Cognitive-behavioural training interventions for assisting foster carers in the management of difficult behaviour.

BACKGROUND The provision of training for foster carers is now seen as an important factor contributing to the successful outcome of foster care placements. It is believed to be associated with enhancing caring attitudes and skills, reducing behaviour problems in foster children, improving relationships between foster carers and child welfare agencies, and decreasing foster carer attrition. Since the late 1960s, foster carer training programs have proliferated, and few of the many published and unpublished training curricula have been systematically assessed and evaluated. The advent of cognitive-behavioural therapy (CBT) and the research evidence demonstrating its effectiveness as a psychotherapeutic treatment of choice, has prompted many working in the social care field to devise CBT-based training programmes. CBT approaches to foster care training derive from a 'skill-based' training format that also seeks to identify and correct problematic thinking patterns that are associated with dysfunctional behaviour by changing and/or challenging maladaptive thoughts and beliefs. OBJECTIVES To assess the effectiveness of cognitive-behavioural training interventions in improving a) looked-after children's behavioural/relationship problems, b) foster carers' psychological well-being and functioning, c) foster family functioning, d) foster agency outcomes. SEARCH STRATEGY We searched databases including: CENTRAL (Cochrane Library Issue 2, 2004), MEDLINE (January 1966 to April 2004), EMBASE (January 1980 to April 2004), CINAHL (January 1982 to April 2004), PsycINFO (January 1872 to April 2004), ASSIA (January 1987 to April 2004), LILACS (up to April 2004), ERIC (January 1965 to April 2004), Sociological Abstracts (January 1963 to April 2004), and the National Research Register 2004 (Issue 1). We contacted experts in the field concerning current research. SELECTION CRITERIA All studies in which participants were foster parents/carers, and who were allocated by random or quasi-random methods to a CBT-based training intervention (in a group and/or one-to-one settings) versus a no-treatment or wait-list control, were selected. DATA COLLECTION AND ANALYSIS Results from the five eligible trials (total n = 443 ) are reported narratively. Due to the diversity of measures employed, no meta-analysis was performed. MAIN RESULTS Training interventions evaluated to date appear to have very little effect on outcomes relating to looked-after children, assessed in relation to psychological functioning, extent of behavioural problems and interpersonal functioning. Results relating to foster carer(s) outcomes indicate some improvements in measures of behavioural management skills, attitudes and psychological functioning. Analysis pertaining to fostering agency outcomes did not show any significant results. AUTHORS' CONCLUSIONS Inconclusive evidence exists about the efficacy of CBT-based training intervention for foster carers. The need for further research in this area is highlighted.

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