move to another foster home), and foster parent retention rates. In addition, for a year following the completion of the intervention, new children entering the home of foster/kin caregiver will be included in the assessments, along with the impact of these additional children on parental stress and family functioning. Finally, several dimensions of intervention fidelity (e.g., facilitator adherence and group engagement) will be assessed and examined in relation to child, family, and system outcomes. PUBLIC HEALTH RELEVANCE: Project Narrative Implementation of evidence-based interventions into community settings has become a public health priority. The primary goal of the proposed study is to examine the fidelity and generalization of parenting effects of the KEEP foster parent training intervention as it is being delivered within a child welfare system of care by a community mental health provider. The KEEP intervention is designed to reduce child behavior problems, decrease the need for mental health services, and reduce placement disruptions among children in foster care. The findings from this investigation have the potential to contribute to preparation for wide scale implementation of the KEEP intervention and have the potential to influence the mental health needs of children in foster care both within and outside the San Diego region.

描述（由申请人提供）：本提案是NIMH资助的题为寄养父母干预的级联传播研究（MH 60195，Patti Chamberlain，PI）的延续。作为多层面治疗寄养（MTFC）的修改版本，干预措施（题为保持-保持寄养父母的培训和支持）的重点是减少5至12岁的儿童的行为问题，谁是定期寄养。这项有效性试验的结果表明，干预措施在降低儿童行为问题水平、增加父母使用有针对性的育儿策略、增加积极离开家庭的数量（例如，与亲生父母团聚，收养），以及减轻安置中断（例如，应养父母的要求将儿童带走），用于有多次安置变化历史的儿童。因此，圣地亚哥县卫生和公众服务局儿童福利服务处开始通过一家私人精神卫生服务承包商（圣地亚哥青年社会倡导者）实施“保持”干预措施。当前提案的主要目标是利用这一机会作为一个现实世界的平台，解决在大规模实施KEEP干预措施之前需要回答的三个关键问题。首先，KEEP家长培训的效果是否（同时）推广到目前在寄养和亲属干预家庭的其他儿童，并导致行为问题的总体水平下降？第二，KEEP干预在干预完成后是否继续产生影响，并（暂时）推广到后来进入这些家庭的新儿童？最后，由于KEEP干预措施是由社区机构在现实世界的护理系统中实施的，干预措施能否以保持干预措施的目标和质量的方式提供和维持？5至12岁的寄养儿童将被随机分配到两个条件之一-KEEP干预或“照常服务”条件。在KEEP干预条件下，寄养家庭和亲属照顾者将参加16次每周小组会议。评估的结果包括儿童问题行为（焦点儿童和家庭中其他儿童的问题行为）、儿童功能、父母压力、家庭功能、心理健康服务的使用、儿童安置变化（例如，与亲生父母团聚，搬到另一个寄养家庭）和养父母保留率。此外，在干预措施完成后的一年内，进入寄养/亲属照料者家庭的新儿童将被纳入评估，沿着这些额外儿童对父母压力和家庭功能的影响。最后，干预保真度的几个方面（例如，辅导员的依从性和小组参与）将根据儿童、家庭和系统的结果进行评估和检查。 公共卫生关系：在社区环境中实施循证干预措施已成为公共卫生的优先事项。拟议的研究的主要目标是研究的保真度和泛化的养育效果的保持养父母培训干预，因为它是由社区精神卫生服务提供者提供的儿童福利系统内的照顾。KEEP干预旨在减少儿童行为问题，减少对心理健康服务的需求，并减少寄养儿童的安置中断。这项调查的结果有可能有助于准备大规模实施KEEP干预措施，并有可能影响圣地亚哥地区内外寄养儿童的心理健康需求。