Community Implementation of KEEP: Fidelity & Generalization of Parenting Effects

描述(由申请人提供)：这项建议是NIMH资助的一项研究的继续，该研究题为寄养父母干预的级联传播(MH60195，Patti Chamberlain，PI)。作为多维治疗寄养护理(MTFC)的改进版本，这项干预措施(题为Keep-Keep Foster Parents Traded and Support)侧重于减少5至12岁定期寄养儿童的行为问题。这项有效性试验的结果显示，干预措施有效地降低了儿童行为问题的水平，增加了父母使用有针对性的育儿策略，增加了积极退出家庭的次数(例如，与亲生父母团聚，收养)，并减轻了有多次安置改变历史的儿童的安置中断(例如，应养父母的要求将儿童带走)。因此，圣地亚哥县卫生和公众服务局(HHSA)儿童福利服务部开始通过一家私人精神健康服务承包商(圣地亚哥青年社会倡导者协会)实施Keep干预。目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，养父母培训的效果是否(同时)推广到目前在寄养和亲属干预之家的其他儿童，并导致总体行为问题水平的降低？第二，在干预结束后，Keep干预是否继续有效，并(暂时)推广到稍后进入这些家庭的新儿童？最后，由于Keep干预是由社区机构在现实世界的护理系统中实施的，干预能否以保持干预的目标和质量的方式提供和维护？寄养儿童，年龄在5岁到12岁之间，将被随机分配到两种条件中的一种--保持干预或“照常服务”条件。在Keep干预条件下，寄养和亲属照顾者将参加每周16次的小组会议。要评估的结果包括儿童问题行为(重点儿童和家庭中其他儿童)、儿童功能、父母压力、家庭功能、精神卫生服务的使用、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，在干预完成后的一年内，新进入寄养家庭/亲属照料者家庭的儿童将被纳入评估，以及这些额外儿童对父母压力和家庭功能的影响。最后，将根据儿童、家庭和系统结果评估和检查干预忠诚度的几个维度(例如，促进者忠诚度和小组参与度)。

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.