Chamberlain, P., Moreland, S., & Reid, K. (1992). Enhanced services and stipends for foster parents: Effects on retention rates and outcomes for children. Child Welfare, 71(5), 387-401.

Type of Study: Randomized controlled trial
Number of Participants: 72 foster families

Population:

• Age — Children: 4-7 years; Adults: Approximately 40 years
• Race/Ethnicity — Children: 86% Caucasian, 6% African American, and 4% Hispanic; Adults: Not specified
• Gender — Children: 61% Female, 39% Male; Adults: Not specified
• Status — Participants were foster and kinship parents and their children.

Location/Institution: Oregon counties

Summary: (To include basic study design, measures, results, and notable limitations)
This study measured the impact on children of a $70-per-month supplement to the foster parent's normal reimbursement and of increased training and support of the foster parents through a training and support program [now called KEEP (Keeping Foster Parents Trained and Supported)] . The effects on foster parent dropout rates were also evaluated. Participants were randomly assigned to an intervention and 2 control conditions. Measure utilized was the Parent Daily Report. The intervention consisted of enhanced training for parents in the form of group sessions, behavior management techniques, and telephone support. Intervention parents also received an additional monthly stipend. One comparison group received the stipend only and the control group received care as usual. Families were assessed at 3 weeks, and at 3, 6, and 9 months. Results indicate that intervention parents reported lower rates of child problem behaviors, had fewer placement disruptions, and fewer foster parents dropped out of providing care. Limitations include small sample size, reliability on self-reported measure, and lack of follow-up.

Length of controlled postintervention follow-up: Not specified.

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, 17-27.

Type of Study: Randomized controlled trial
Number of Participants: 1,400 (700 parents and 700 children)

Population:

• Age — Children: Intervention-Mean=8.88 years, Control-Mean=8.72 years; Parents: Intervention-Mean=49.86 years, Control-Mean=47.29 years
• Race/Ethnicity — Children: 33% Latino, 22% Caucasian, 22% Mixed ethnic, 21% African American, 1% Asian American, and 1% Native American; Parents: 25% African American, 37% Latino, 27% Caucasian, 6% Mixed ethnic, 3% Asian/Pacific Islander, and 1% Native American
• Gender — Children: 52% Female and 48% Male; Parents: 94% Female and 6% Male
• Status — Participants were foster and kinship parents.

Location/Institution: San Diego, California

Summary: (To include basic study design, measures, results, and notable limitations)
Parents were randomly assigned to receive 16 weeks of training, supervision and support or to casework services as usual. The intervention used was KEEP (Keeping Foster Parents Trained and Supported). Child behavior problems were measured using the Parent Daily Report Checklist (PDR) at baseline and termination (5 months postbaseline). Based on the baseline measure, families were split into high- and low-risk groups for analysis. High-risk children were those with more than six reported behavior problems at baseline. The parent also completed an interview including measures of positive reinforcement and discipline. Results showed higher levels of positive reinforcement and accompanying lower levels of children's behavior problems for the intervention group. Effects were strongest for the high-risk group. Limitations include generalization of parenting effects to nonstudy foster children, reliability on a self-reported measure, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Price, J. M., Chamberlain, P., Landsverk, J., Reid, J., Leve, L., & Heidemarie, L. (2008). Effects of a foster parent training intervention on placement changes of children in foster care. Child Maltreatment, 13(1), 64-75. doi:10.1177/1077559507310612

Type of Study: Randomized controlled trial
Number of Participants: 1,400 (700 parents and 700 children)

Population:

• Age — Children: 5-12 years; Adults: Mean=47-49 years
• Race/Ethnicity — Children: 33% Latino, 22% Caucasian, 22% Mixed ethnic, 21% African American, 1% Asian American, and 1% Native American; Adults: 37% Latino, 27% Caucasian, 25% African American, 6% Mixed ethnic, 3% Asian/Pacific Islander, and 1% Native American
• Gender — Children: 52% Female and 48% Male; Adults: 94% Female and 6% Male
• Status — Participants were foster and kinship parents.

Location/Institution: San Diego, CA

Summary: (To include basic study design, measures, results, and notable limitations)
This study uses the same sample as Chamberlain et al. (2008). Parents were randomly assigned to receive 16 weeks of training, supervision, and support or to casework services as usual. The intervention used was KEEP (Keeping Foster Parents Trained and Supported). Child placement exits from foster care were defined as occurring within 200 days of baseline and were based on foster parent report. Positive placement exits were defined as reunion with a parent or relative or adoption. Negative placement exits included another foster placement, more restrictive placement, or running away. Analyses regarding the KEEP intervention found that those in the intervention group were nearly twice as likely to experience a positive placement exit as the control group, but were no more or less likely to experience a negative exit as the control group. However, children with a higher number of placements prior to the beginning of the study were more likely to have negative placement exits if they were in the control group but not if they were in the intervention group, which suggested a mitigating effect. The authors note that 70% of the sample experienced no change in placement during the study period. Limitations include generalization of parenting effects to nonstudy foster children and lack of follow-up.

