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Program Profile: KEEP (Keeping Foster and Kinship Parents Supported and Trained)

Evidence Rating: Effective - More than one study Effective - More than one study

Date: This profile was posted on August 07, 2018

Program Summary

This a parent-training intervention for foster and kinship parents with a foster child in the home ages 4 to 12, designed to reduce children’s problem behaviors by strengthening foster parents’ skills. The program is rated Effective. The program was found to statistically significantly improve child problem behaviors, increase parents’ use of positive reinforcement relative to discipline, reduce parenting stress, and increase positive exits from the foster home for children.

Program Description

Program Goals
Keeping Foster and Kinship Parents Supported and Trained (KEEP) is a theoretically based, developmentally sensitive parent-training intervention for foster and kinship parents. KEEP is an adaptation of Treatment Foster Care Oregon (TFCO), formerly Multidimensional Treatment Foster Care (MTFC), a program that has been used to train foster care providers for adolescents who are referred by the juvenile justice system as an alternative to placement in group or residential care. KEEP uses specific components of TFCO with foster and kinship parents who work in state child welfare systems. The goal of KEEP is to reduce child problem behaviors through strengthening foster parents’ skills. The focus is on increasing foster parents’ positive reinforcement relative to the amount of discipline used.

Target Population/Eligibility
KEEP targets foster and kinship parents with a foster child in the home ages 4 to 12. The child may be placed in foster care for the first time or have been moved from a previous foster care placement or other setting.

Program Activities
Following detailed program manuals for trained facilitators and foster parents, KEEP involves 90-minute weekly sessions of training, supervision, and support in behavior management methods over a period of 16 weeks. The group meetings include 3 to 10 foster parents.

Curriculum topics map onto protective and risk factors that have been found to be developmentally relevant, malleable targets for change (Price et al. 2008). Curriculum content is integrated into group discussions, and primary concepts are illustrated by using role plays and videotapes. The program manuals allow for two floating “free” sessions that allow facilitators to deal with any remaining issues from previous sessions or to conduct reviews of past topics.

The primary focus of the program content is to increase foster parents’ use of positive reinforcement, to train them in consistently using non-harsh discipline methods (such as brief timeouts or temporary privilege removal), and to teach them the importance of close monitoring of children’s whereabouts and peer associations.

Home practice assignments are given each week to help parents practice implementing the behavioral procedures taught in the group meetings. The assignments are intended to help parents in specific ways to implement the behavioral procedures taught in the group meetings. If foster parents miss a session, they can receive the material during a home visit.

Key Personnel
KEEP is implemented by paraprofessionals with no previous experience with the model or with other parent-mediated interventions. The only requirements for paraprofessionals are group experience, good interpersonal skills, motivation, and knowledge of children.

Evaluation Outcomes

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Study 1
Child Problem Behaviors
Chamberlain and colleagues (2008) found that, from baseline to posttreatment and controlling for initial levels of behavior problems, children in the Keeping Foster and Kinship Parents Supported and Trained (KEEP) intervention group had a statistically significant reduction in behavior problems, compared with children in the control group, as rated by parents.

Positive Reinforcement
 From baseline to posttreatment, controlling for initial levels of reinforcement, parents in the KEEP intervention group reported a statistically significant improvement in the proportion of positive reinforcement, compared with parents in the control group.

Study 2
Placement Status–Positive Exit
Price and colleagues (2008) found that children in the KEEP treatment group had nearly double the likelihood of achieving a positive exit by the end of the intervention period, compared with children in the control group. This difference was statistically significant.

Placement Status–Negative Exit
 There was no statistically significant between-group difference in achieving a negative exit by the end of the intervention period.

Study 3
Focal Child Behavior Problems
 Price and colleagues (2015) found that, from baseline to posttreatment, focal children in the KEEP treatment group had a statistically significant reduction in behavior problems, compared with focal children in the control group, as rated by parents.

Focal Sibling Behavior Problems
 From baseline to posttreatment, focal siblings in the KEEP intervention group had a statistically significant reduction in behavior problems, compared with focal siblings in the control group, as rated by parents.

Parenting Stress Related to the Focal Child
 From baseline to posttreatment, parents in the KEEP treatment group reported a statistically significant reduction in parental stress related to the focal child, compared with parents in the control group.

Parenting Stress Related to the Focal Sibling
 There was no statistically significant between-group difference in parenting stress related to the focal sibling.
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Evaluation Methodology

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Study 1
Chamberlain and colleagues (2008) randomly assigned eligible foster families to either the Keeping Foster and Kinship Parents Supported and Trained (KEEP) intervention group or to the control group. Families were eligible to participate in the study if they were foster and kinship parents who had a foster child in the home ages 4-12 from the San Diego County (California) Department of Health and Human Services child welfare system. Families in the intervention group received the KEEP intervention, while families in the control group received usual caseworker services.

