TREAT-part (clinical trial)

Foster care today faces a number of challenges, among them challenges of being a caregiver for a maltreated child. Foster children show high prevalence of behavioral problems (up to 60%); these problems are in turn associated with an increased level of parenting stress and also with less effective parenting behavior in foster parents. As a consequence, the foster placement may be prematurely terminated leading to unfavorable placement disruptions. These disruptions put foster children at a greater risk for worse developmental trajectories. Family stability, reduced foster parenting distress, and a better parent-child relationship are therefore important bolsterers for children in foster care. One approach to enhance these factors is making high-quality training programs for foster caregivers widely available.

The clinical trial (TREAT-part) is embedded in a larger longitudinal study, the GROW-part, on the development of children in foster care. For the clinical trial, 100 foster children with previous experiences of maltreatment (including physical, sexual, emotional or psychological abuse and/or neglect) are included and will be randomly assigned to either Usual Care or Usual Care + a foster parent-based intervention to raise resilient children.

The goal of the TREAT-part is to investigate the specific and additional impact of a parent-focused intervention to support foster parents in raising maltreated children. The primary outcome is related to the foster parent-child relationship. Secondary outcomes are child conduct and anxiety problems, changes in placements or rather in the intent to continue fostering, emotion regulation, and neurobiological changes in the stress response system. Developmental trajectories will help to estimate how much maltreated children may thrive - when in skilled and safe foster care - and regain a chance for a normal life.

Treatment Aims

Usual Care Condition
The parent-focused intervention will only be offered to half of the foster families. Because foster children usually receive a number of services from the child welfare system on a routine basis, Usual Care was selected as a control condition. The government has the responsibility to protect children from further harm and therefore the Usual Care condition includes all services deemed necessary by the government to follow their responsibility. As a result, the same services will also be available to the intervention group so that both groups only differ in the delivery of the parenting intervention. This allows evaluating the additional benefit of the intervention to Usual Care in foster families.

The Usual Care services the foster-children and families may receive, will be assessed over the study course.

Usual Care + foster-parent-based intervention (Taking Care Triple P)
Subsamples of the families participating in the longitudinal study are allocated (by randomization) to an intervention focusing on their primary caregiver, in this case the foster parents. The Taking Care intervention is part of a comprehensive parenting support system (Triple P) that promotes positive, caring, and consistent parenting practices, which have been shown to modify risks, and reduce the incidence of maltreatment (Prinz et al., 2009). The intervention has been adapted and tailored to the needs of foster parents by using consumer input (e. g., from foster parents and agencies, using focus groups) and research evidence. A pilot study is currently running in Australia. Preliminary results support the feasibility of the intervention in foster care and demonstrate high acceptability for foster parents. First results on outcome variables indicate significant reductions in child behavior problems from pre to post assessment as well as significant improvements in parenting styles (Chandler & Sheffield, 2013).

The parent trainings is provided in groups because the group setting is important for networking and mutual support of foster parents. It is going to be carried out according to the manual (Chandler & Sanders, 2013), and will take a total of eight weekly sessions (see Table 1):

  • Weeks 1-5: Five weekly 3-hour sessions
  • Weeks 6-7: Two weekly 20 minutes individual telephone consultations
  • One 3-hour closure session (back in the group)

The total intervention time will take approximately 17 hours.

Table 1: Contents of Training Sessions
1 Positive Parenting After an introduction to the aims of the training, positive parenting and causes of child behavior problems are discussed. Foster-parents should think about their current problems as behavior difficulties, name interaction problems with their child, and formulate their own training goals for change. Homework task: keeping track of children's behavior
2 Helping children develop Introduction of diverse parenting strategies to
a) strengthen the positive parent-child relationship by using, e.g. Quality Time, Talking with Children, Show affection,
b) encourage good behavior, e.g., by Descriptive praise, and
c) encourage relationships with others, e.g., by Teaching new skills and behaviors, Set a good example

Foster-parents should choose one or several strategies to try out with their child
3 Managing misbehavior Introduction of diverse parenting strategies to
a) manage misbehavior, e.g., by using Diversion to another activity, Planned ignoring, Clear, calm instructions, and Logical consequences
b) deal with relationship problems, e.g., How to respond when a child hurts another child, How to manage difficulties between siblings

Introduction of diverse strategies with regard to
c) seeking professional help

Foster-parents should choose one or several strategies to try out with their child or for themselves.
4 Building self-esteem and resilience Introduction of
a) the importance of healthy self-esteem (Why is self-esteem important?),
b) how to develop healthy self-esteem, and
c) how to raise resilient children, e.g., by e.g., Recognizing and accepting feelings, Expressing feelings appropriately, Dealing with intense emotions

Foster-parents should choose one or several strategies to try out with their child.
5 Planning ahead Introduction of the importance
a) to take care of yourself and your family, and
b) to prepare for high-risk situations, e.g. for alternative care situations such as contact with biological family

Foster-parents should think about potential high-risk situations and how to better prepare themselves and their family. Moreover they are invited to think about possibilities to enhance family life.
6 Telephone consultation The individual telephone consultations serve to support foster parents in their home when applying skills learned in the five sessions before.
7 Telephone consultation  
8 Closure session The closure session is the final reconvention as a group. In order to encourage generalization and maintenance of skills, the parent skills sessions are completed with planned activities routines. These draw together the parenting skills learned throughout the program and prepare parents for high-risk situations in a variety of settings.


Chandler, C. L. & Sanders, M. R. (2013).Taking Care Triple P - Positive Parenting Program for out-of-home care providers workbook for use with children up to 12 years old (1st Ed.). University of Queensland, Brisbane, Australia.

Chandler, C. L. & Sheffield, J. (2013, February). Does Triple P work with foster carers? Taking Care Triple P: Program design and review of feasibility trial. Poster presented at the Helping Families Change Conference hfcc, Los Angeles, USA.

Prinz, R. J., Sanders, M. R., Shapiro, C. J. et al. (2009). Population-based prevention of child maltreatment: The US Triple P system population trial. Prevention Science, 10, 1-12.