Length of controlled postintervention follow-up: None.

Chamberlain, P., Price, J., Reid, J. B., & Landsverk, J. (2008). Cascading implementation of a foster and kinship parent intervention. Child Welfare, 87(5), 27-48. doi:10.1007/s11121-007-0080-7

Type of Study: Randomized controlled trial
Number of Participants: 700

Population:

• Age — 19–81 years (Mean=48.6 years)
• Race/Ethnicity — 37% Latino, 27% Caucasian, 26% African American, 6% Multiethnic, 3% Asian/Pacific Islander, and 1% Native American
• Gender — 94% Female and 6% Male
• Status — Participants were foster/kinship parents in San Diego County.

Location/Institution: San Diego County, CA

Summary: (To include basic study design, measures, results, and notable limitations)
This study uses the same sample as Price et al. (2008). This study tests the effectiveness of KEEP (Keeping Foster Parents Trained and Supported) with 700 foster/kinship parents in San Diego County. Child behavioral outcomes were measured using the Parent Daily Report (PDR) checklist. In this study, PDR data were collected from foster and kin parents for three days at baseline and three days at treatment termination. No differences existed between the behavior rates reported by intervention parents and those reported by control parents at baseline. At treatment termination, however, foster/kin parents in the KEEP intervention condition reported significantly fewer child behavior problems than those in the control condition. In addition, these changes in child behavior were found to be mediated by changes in parenting behavior. At the five-month postbaseline interview, foster parents who participated in the KEEP groups showed an increase in the proportion of positive reinforcements relative to discipline parenting practices, and this increase predicted a decrease in child problem behaviors. Children of parents in the KEEP group were also found to have higher rates of reunification with biological or adoptive families and fewer placement disruptions than those in the control condition. Limitations include generalization of parenting effects to nonstudy foster children and lack of follow-up.

Length of controlled postintervention follow-up: None.

DeGarmo, D. S., Chamberlain, P., Leve, L. D., & Price, J. (2009). Foster parent intervention engagement moderating child behavior problems and placement disruption. Research on Social Work Practice, 19(4), 423-433. doi:10.1177/1049731508329407

Type of Study: Randomized controlled trial
Number of Participants: 337

Population:

• Age — Children: 5-12 years, Adults: Not specified
• Race/Ethnicity — Children: Not specified; Adults: 33% Latino, 22% Caucasian, 22% mixed ethnicity, 21% African American, 1% Asian American, and 1% Native American
• Gender — Children: Not specified, Adults: Not specified
• Status — Participants were individuals involved in the child welfare system.

Location/Institution: San Diego County, California

Summary: (To include basic study design, measures, results, and notable limitations)
This study uses a subset of the same sample as Chamberlain et al. (2008). The primary goal of this study was to conduct a within intervention group analysis to test whether caregiver engagement (e.g., participation, homework completion, openness to ideas, apparent satisfaction) in KEEP (Keeping Foster Parents Trained and Supported) moderates risk factors for foster child outcomes. Measures utilized include the Parent Daily Report Checklist (PDR). Results showed caregiver engagement moderates both the influence that the number of prior placements has on increases in child problem behaviors and the risk of negative placement disruption for Hispanics. Limitations include reporter bias and absence of measures focusing on implementation fidelity, adherence to the weekly session curricula, or specific weekly intervention goal and lack of follow-up.

Length of controlled postintervention follow-up: None.

Greeno, E. J., Lee, B. R., Uretsky, M. C., Moore, J. E., Barth, R. P., & Shaw, T. V. (2015). Effects of a foster parent training intervention on child behavior, caregiver stress, and parenting style. Journal of Child and Family Studies, 25(6), 1991-2000. doi:10.1007/s10826-015-0357-6

Type of Study: Pretest-posttest with comparison group
Number of Participants: 113

Population:

• Age — Children: 4-12 years, Caregivers: 27-82 years
• Race/Ethnicity — Children: 43% Black, 38% Caucasian, 12.5% Other, and 6.5 Missing; Caregivers: 47.5% Black/African American, 43% 3% Hispanic and 6.5% Mixed
• Gender — Children: 42% Male and 58% Female, Caregivers: 99% Female
• Status — Participants were individuals involved in the child welfare system.