A total of 700 foster families (34 percent kinship, 66 percent non-relative) participated in the study between 1999 and 2004. Of those, 359 were assigned to the intervention group, and 341 were assigned to the control group. Most participating foster/kinship parents were female (94 percent intervention, 93 percent control), with an average age of 48.6 years (49.9 intervention, 47.3 control). Parents reported their race/ethnicity as Latino (41 percent intervention, 33 percent control), white (21 percent intervention, 34 percent control), African American (27 percent intervention, 24 percent control), Asian/Pacific Islander (4 percent intervention, 2 percent control), Native American (1 percent both groups), and multi-ethnic (6 percent both groups). Participating children were divided evenly between females (50 percent intervention, 54 percent control) and males (50 percent intervention, 46 percent control), with an average age of 8.8 years (8.9 intervention, 8.7 control). The children’s race/ethnicity was reported as Latino (35 percent intervention, 30 percent control), white (20 percent intervention, 25 percent control), African American (23 percent intervention, 19 percent control), Asian/Pacific Islander (1 percent both groups), Native American (1 percent both groups), and multi-ethnic (20 percent intervention, 24 percent control). The between-group differences on baseline characteristics were not statistically significant except for one factor: fewer intervention group foster parents spoke English, compared with parents in the control group. This difference was not controlled for in analyses.

The outcomes of interest were child behavior problems and positive reinforcement by foster/kinship parents. Child problem behaviors were assessed using the Parent Daily Report Checklist (PDR), a 30-item measure administered through a telephone interview during 3 consecutive or closely spaced days. Parents reported whether each problem behavior occurred in the past 24 hours. Proportion of positive reinforcement to discipline was assessed using foster parents’ reports of their positive reinforcement and discipline behaviors during both a 2-hour interview and on the PDR. A ratio of total daily positive reinforcement to total daily positive reinforcement plus discipline was computed. Data was collected at baseline and termination (5 months post-baseline). Path model analysis was used to measure the effects of the intervention. Subgroup analyses were performed to determine whether intervention effects were moderated by the child’s initial risk status (six or fewer baseline behavior problems versus more than six behavior problems).

Study 2
Price and colleagues (2008) used the data from the Chamberlain and colleagues (2008) study. The primary outcome of interest was placement status. Placement status was determined at the termination assessment, where foster parents reported whether the child had remained in the home or moved. Positive exits were those where the child moved out of the home for a positive reason, such as a reunion with a biological parent or other relative or an adoption. Negative exits were those where the child moved out of the home for a negative reason, such as being moved to another foster placement, a more restrictive environment such as a psychiatric care or juvenile detention center, or the child had run away. Cox hazard models were used to examine the effects of the intervention on the likelihood of either positive or negative placement changes. In this study, primary language spoken (in which there was a significant between-group difference) was one of several variables examined as control variables. There were no subgroup analyses.

Study 3
Price and colleagues (2015) randomly assigned eligible foster families to either the KEEP intervention group or the control group. Families were eligible to participate in the study if they were foster or kinship parents receiving a new child between the ages of 5 and 12 years from the San Diego County Department of Health and Human Services child welfare system between 2009 and 2013. The focal child in each family was a dependent of Child Welfare Services, while a focal sibling was identified as another child in the home closest in age to the focal child.

Families in the intervention group received the KEEP intervention, while families in the control group received services as usual, including parenting classes and support groups provided by local service agencies .A total of 335 families (47.5 percent kinship, 52.5 percent non-relative) participated in the study. Of those, 164 were assigned to the intervention group, and 171 were assigned to the control group. Most participating foster/kinship parents were female (94 percent intervention, 91 percent control), with an average age of 45.4 years (45.1 intervention, 45.8 control). Parents reported their race/ethnicity as Hispanic (40 percent intervention, 42 percent control), white (33 percent intervention, 39 percent control), African American (24 percent intervention, 9 percent control), Native American (1 percent intervention, 4 percent control), Asian/Pacific Islander (0 percent intervention, 3 percent control), and mixed ethnicity (2 percent both groups). Participating children were divided evenly between females (47 percent intervention, 49 percent control) and males (53 percent intervention, 51 percent control), with an average age of 7.6 years (7.8 intervention, 7.3 control).

