Proximal outcomes of Connecting, an evidence-based, family-focused prevention program for caregivers of adolescents in foster care

Highlights

• Family-focused prevention programs for teens in foster care are underdeveloped.

• Connecting was adapted from an evidence-based intervention for families with teens.

• Connecting improved youth problem solving, refusal skills, and family involvement.

• This study provides valuable evidence of proximal outcomes from a randomized trial.

• Foster families can benefit from self-administered prevention interventions.

Abstract

This study experimentally tested proximal outcomes of Connecting, a low-cost, self-directed, family-based substance-use prevention program for foster families. Families (n = 220) fostering youth age 11 to 15 years were recruited and randomly assigned into the self-administered program with telephone support (n = 110) or a treatment as usual, control condition (n = 110). Program materials included a workbook with family activities and DVDs with video clips. Survey data were collected from youth and their caregivers at baseline and 4 months later. Results indicate 60% were ‘very satisfied’ with Connecting, and 85% would recommend Connecting to other caregivers. Analyses revealed foster youth in the program (n = 93) were significantly more likely than controls (n = 104) to report improved problem-solving skills (Cohen's d = 0.13, p = .02), involvement in making family rules (OR = 2.6, p = .02), and caregiver recognition for positive behavior (OR = 3.8, p = .03) at posttest. Improvement was observed in youth report of intervention-specific communications (B = 0.15, p = 0.07) and improved refusal skills (OR = 2.09, p = .06). No significant effects were found on bonding communication, inconsistent discipline, family conflict, monitoring, and antisocial norms about substance use and violence, nor were there significant effects from any caregiver reports on similar measures. This evidence suggests that a self-administered family-focused preventive intervention can positively influence known risk and protective factors for youth in foster care.

Introduction

On any given day in the United States, there are over 84,000 youth from 11 to 15 years of age (early adolescents) in foster care (iFoster, , 2020, U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau., 2018). Youth in foster care have higher incidences of substance use, conduct problems, anxiety symptoms, and self-harm (Pilowsky & Wu, 2006), and are at a higher risk for involvement in the juvenile justice system (Orsi, Lee, Winokur, & Pearson, 2018) than youth in general.

Foster caregivers caring for early adolescents provide an important opportunity for prevention of behavioral health problems among youth in foster care by providing strong, protective environments for development. Yet, researchers have noted that foster parents are consistently underprepared to address the challenges faced by youth in their care, and are expected to provide care above and beyond their own perceived ability to do so (Barnett et al., 2018, Storer et al., 2014). Foster and relative caregivers need effective tools to care for youth who have complex developmental, social, emotional, mental, and behavioral health needs (Leve, Fisher, & Chamberlain, 2009). While foster caregivers typically receive pre-service training, researchers have raised questions as to whether the training adequately prepares them to be emotionally responsive, communicate, and provide for the needs of youth in their care (Barnett et al., 2018, Festinger and Baker, 2013). Studies that have examined the competence of caregivers who received the usual pre-service trainings found that caregivers were inadequately meeting program-identified goals and were unable to manage behavior problems in the children they were caring for (Puddy and Jackson, 2003, Rork and McNeil, 2011). Day et al. (2018) found that caregiver ability to effectively communicate, attend to the caregiver/child relationship (i.e., using routines and structure while also offering children a variety of experiences), teach socio-emotional skills, provide culturally competent care, provide positive recognition, and attend to self-care promotes placement stability and wellness. Although effective caregiver training can improve placement stability and outcomes for children in care (Cooley and Petren, 2011, Whenan et al., 2009), it is not systematically available, particularly for caregivers of adolescents (Dorsey et al., 2008).

Despite this important need, there is a dearth of evidence-based parenting programs tailored to foster youth and their caregivers. The programs that do exist and have been found to be effective are intensive, expensive, focused on reducing existing problem behaviors rather than prevention, and target youth with the highest level of need (Barth et al., 2005). Although effective models of parenting programs for the general population of parents and their children exist (Van Ryzin, Kumpfer, Fosco, & Greenberg, 2016), they do not consider the unique situation of foster families.

In response to the need for parenting programs tailored to support the needs of early adolescents in foster care that are easy to use, affordable, and evidence based, we developed Connecting by adapting an existing universal program with evidence for preventing risky behaviors in adolescence. Connecting is a low-cost, prevention-focused program designed to strengthen relationships between foster caregivers and the youth in their care. It was systematically adapted for foster youth and their caregivers (Barkan et al., 2014, Haggerty et al., 2016, Storer et al., 2012) using the ADAPT-ITT framework (Wingood & DiClemente, 2008) from an evidence-based universal parenting program, Staying Connected with Your Teen (SCT; Haggerty, Skinner, MacKenzie, & Catalano, 2007). Staying Connected with Your Teen, formerly known as Parents Who Care, is theoretically guided by the social development model (SDM) (Hawkins & Weis, 1985) and was designed to improve family functioning, reduce youth engagement in risky behaviors, and promote protective factors. The SDM organizes research on risk and protective factors into an etiological model that integrates perspectives from social control (Hirschi, 1969), social learning (Bandura, 1977), and differential association theories (Sutherland, 1973). According to the SDM, prosocial opportunities or involvements, skills, rewards, bonds, and beliefs are hypothesized to influence prosocial behavior. A similar process is believed to operate for antisocial opportunities and behavior. This general theory specifies the causal pathways by which risk and protective factors operate in the etiology of problem behaviors. Each chapter of the SCT program targets specific SDM constructs.

A small, randomized, waitlist control pilot study of Connecting examined feasibility, usability, and proximal outcomes for youth 11 to15 years of age and their caregivers. In that pilot study, participation in the Connecting program was associated with stronger family management, better communication between caregivers and youth, youth being likely to participate in making family rules, and being less likely to have attitudes that were favorable to antisocial behavior (Haggerty et al., 2016). These proximal outcomes represent risk and protective factors as outlined by the SDM and as such are intended as mechanisms for the intervention to prevent the development of substance use and other risky behaviors. Building on these promising results, the purpose of the current study is to examine the posttest effects of the Connecting program on proximal variables in a new larger randomized controlled trial (RCT). Based on the results from the pilot, we hypothesize that foster families participating in the Connecting intervention would demonstrate stronger proximal outcomes of improved family management practices, less family conflict, stronger foster family bonding, and more positive youth involvements and social skills compared to controls.