Effects of a Behavioral Intervention with Foster Families: A Randomized Controlled Trial

Abstract

Background: Children in foster care are highly vulnerable populations with poor health outcomes. Key protective factor is having a safe, consistent environment in which to adapt and heal from past traumas, which often comes in form of consistent and nurturing foster homes. Study Aims: Current study is aimed to investigate technology delivered family (sibling inclusive) intervention titled The Connected Family Series – For Foster Families. Emphasis was on increasing family hardiness, preparation to care for children in foster care particularly those with disabilities and special needs. Aims included: (1) establish feasibility of technology-based intervention, (2) explore effects of intervention on stress and relational quality outcomes among family member participants, and (3) determine feasibility of in-home saliva collection to assess diurnal cortisol rhythm (objective, stress-related physiological outcome). Methods: This study employed randomized control trial design of behavioral interventions. Stress and relational quality outcomes among members were measured (pre- and post- intervention) using concepts of family hardiness, preparedness, and relationship development through self-report questionnaire which included Family Hardiness Index (FHI), portions of Casey Foster Applicant Inventory (CFAI), and Sibling Inventory of Behavior (SIB), respectively. Additionally, objective indicators of stress-related biology, saliva diurnal cortisol rhythm was measured before intervention, after completion of intervention, and 1-month post intervention over course of a day, for three consecutive days at each time point. Results: The Connected Family Series intervention was successfully adapted for foster families. Families in intervention group (n= 59 dyads) participated in online videos and activities at rate of 78% for those who stayed in study. Statistically significant increases in family hardiness in intervention group (p<0.001, Cohen’s d=0.97) compared to control group. Measures of positive sibling relationship scores also increased significantly in intervention group compared to control group (p<0.002, Cohen’s d=0.76), accounting for approximately 32% of increase in FHI score. Salivary collection to assess diurnal cortisol rhythm was found challenging, but possible within population before and after intervention. Discussion: Providing fostering families an online behavioral intervention increased sibling and foster child relationships and improved overall family functioning. Future research should focus on long-term impact possibly on placement stability and outcomes for children in foster care.