A Pilot Study of the Adoption and Guardianship Enhanced Support (AGES) Program: Preventing Discontinuity by Walking Alongside Adoptive and Guardianship Families Who are Struggling.

PURPOSE: There is a strong preference for evidence-based child welfare services, however, there are few well-researched programs for families that struggle post-permanence. Following adoption or guardianship, some families experience significant challenges, struggle to find effective programs, and run the risk of family instability. This study described the process used to develop the Adoption and Guardianship Enhanced Support (AGES) intervention and explored: 1) the needs of families participating in the program and 2) how AGES worked with families to address those challenges. METHODS: This descriptive study utilized quantitative structured assessment data and qualitative data from case records to explore the needs of families and provide context for qualitative, in-depth interviews with families regarding their experiences with the AGES program, presented using thematic analysis. RESULTS: Pre-service structured assessments indicated multiple dimensions of parenting strain, with case record reviews and interviews with families providing a nuanced picture of multiple sources of strain, suggesting the project was reaching the intended audience. Record review and interviews demonstrated strong alignment between needs of families and the support provided by AGES workers. Intended analysis of quantitative post-assessment data was not possible, due to lower enrollment and higher staff turnover than expected, as well as study timeframes. DISCUSSION AND CONCLUSION: The approach utilized by AGES workers, one that walked alongside families and provided flexible responses to identified needs, showed promise for adoptive and guardianship families. Replication and additional research are needed to assess the program with a larger sample and more rigorous methods.

Longitudinal Evaluation of the Neurosequential Model of Therapeutics with Adoptive Families in Tennessee.

PURPOSE: This study evaluated effectiveness of the Neurosequential Model of Therapeutics (NMT) with adoptive families who received post adoption services in Tennessee. METHODS: Researchers obtained a sample of 552 families who received post adoption services in the U.S. state of Tennessee. Most families (77%) had adopted children through public child welfare services. A quasi-experimental design examined wellbeing outcomes for an NMT group (n = 319) versus a services-as-usual (SAU) group (n = 233) in intent-to-treat analyses. Then, the SAU group was contrasted to an NMT subgroup that had high adherence to the NMT model (n = 109) in an analysis of treatment-on-the-treated. RESULTS: Intent-to-treat models indicated no differences on outcomes between the NMT and SAU groups. However, the results of treatment-on-the-treated analyses showed slightly greater reduction on the Behavior Problems Index over time for the NMT with high adherence group as compared to SAU. DISCUSSION AND CONCLUSION: Adoptive families may face challenges that could be addressed through developmentally sensitive, trauma-informed services, such as NMT. The results of this study suggest that the NMT might benefit adoptive families if greater attention is paid to implementation adherence, or fidelity.

Social Determinants of Health and Child Maltreatment Prevention: The Family Success Network Pilot.

Child maltreatment is a highly prevalent public health concern that contributes to morbidity and mortality in childhood and short- and long-term health consequences that persist into adulthood. Past research suggests that social determinants of health such as socioeconomic status and intergenerational trauma are highly correlated with child maltreatment. With support from the U.S. Children's Bureau, the Ohio Children's Trust Fund is currently piloting the Family Success Network, a primary child maltreatment prevention strategy in Northeast Ohio that seeks to address these social determinants through pillars of service that include family coaching, financial assistance, financial education, parenting education, and basic life skills training. This study highlights the initial development phase of a pilot study. Plans for in-depth process and outcome evaluations are discussed. The project seeks to improve family functioning and reduce child protective services involvement and foster care entry in an economically disadvantaged region.

Implementation Fidelity in the Replication of Tuning in to Teens (TINT) Adapted for Adoptive Parents and Guardians in the US.

Purpose: Clear explication of the conditions necessary to reproduce results is imperative in the development of evidence-based interventions.Methods: This study used a fidelity framework to guide the exploration of implementation fidelity in a study of the Tuning in to Teens (TINT) intervention in New Jersey. TINT is an evidence-based prevention program - previously tested with parents of pre-adolescents to reduce emotionally dismissive parenting - that was adapted for use with adoptive and guardianship families.Results: The review of intervention design adaptation and protocols; intervention training; and monitoring of intervention delivery revealed extensive efforts by an adoption clinician, the purveyor of the program, and an implementation team to support the implementation efforts. Results of the monitoring of intervention receipt indicate that the intervention was implemented with high fidelity.Discussion: Future intervention research should consider assessing the effects of implementation efforts on outcomes to improve replication under real-world conditions. Regardless, this exploration of fidelity has implications for public and private organizations seeking to implement an evidence-based intervention. The framework developed by Gearing and Colleagues and the TIDieR checklist could provide useful guidance when planning for and reporting on implementation fidelity in the furtherance of developing and disseminating evidence-based interventions.