The children’s race/ethnicity was reported as Hispanic (46 percent intervention, 51 percent control), African American (23 percent intervention, 12 percent control), white (11 percent intervention, 18 percent control), Asian/Pacific Islander (2 percent intervention, 1 percent control), Native American (1 percent both groups), and mixed ethnicity (16 percent intervention, 17 percent control). Focal siblings had an average age of 8.2 years (8.4 intervention, 8.0 control), with females making up 48 percent of the intervention group and 53 percent of the control group. There were no statistically significant differences between groups on baseline characteristics except for a few factors. Parents in the control group had been foster parents or kinship caregivers for a longer period of time, compared with parents in the intervention group. Focal children in the intervention group were significantly older, compared with focal children in the control group. These variables were controlled for in the analyses.

The outcomes of interest included child problem behaviors (of the focal child and focal sibling), and parent stress (related to the focal child and focal sibling). Child problem behaviors were assessed using the PDR. Parents reported whether each problem behavior occurred in the past 24 hours, with separate responses obtained for the focal child and the focal sibling. For each problem behavior that occurred, parents were asked to rate how upset they were by that behavior. Data was collected at baseline and following the intervention period, approximately 18 to 20 weeks later. Hierarchical linear modeling was used to measure the effects of the intervention. There were no subgroup analyses.

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Cost

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There is no cost information available for this program.
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Implementation Information

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The Keeping Foster Parents Trained and Supported (KEEP) program is an adaptation of the Multidimensional Treatment Foster Care–Adolescents (MDFC–A). The CrimeSolutions.gov profile of MDFC–A can be found here: https://www.crimesolutions.gov/ProgramDetails.aspx?ID=141.
KEEP includes detailed program manuals for group facilitators and foster parents. Session materials are available in English and Spanish. Facilitators and co-facilitators receive a 5-day training. Materials can be found on the KEEP websites: http://www.oslc.org/projects/keep/ or http://www.keepfostering.org
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Other Information

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Chamberlain and colleagues (2008) performed subgroup analyses to determine whether Keeping Foster and Kinship Parents Supported and Trained (KEEP) intervention effects were moderated by the child’s initial risk status (six or fewer baseline behavior problems versus more than six behavior problems). They found that KEEP was indirectly related to improvement in child behavior problems, mediated by an increase in the proportion of positive reinforcement. This effect was most evident for families where children had relatively high levels of behavior problems at baseline. That is, for families with children who had more behavior problems initially, KEEP led to an increase in the proportion of positive reinforcement exhibited by the parents, which then led to improvement in child behavior problems.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Chamberlain, Patricia, Joe Price, Leslie D. Leve, Heidemarie Laurent, John A. Landsverk, and John B. Reid. 2008. “Prevention of Behavior Problems for Children in Foster Care: Outcomes and Mediation Effects.” Prevention Science 9:17–27.


Study 2
Price, Joseph M., Patricia Chamberlain, John Landsverk, John Reid, Leslie Leve, and Heidemarie Laurent. 2008. “Effects of a Foster Parent Training Intervention on Placement Changes of Children in Foster Care.” Child Maltreatment 13:64–75.


Study 3
Price, Joseph M., Scott Roesch, Natalia E. Walsh, and John Landsverk. 2015. “Effects of the KEEP Foster Parent Intervention on Child and Sibling Behavior Problems and Parental Stress During a Randomized Implementation Trial.” Prevention Science 16:685–95.

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Additional References

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These sources were used in the development of the program profile:

Buchanan, Rohanna, Patricia Chamberlain, Joseph M. Price, and Peter Sprengelmeyer. 2013. “Examining the Equivalence of Fidelity Over Two Generations of KEEP Implementation: A Preliminary Analysis.” Children and Youth Services Review 35:188–93.


Price, Joseph M., Patricia Chamberlain, John Landsverk, and John Reid. 2009. “KEEP Foster-Parent Training Intervention: Model Description and Effectiveness.” Child and Family Social Work 14:233–42.

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Program Snapshot

Age: 5 - 12

Gender: Both

Race/Ethnicity: Black, American Indians/Alaska Native, Asian/Pacific Islander, Hispanic, White, Other

Geography: Suburban, Urban

Setting (Delivery): Other Community Setting

Program Type: Conflict Resolution/Interpersonal Skills, Parent Training

Targeted Population: Families

Current Program Status: Active

Listed by Other Directories: Model Programs Guide

Program Developer:
Patricia Chamberlain
Oregon Social Learning Center
10 Shelton McMurphey Boulevard
Eugene OR 97401
Phone: 541.485.2711
Website
Email

Program Director:
Katie Bennett
KEEP Director of Implementation
Oregon Social Learning Center
10 Shelton McMurphey Boulevard
Eugene OR 97401
Phone: 541.485.2711
Website
Email