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Behavioural and cognitive-behavioural training interventions for assisting foster carers in the management of difficult behaviour

Additional Info

  • Authors: William Turner, Geraldine M. Macdonald, Jane A. Dennis
  • Published date: 2007-07-19
  • Coordinating group(s): Social Welfare
  • Type of document: Review, User abstract
  • Title: Behavioural and cognitive-behavioural training interventions for assisting foster carers in the management of difficult behaviour
  • See the full review: https://onlinelibrary.wiley.com/doi/10.4073/csr.2007.3
  • English:

    Need for further research on cognitive-behavioural training interventions for foster carers

    There is a lack of evidence about the efficacy of behavioural or cognitive-behavioural training interventions for foster carers. The programmes are intended to assist foster carers in the management of the difficult behaviour of looked-after children and to provide competent care. However, a new Campbell/Cochrane review, supported by Nordic Campbell Center, finds no evidence of the efficacy of the programmes. On the contrary, there is a need to further investigate whether such programmes may be harmful to looked-after children.

    Looked-after children need more than stability alone

    Children placed with foster families have special needs. Many have complex problems which place heavy demands on foster carers and their ability to manage difficult behaviour. A stable and secure home environment is not enough.

    The idea behind the training programmes for foster carers is to increase their skills and thereby support the children and limit difficult behaviour. A number of programmes train foster carers to use cognitive-behavioural interventions, as this form of treatment has been shown to be effective in other contexts. Cognitive-behavioural training interventions combine specific child-rearing tools with cognitive techniques, which seek to correct the problematic thinking patterns of the child associated with dysfunctional behaviour.

    Based on the best research to date in this field, the review maps the effect of the programmes where carers are taught to use cognitive-behavioural training methods when dealing with the problematic behaviour of the looked-after children. The review covers six different studies. Four from the UK and two from the US, in which a total of 463 foster carers participated.

    Uncertainty about the effect

    The authors of the review can find no evidence about the efficacy of the programmes. They investigate the effect of the programmes on a total of 21 outcome measures concerning the looked-after child’s behaviour and psychosocial functioning, the psychological well-being of the foster carers and the stability of the placement. Only two of the studies in the review find effects in some of the criteria set:

    One study shows that the programmes provide carers with a moderately higher knowledge regarding different behavioural principles.

    On the other hand, another larger and better-conducted study indicates that the programmes may have a negative effect. The study finds a higher level of psychopathology among the children whose

    foster carers have received cognitive-behavioural training, than among children whose foster carers have not participated in the programmes.

    The same study also reports that the children whose foster carers have participated in programmes suffer from attachment disorders to a moderately higher degree than children whose foster carers did not take part in training.

    The authors of the review point out that it is not possible to reach any overall conclusion on the efficacy of the training of foster carers on the basis of the results.

    Are short programmes for foster carers adequate?

    There is no evidence to indicate that cognitive-behavioural training interventions are of benefit to the looked-after children or their foster carers. The authors consider that this should be explored with the complex problems of looked-after children in mind. Their emotional, psychological and social traumas are often so severe that the generally short programmes are unlikely to provide foster carers with the tools necessary to deal with the problems. In addition to longer, more intensive and more specialised programmes, the researchers propose that they should be supplemented with other interventions.

    About the systematic review

    The review includes six different studies of cognitive-behavioural training interventions for foster carers who take care of children aged between 0-18 years. All studies are based on randomised controlled trials or other trials that compare the groups which have participated in the intervention with a control group.

    Recommendations for future research

    The researchers point out that there are methodological weaknesses in all six studies, and that it is difficult to draw any certain conclusions. The need for further research in this area is therefore highlighted – especially as one study indicates possible negative effects on looked-after children.

    In continuation of the considerations regarding the intervention and the various psychosocial problems of the looked-after children, the researchers point out that future research should take into account the length and intensity of programmes and make a more specific distinction between which behavioural problems the foster carers participating should be assisted in managing.

Select language:

Need for further research on cognitive-behavioural training interventions for foster carers

There is a lack of evidence about the efficacy of behavioural or cognitive-behavioural training interventions for foster carers. The programmes are intended to assist foster carers in the management of the difficult behaviour of looked-after children and to provide competent care. However, a new Campbell/Cochrane review, supported by Nordic Campbell Center, finds no evidence of the efficacy of the programmes. On the contrary, there is a need to further investigate whether such programmes may be harmful to looked-after children.

Looked-after children need more than stability alone

Children placed with foster families have special needs. Many have complex problems which place heavy demands on foster carers and their ability to manage difficult behaviour. A stable and secure home environment is not enough.

The idea behind the training programmes for foster carers is to increase their skills and thereby support the children and limit difficult behaviour. A number of programmes train foster carers to use cognitive-behavioural interventions, as this form of treatment has been shown to be effective in other contexts. Cognitive-behavioural training interventions combine specific child-rearing tools with cognitive techniques, which seek to correct the problematic thinking patterns of the child associated with dysfunctional behaviour.

Based on the best research to date in this field, the review maps the effect of the programmes where carers are taught to use cognitive-behavioural training methods when dealing with the problematic behaviour of the looked-after children. The review covers six different studies. Four from the UK and two from the US, in which a total of 463 foster carers participated.

Uncertainty about the effect

The authors of the review can find no evidence about the efficacy of the programmes. They investigate the effect of the programmes on a total of 21 outcome measures concerning the looked-after child’s behaviour and psychosocial functioning, the psychological well-being of the foster carers and the stability of the placement. Only two of the studies in the review find effects in some of the criteria set:

One study shows that the programmes provide carers with a moderately higher knowledge regarding different behavioural principles.

On the other hand, another larger and better-conducted study indicates that the programmes may have a negative effect. The study finds a higher level of psychopathology among the children whose

foster carers have received cognitive-behavioural training, than among children whose foster carers have not participated in the programmes.

The same study also reports that the children whose foster carers have participated in programmes suffer from attachment disorders to a moderately higher degree than children whose foster carers did not take part in training.

The authors of the review point out that it is not possible to reach any overall conclusion on the efficacy of the training of foster carers on the basis of the results.

Are short programmes for foster carers adequate?

There is no evidence to indicate that cognitive-behavioural training interventions are of benefit to the looked-after children or their foster carers. The authors consider that this should be explored with the complex problems of looked-after children in mind. Their emotional, psychological and social traumas are often so severe that the generally short programmes are unlikely to provide foster carers with the tools necessary to deal with the problems. In addition to longer, more intensive and more specialised programmes, the researchers propose that they should be supplemented with other interventions.

About the systematic review

The review includes six different studies of cognitive-behavioural training interventions for foster carers who take care of children aged between 0-18 years. All studies are based on randomised controlled trials or other trials that compare the groups which have participated in the intervention with a control group.

Recommendations for future research

The researchers point out that there are methodological weaknesses in all six studies, and that it is difficult to draw any certain conclusions. The need for further research in this area is therefore highlighted – especially as one study indicates possible negative effects on looked-after children.

In continuation of the considerations regarding the intervention and the various psychosocial problems of the looked-after children, the researchers point out that future research should take into account the length and intensity of programmes and make a more specific distinction between which behavioural problems the foster carers participating should be assisted in managing.

See the full review

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