Implementation Science and Prevention in Action: Application in a Post-Permanency World.

This article describes how implementation science and intervention research guided the process of selecting and implementing an evidence-informed intervention (Tuning in to Teens; TINT). TINT was provided as a selective prevention effort offered to families with youth aged 10 to 13 years old, with characteristics that suggest an elevated risk for post-permanency discontinuity. Usability testing findings: Contact was made with 54% of families, and 12% participated in the intervention. Multivariate results found no statistically significant differences between families who responded to outreach efforts and those who did not; families who participated in TINT and those who did not. Implications: Large public child welfare systems wanting to implement evidence-informed interventions can follow the steps detailed in this paper for selecting, adapting and implementing an intervention. Further, providers that seek to offer post adoption and guardianship services, a growing service need, may gain some insights into activities that promote service usage with this population.

Continuity for children after guardianship versus adoption with kin: Approximating the right counterfactual.

Over the past two decades there has been a rapid increase in the number of children and youth living in guardianship and adoptive homes who were previously in foster care. Further, previous studies compared outcomes for children in guardianship homes to those for children in adoptive homes, despite the fact that many factors likely affect the selection of foster youth into different types of permanent placements. This study examined two counterfactuals for guardianship as a permanent placement type: adoption only and adoption or long-term-fostercare (A+LTFC). Longitudinal outcomes were tracked for children who exited foster care with relatives through guardianship (N=4,884) or adoption (N=12,163), as well as children in long-term foster care with relatives (N=4,840). Propensity scores were used to match children on key indicators. In the matched sample of guardianship versus adoption cases only, children who exited to guardianship were more likely to experience discontinuity than children who exited through adoption, 11% vs. 6% respectively. However, when guardianship was compared to the combination of adoption or long-term foster care, children in guardianship experienced the same proportion of discontinuity, 11% vs. 11% respectively. These results suggest that simply matching guardianship to adoption without taking into account LTFC may be the wrong way to estimate the "what if" counterfactual if children were not discharged to guardianship. Findings also support the use of guardianship as a potential solution for children in LTFC whose caregivers are not planning to adopt.

Formative Evaluation: A Case Study of the Illinois Birth-to-Three IV-E Waiver.

Few interventions addressing early childhood trauma have adequate evidence. The Illinois Birth-to-Three Waiver is a 5-year federal project to reduce trauma and increase permanency for young children. In this article the authors describe the explorative and formative phases, including: (a) developing a well-built research question; (b) working with purveyors of evidence-supported interventions (ESIs); (c) adapting ESIs to a large public child welfare system; (d) developing fidelity measures, assessment data and outcomes; and (e) managing the challenges of implementing a randomized controlled trial. Public and private agency staff work in conjunction with university partners to merge implementation science, program evaluation, and intervention research. The project's theory of change stipulates that working with the triad of birth parent(s), foster parent(s), and focal child is critical to achieving project outcomes. The authors articulate the importance of working closely with an interdisciplinary team to achieve these outcomes, and the challenges associated with the early stages of implementation.

Adoption and guardianship: A moderated mediation analysis of predictors of post-permanency continuity.

