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Parent-Child Care (PC-CARE) as a Universal Secondary Prevention Program for Children Entering New Foster Placements

Fri, March 22, 7:45 to 9:15am, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Research suggests that nearly 50% of children entering foster care nationwide evidence mental health problems, particularly externalizing and trauma-related behavior problems (Burns et al., 2004). These externalizing behaviors are related to placement instability and future psychopathology (James et al., 2004). Although many interventions exist for foster children, they often take months to implement and tend to target only children with moderate to severe behavior problems. To address this issue, we are working with county Child Welfare Services (CWS) to implement Parent-Child Care (PC-CARE; Timmer et al., 2018), a 7-session dyadic intervention for children who have or are at risk of developing externalizing problems, as a universal secondary preventive intervention for all children aged 1-5 years in new foster placements. Our goals are to reach a larger portion of foster children than typically receive mental health services, reduce behavioral and trauma symptoms for these children, and increase positive caregiver-child relationships and placement stability.

Method: Participants include 109 children aged 1-5 years (55% male) who entered a new foster placement and whose foster caregivers agreed to participate in PC-CARE. Children and caregivers were ethnically diverse; treatment was conducted in English and Spanish. Caregivers completed the Early Childhood Traumatic Stress Screen (ECTSS) and the Devereaux Early Childhood Assessment (DECA) at pre- and post-treatment. Caregivers and CWS staff were contacted 1 and 6 months after ending treatment to assess placement stability.

Results:
Reaching Children: Foster parents of 63% (N=109) of eligible children agreed to treatment, including 85% of caregivers who reported behavioral concerns and 46% of caregivers who reported no current behavioral concerns for the child. Excluding children who reunified with biological parents or moved to permanent placements mid-treatment (N=24), the retention rate for PC-CARE was 74%, with many children still in treatment.

Improving Outcomes: For the 40 children who completed PC-CARE, results of the ECTSS indicated that the severity of trauma symptoms decreased. Results of the DECA indicated that children’s behavioral concerns decreased and protective factors (i.e., self-regulation, initiative to meet their own needs, attachment relationships, total protective factors) increased (see Figure 1).

Placement Stability: Of the 25 children who completed PC-CARE and had 1-month follow-up data, 80% were in the same placement and 20% were reunified with biological parents. Of the 28 children with 6-month follow-up data, all children who completed PC-CARE (N=15) were reunified or in a permanent placement (87%) or in the same resource home (13%). For those who dropped treatment (N=13), 38% were reunified or in a permanent placement, 54% were in the same resource home, and 8% had a non-permanency related placement change.

Conclusion: Through collaborating with CWS to offer universal services to newly-placed foster children, we provided services to children who may not have qualified for mental health treatment and observed improvements in trauma symptoms, behaviors, and relationships in only 7 weeks. Follow-up data suggest that children exposed to these services had promising rates of placement stability. Findings support the creation of policies that promote universal preventive interventions for foster children.

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