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

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.

An Effective rating implies that implementing the program is likely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

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.

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.

The Keeping Foster Parents Trained and Supported (KEEP) program is an adaptation of the Multidimensional Treatment Foster Care–Adolescents (MDFC–A). The CrimeSolutions profile of MDFC–A can be found here: https://www.crimesolutions.ojp.gov/ratedprograms/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 https://www.keepfostering.org/

Subgroup Analysis

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.

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

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

Following are CrimeSolutions-rated programs that are related to this practice:

Kinship Care for Children Removed from Home for Maltreatment

An alternative to traditional foster care, this practice places children removed from home due to maltreatment with other members of their family or with friends of the family. This practice is rated Promising for reducing behavioral and adaptive problems, increasing child well-being, decreasing the number of placements, and reducing institutional abuse. The practice is rated No Effects for increasing family reunification and attachment.

Evidence Ratings for Outcomes

	Mental Health & Behavioral Health - Multiple mental health/behavioral health outcomes
	Mental Health & Behavioral Health - Adaptive problems
	Mental Health & Behavioral Health - Emotional wellbeing
	Victimization - Child abuse/neglect/maltreatment
	Family Functioning - Out-of-home placement/permanency
	Family Functioning - Reunification
	Family Functioning - Attachment

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?