KEEP parent training program leads to reduction in caregiver reporting of problematic child behaviour and increase in placement stability

Date Published: 

Greeno, E. J., Uretsky, M. C., Lee, B. R., Moore, J. E., Barth, R. P., & Shaw, T. V. (2016). Replication of the KEEP foster and kinship parent training program for youth with externalizing behaviors. Children and Youth Services Review, 61, 75–82. 

Reviewed by: 
Leila Malone
Tara Black
Barbara Fallon

Sixty-five foster and kinship caregivers in Maryland, USA participated in a 16-week caregiver training intervention, Keeping Foster Parents Trained and Supported (KEEP). This intervention teaches foster and kinship caregivers skills to reduce and manage child problem behaviours. The authors measured the impact of the intervention on child behavioural problems, parenting style, placement stability, and permanency.

Baseline and post-test analyses measured changes in child behavioural problems and parenting style. Following participation in the program, researchers found a statistically significant reduction in caregiver reporting of problematic child behaviour. They also found a significant decrease in severity levels of problematic behaviours between baseline and post-test. For total score and internalizing behaviours measured on the Child Behaviour Checklist (CBCL), these dropped from being in the borderline range at baseline to normal range at post-test, and for externalizing behaviours these dropped from clinical to borderline range. Placement stability significantly increased over the study period. There was no significant change in parenting style or in the relationship between child behaviour and permanency outcomes.

This study builds upon these previously demonstrated empirical results for the KEEP program as being effective in reducing caregiver reporting of problematic child behaviours. Previous studies have shown that caregiver participation in the KEEP program can lead to a significant reduction in the number of caregiver self-reported child behaviour problems, and a significant increase in the proportion of positive reinforcement used by caregivers (Chamberlain et al., 2008). 

Methodological notes: 

The study had 75 participants, with caregivers from 65 households and 10 spouses. Only one caregiver per household was included in the evaluation (n=65; 99% of whom were female). Response rates were not provided, and attrition rates at post-test were 22%. The original KEEP model was adapted with the minimum child age lowered from five to four years as suggested by the model developers. Child behavioural and emotional problems were measured through changes in caregiver responses to the Parent Daily Report (PDR) and CBCL at baseline and post-test (two months after program completion) via telephone. Parenting style was measured through changes in self-reporting of specific parenting techniques, and permanency (defined as child leaving child welfare system for reunification, adoption, placement with a relative, trial adoption or trial custody home). Placement stability (two or fewer placements within the study period) was measured using administrative data.

The authors highlight a number of limitations with the study: small sample size and subsequent limited generalizability, lack of control group, participant self-selection, and short duration of post-test. The CBCL and PDR are both caregiver reports of child behaviour provided via telephone and researchers did not witness child behaviour. External factors such as child participation in alternative treatments (which may have impact reported behaviours), reasons for child welfare referral and circumstances pertaining to biological family (which may impact permanency) are not included in the analysis.  

Chamberlain, P., Price, J., Leve, L. D., Laurent, H., Landsverk, J. A., & Reid, J. B. (2008). Prevention of Behavior Problems for Children in Foster Care: Outcomes and Mediation Effects. Prevention Science, 9(1), 17–27.