Tailoring CPP for the Foster Care Setting

This study involves the administration of an evidence-based prevention program to prevent and reduce behavior problems in young children (the Chicago Parent Program; CPP). CPP will be tailored by creating additional handouts, discussion questions, and topics that contextualize CPP material to foster care, to meet the needs and social norms of foster and kinship caregivers. The CPP-FC 12-session curriculum will be delivered to two cohorts of foster and kinship caregivers virtually. Data for this study will come from multiple sources, including caregiver participant report and a review of existing electronic databases at CCHMC.

• Chicago Parent Program for Foster Care (Behavioral): The Chicago Parent Program for Foster Care FC consists of a 12-session parent training program that focuses on building caregiver-child relationships, behavioral management strategies, managing caregiver stress, and skill maintenance.

Primary outcomes

• Change in Perceived Stress Scale [Pre Intervention and 18 weeks]: The Perceived Stress Scale is a 14-item self-report measure of how unpredictable, uncontrollable, and overloaded individuals find their life circumstances. All items are rated on a 5-point scale, ranging from 0 ("Never") to 4 ("very often"). Some items are reverse-scored. Responses are summed to yield a total score (range 0 - 56), with higher scores indicating greater perceived stress.
• Change in Child Adjustment & Parent Efficacy Scale [Pre Intervention and 18 weeks]: The Child Adjustment \& Parent Efficacy Scale, Total Intensity subscale is a 27-item measure of child behavior and emotional problems. Item responses are rated on a 4-point scale, ranging from 0 ("Not true of my child at all") to 3 ("True of my child very much"/"Most of the time"). Twenty-four items are summed to yield a Behavior Problems score (range 0-72), and three items are summed to yield an Emotional Problems score (range 0-9). Behavioral and Emotional Problems scores can be summed for a Total Intensity score (range 0-81). Higher scores indicate a higher level of problems.
• Change in Parenting Sense of Competence Scale [Pre Intervention and 18 weeks]: The Parenting Sense of Competence Scale is a 17-item questionnaire that measures overall parenting satisfaction and competence. Items are measured on a 6-point scale, with responses ranging from 1 ("Strongly disagree") to 6 ("Strongly agree"). Some items are reverse-scored. Items are summed to yield a total scale (range 17-102) and two subscales: parental self-efficacy (range 8-48) and parental satisfaction (range 9-54). Higher scores indicate higher levels of parental self-efficacy and parental satisfaction.
• Change in Eyberg Child Behavior Inventory [Pre Intervention and 18 weeks]: The Eyberg Child Behavior Inventory, a 36-item measure that assesses child behavior problems. Each item has 2 parts that make up 2 subscales: Intensity and Problem. Intensity items are rated on a 7-point scale, from 1 (Never) to 7 (Always), and Problem items are Yes/No responses. Items from each scale are summed to yield raw scores and converted to T-scores (M=50, SD=10). Higher Intensity scores indicate more frequent displays of the child behaviors, and higher Problem scores indicate the parent perceives the behaviors as more problematic. T-scores above 60 indicate elevated behavior problems.
• Strengths and Difficulties Questionnaire [Pre Intervention and 18 weeks]: The Strengths and Difficulties Questionnaire (SDQ) is a 25-item questionnaire that assesses child behavior. Items are rated on a 3-point scale and responses range from 0 ("Not true") to 2 ("Certainly true"). Some items are reverse-scored. Items are summed to yield 5 subscales: Emotional Problems, Conduct Problems, Hyperactivity, Peer Problems, and Prosocial (ranges 0 -10). A total score (range 0-40) is calculated using the sum of all the subscales, except Prosocial. Higher scores in each subscale and the total score indicate more child behavior problems.
• Change in Parental Stress Scale [Pre Intervention and 18 weeks]: The Parental Stress Scale is an 18-item questionnaire that assesses parental stress relating to parental sensitivity to the child, child behavior, and quality of the parent-child relationship. Items are rated on a 5-point scale, ranging from 1 ("Strongly disagree") to 5 ("Strongly agree"). Some items are reverse-scored. Items are summed to yield a total score (range 18-90), with higher scores indicating higher levels of parental stress.
• Change in Group Environment Scale [Week 7, Week 11, Week 19]: The Group Environment Scale is a 25-item measure that assesses the dimensions of intervention group environments. Items are rated on a 5-point scale, with responses ranging from 1 ("Strongly disagree") to 5 ("Strongly agree"). Items are averaged to yield three subscales: Cohesiveness, Implementation and Preparedness, and Counterproductive Activity. Higher scores on the Cohesiveness Scale (range 1-5) indicate more group cohesiveness. Higher scores on the Implementation and Preparedness Scale (range 1-5) indicate greater group implementation quality. Higher scores on the Counterproductive Activity Scale (range 1-5) indicate more counterproductive group activities.