Location/Institution: Maryland

Summary: (To include basic study design, measures, results, and notable limitations)
The purposes of this study were to evaluate child behavior change, changes in caregiver parenting style, and permanency and placement stability at baseline and then after the KEEP (Keeping Foster Parents Trained and Supported) intervention. Measure utilized was the Parent Daily Report Checklist (PDR), Child Behavior Checklist (CBCL), the Discipline and Supervision Measure, and the Parenting Stress Index Short Form (PSI-SF). KEEP participants were referred by their child welfare caseworker, while comparison participants were recruited via mail and a foster parenting newsletter. Results indicated that significant decreases in child behavior problems for participants in KEEP interventions as compared to the comparison group. Additionally, the KEEP group displayed a significant reduction in PDR scores with a display of five fewer problem behaviors reported from baseline to posttest, while the comparison group did not demonstrate any significant change. The decrease of externalizing behaviors for the KEEP group, as measured by the PDR, was not associated with decreased parental stress (as measured by the PSI-SF) and there was not a significant relationship for the KEEP group at posttest for stress and child behavior. There was no change in the discipline and supervision ratio for either the KEEP group or the comparison group and there was no impact of the KEEP training on permanency outcomes for foster and kinship children. In addition, for KEEP parents, placement stability significantly increased between baseline and postintervention when compared to the comparison group. Limitations include nonrandomization of participants, small sample size, and significant differences between the two groups at baseline.

Length of controlled postintervention follow-up: 2 months.

Price , J. M., Roesch, S., Walsh, N. E., & Landsverk, J. (2015). Effects of the KEEP foster parent intervention on child and sibling behavior problems and parental stress during a randomized implementation trial. Prevention Science, 16(5), 685-695. doi:10.1007/s11121-014-0532-9

Type of Study: Randomized controlled trial
Number of Participants: 335

Population:

• Age — Children: Mean= 7.32-7.84 years, Caregivers: Mean=45.10-45.75 years
• Race/Ethnicity — Children: 48.5% Hispanic, 14.5% Caucasian, 17.5% African American 16.5% Mixed, and 1% Native American; Caregivers: 41% Hispanic, 36% Caucasian, 16.5% African American, 3% Asian/Pacific Islander, 2.5% Native American, and 2% Mixed
• Gender — Children: 52% Males and 48% Female; Caregivers: 92.5% Female and 7.5% Male
• Status — Participants were individuals involved in the child welfare system.

Location/Institution: San Diego County, California

Summary: (To include basic study design, measures, results, and notable limitations)
The primary goals of this study were to (a) examine the effectiveness of KEEP (Keeping Foster Parents Trained and Supported) in reducing child behavior problems, as delivered by a community agency; (b) determine if the effects of KEEP generalize to more than one child in the same home; and (c) examine the effectiveness of KEEP in reducing parental stress associated with child behavior problems. Measure utilized was the Parent Daily Report Checklist (PDR). Participants were randomly assigned to either KEEP or the control group. Results indicated that KEEP was effective in reducing child behavior problems when delivered by a community agency. These results expanded prior research on KEEP, revealing that KEEP was effective in reducing the behavior problems of more than one child in the same household and in reducing parental stress levels associated with the behavioral issues of the focal child. Limitations include reliance on parental observation, unequal ethnic distribution of African Americans in the KEEP group, changes in the target child between baseline and follow-up, and lack of follow-up.

Length of controlled postintervention follow-up: None.

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. doi:10.1016/j.childyouth.2015.12.003

Type of Study: One group pretest-posttest study
Number of Participants: 65

Population:

• Age — Children: 4-12 years, Caregivers: 27-72 years
• Race/Ethnicity — Children: 48% Black, 32% Caucasian, 17% Other, and 3% Missing; Caregivers: 51% Black/African American, 32% Caucasian 3% Hispanic, and 14% Multiracial
• Gender — Children: 51% Male, Caregivers: 99% Female
• Status — Participants were individuals involved in the child welfare system.

Location/Institution: Maryland

Summary: (To include basic study design, measures, results, and notable limitations)
This study utilizes the intervention sample from Greeno et al. (2015). The purpose of this study is to evaluate a replication of the KEEP (Keeping Foster Parents Trained and Supported) foster and kinship parent training program. Measure utilized was the Parent Daily Report Checklist (PDR), the Child Behavior Check List (CBCL), the Discipline and Supervision Measure, and the Parenting Stress Index Short Form (PSI-SF). The foster and kinship parents who participated in the KEEP group reported the number of problem behaviors on the PDR at baseline was 8 and that decreased to 3 behaviors reported by posttest and there was a significant difference in CBCL severity level scores with all severity levels decreasing from baseline to posttest. Additionally, placement stability significantly improved between baseline and posttraining. Limitations include the lack of control group, small sample size, and length of follow-up.