The original thinking behind permanency planning for foster children was to secure a caregiver's intention to provide a permanent home, not to guarantee it. Little is known, however, about how intentions change after permanence or what effect this change has on post-permanency continuity of care. This study examined the mediating effects of caregivers' thoughts about ending an adoption or guardianship, and how this mechanism may be contingent on primordial and bureaucratic factors that child welfare agencies rely on to ensure family continuity after legal permanence. In 2006, a sample of 346 Illinois caregivers who finalized an adoption or guardianship between 1998 and 2002 completed surveys about child behavior problems, the adequacy of financial assistance, and thoughts about maintaining the permanency relationship. Responses were linked to administrative data that tracked continuity of care through 2012. Simple mediation and moderated mediation hypotheses of the effects of caregiver thoughts on post-permanency continuity were tested. At last observation, 8% of caregivers were no longer living with the child or stopped receiving subsidies on the child's behalf. Thoughts expressed at survey time about ending the permanency relationship mediated the effect of child behavior problems on post-permanency discontinuity rates. This indirect effect was more pronounced among distantly related kin, lone caregivers, and caregivers who felt the subsidy was inadequate to cover their expenses. Our findings suggest that post-permanency services should target a narrow segment of caregivers who express weakened permanency commitments that arise from the challenges of parenting a child with multiple behavioral problems.

Substitute care entry: the relationship between race or ethnicity and levels of county organization.

OBJECTIVE: Past studies demonstrate a relationship between race and the likelihood of children entering state custody subsequent to a maltreatment investigation. Research also shows that community structural characteristics such as poverty and residential mobility are correlated with entry rates. The combined effect, however, of race and community characteristics on substitute care entry is unclear. We analyzed 3 years of Illinois child welfare administrative and county-level structural data to assess the combined effect of child characteristics and level of community organization on substitute care entry. METHODS: Based on county indicators of crime, socioeconomic status, residential mobility, and child care burden, a latent profile analysis classified Illinois counties into three levels of social organization (high, moderate, and low). To test the relationship between community and child level predictors of substitute care entry, a dichotomous variable representing substitute care entry was regressed onto county level and individual covariates (child age, race or ethnicity, gender, and allegation). To test the combined relationship of community and individual level characteristics, interactions between county level of organization and race were explored. RESULTS: Like previous studies, results showed that individual factors of race, age, and allegation were associated with the decision to place children in substitute care. Also consistent with past research, they revealed a general trend in which decreasing levels of social organization were associated with relatively higher odds of entry to care. The magnitude of this effect at each level of social organization, however, varied by race, with African American children in disorganized communities experiencing the greatest risk of removal. CONCLUSIONS: These findings suggest that efforts to understand the decision to place a child in substitute care may need to be community specific. In particular the level of community organization may influence the response of the system to maltreatment investigations. In communities with different characteristics and across racial groups, child welfare systems may need to examine decision making processes regarding children's removal from parental care.

Behavior problems, foster home integration, and evidence-based behavioral interventions: What predicts adoption of foster children?

OBJECTIVES: Adoption is particularly important for foster children with special mental health needs who are unable to return home, as adoption increases parental support often critically needed by youth with mental health issues. Unfortunately, significant behavior problems frequently inhibit foster parents from adopting, and little is known about factors that predict adoption when a child has behavior problems. Previous research suggests that foster parent behavioral training could potentially increase rates of successful adoptions for pre-school-aged foster children with behavior problems (Fisher, Kim, & Pears, 2009), but this has not been previously tested in older samples. In older children, effective treatment of behavior problems might also increase adoption by reducing the interference of behavior problems and strengthening the child's foster home integration. This pilot study focused on this question by testing associations between behavior problems, foster home integration, an evidence-based foster parent intervention, and adoption likelihood. METHODS: This study used an intent-to-treat design to compare foster home integration and adoption likelihood for 31 foster children with histories of abuse and neglect whose foster parents received a foster behavioral parenting intervention (see Chamberlain, 2003) or usual services. Random effect regression analyses were used to estimate outcomes across four time points. RESULTS: As expected, externalizing behavior problems had a negative effect on both integration and adoption, and foster home integration had an independent positive effect on adoption. Internalizing behavior problems (e.g., depression/anxiety) were not related to adoption or integration. However, the intervention did not have a direct effect on either foster home integration or adoption despite its positive effect on behavior problems. CONCLUSIONS: Results from this preliminary study provide further evidence of the negative effect of externalizing behavior problems on adoption. Its findings also suggest that foster home integration is an important dimension of foster home adaptation that appears particularly relevant to chances for adoption. While behavior problems appear to weaken foster home integration, integration is also an independent predictor of adoption likelihood. If these results are replicated in a larger study, consideration of foster home integration in case planning and future intervention studies focused on increasing permanency could potentially improve outcomes for foster children with behavior problems.