Length of controlled postintervention follow-up: 2 months.

Roberts, R., Glynn, G., & Waterman, C. (2016). ‘We know it works but does it last? – The implementation of the KEEP foster and kinship carer training programme in England. Adoption & Fostering, 40(3), 247-263. doi:10.1177/0308575916657956 

Type of Study: Pretest-posttest without control group
Number of Participants: 1,798 (892 carers; 906 children)

Population:

• Age — Children: 3-17 years; Adults: 19-78 years
• Race/Ethnicity — Children: 78% White British/White Other, 7% Black British/Black Other, 3% Asian British/Asian Other, 7% Other; 9% Not Known; Adults: 86% White British/White Other, 8% Black British/Black Other, 2% Asian British/Asian Other, 2% Mixed/Other, 2% Not Known
• Gender — Children: 54% Male and 46% Female; Adults: 86% Female and 14% Male
• Status — Participants were individuals involved with the child welfare services (CWS).

Location/Institution: England

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to determine the efficacy of the KEEP Standard program. Individuals were assigned to one of three programs: KEEP Standard (5-12 years), KEEP Safe (12-19 years) or KEEP 3-6. Measures utilized include the Parent Daily Report (PDR), the Strengths and Difficulties Questionnaire (SDQ), and the Parenting Scale (PS). Results show the PDR scores for number of problematic behaviors and carer stress are higher for kinship carers for the KEEP Standard group. Data on the reasons for unplanned moves or disruptions were unknown for a third of the KEEP Standard group. In addition, longer-term outcome data for 6- and 12-month postgroup follow-up for KEEP Standard (for carers of children aged 5–12 years) show that significant improvements in behavioral difficulties, foster carer stress, and parenting discipline style are all maintained. For KEEP Standard, the percentage of children with seven or more behaviors shows a slight increase from the postintervention scores at the 6-month follow-up time point, but decreases again at the 12-month stage and remains significantly improved from the preintervention scores. Prior to the intervention, 62% (n=245) of KEEP Standard children were reported to have seven or more behaviors per day on average. This was reduced to 35% (n=139) postintervention as a large proportion moved from the increased-risk to the low-risk category. Limitations include lack of randomization, lack of control group, and missing data.

Length of controlled postintervention follow-up: 6 and 12 months.

Price, J. M., Roesch, S., & Burce, C. M. (2019). The effects of the KEEP foster parent training intervention on child externalizing and internalizing problems. Developmental Child Welfare, 1(1), 5-21. doi:10.1177/2516103218812092

Type of Study: Randomized controlled trial
Number of Participants: 310 Child-parent pairs

Population:

• Age — Children: 5-12 years - KEEP: Mean=7.82 years; Control: Mean=7.30 years; Parents: Not specified
• Race/Ethnicity — Children: Not specified; Parents: Hispanic: KEEP: 41%; Control: 41%; Caucasian: KEEP: 32%; Control: 41%; African American: KEEP: 24%; Control: 10%; Native American: KEEP: 1%; Control: 4%; Asian/Pacific Islander: KEEP: 0%; Control: 3%; and Mixed Ethnicity:
• Gender — Children: 51.5% Male; Parents: Not specified
• Status — Participants were foster and kinship families in the child welfare system.

Location/Institution: San Diego, CA

Summary: (To include basic study design, measures, results, and notable limitations)
Note: This study uses the same sample as Price, Roesch, Walsh, & Landsverk, J. (2015). This study examined the effectiveness of the KEEP (Keeping Foster Parents Trained and Supported) intervention at reducing behavior problems among children in foster care. Foster and kinship families were randomly assigned to either the KEEP intervention or usual services. Measures included the Child Behavior Checklist (CBCL) at baseline and at the end of the intervention (4 months after baseline). Results showed the KEEP intervention was effective at reducing the proportion of children in the borderline group for rule-breaking between baseline and follow-up. The intervention was also effective at reducing internalizing problems, as indicated by reductions in internalizing raw scores and the proportion of children in the borderline group over the course of the intervention. Limitations include the lack of blinding to condition in the study, sole reliance in parent report, and attrition.

Length of controlled postintervention follow-up: None.