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

* Must be a licensed foster caregiver or kinship caregiver to a child ages 2 years to 8 years
* Must be in good standing with the foster care agency
* Must be English-speaking

Exclusion Criteria:

* Not having a foster child ages 2 - 8 years in the home
* Caregiver is unable to commit to participating in CPP-FC
* This foster child age 2 - 8 years was placed in the home more than 45 days prior to enrollment

Participant flow

Outcome results

• Change in Perceived Stress Scale (Primary), Mean, score on a scale: Chicago Parent Program for Foster Care 14.70 +/- 8.41
• Change in Child Adjustment & Parent Efficacy Scale (Primary), Mean, score on a scale: Chicago Parent Program for Foster Care 24.61 +/- 15.63
• Change in Parenting Sense of Competence Scale (Primary), Mean, score on a scale: Chicago Parent Program for Foster Care 72.60 +/- 10.70
• Change in Eyberg Child Behavior Inventory (Primary), Mean, T-score: Chicago Parent Program for Foster Care 53.70 +/- 12.49
• Strengths and Difficulties Questionnaire (Primary), Mean, score on a scale: Chicago Parent Program for Foster Care 2.40 +/- 2.22
• Change in Parental Stress Scale (Primary), Mean, score on a scale: Chicago Parent Program for Foster Care 36.00 +/- 12.24
• Change in Group Environment Scale (Primary), Mean, score on a scale: Chicago Parent Program for Foster Care 4.44 +/- 0.44

Adverse events

Time frame: Adverse event data were collected for approximately 19 weeks that each participant was enrolled.

Limitations and caveats: Due to an error in survey firing logic, The Strength and Difficulties Questionnaire was not administered at the Pre Intervention event. There are only sample means for the scale scores, and no mean differences listed in Outcome Measures.

• Lee EH. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res (Korean Soc Nurs Sci). 2012 Dec;6(4):121-7. doi: 10.1016/j.anr.2012.08.004. Epub 2012 Sep 18. PMID 25031113
• Guo M, Morawska A, Filus A. Initial Validation of the Parent-Report Child Adjustment and Parent Efficacy Scale (CAPES) in a Chinese Cultural Context. Assessment. 2018 Dec;25(8):1056-1073. doi: 10.1177/1073191116681493. Epub 2016 Dec 20. PMID 30392414
• Heerman WJ, Taylor JL, Wallston KA, Barkin SL. Parenting Self-Efficacy, Parent Depression, and Healthy Childhood Behaviors in a Low-Income Minority Population: A Cross-Sectional Analysis. Matern Child Health J. 2017 May;21(5):1156-1165. doi: 10.1007/s10995-016-2214-7. PMID 28092060
• Gross D, Fogg L, Young M, Ridge A, Cowell J, Sivan A, Richardson R. Reliability and validity of the Eyberg Child Behavior Inventory with African-American and Latino parents of young children. Res Nurs Health. 2007 Apr;30(2):213-23. doi: 10.1002/nur.20181. PMID 17380522
• Goodman R. Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001 Nov;40(11):1337-45. doi: 10.1097/00004583-200111000-00015. PMID 11699809
• Agazio JB, Buckley KM. Revision of a Parental Stress Scale for use on a pediatric general care unit. Pediatr Nurs. 2012 Mar-Apr;38(2):82-7. PMID 22685867
• Wilson PA, Hansen NB, Tarakeshwar N, Neufeld S, Kochman A, Sikkema KJ. SCALE DEVELOPMENT OF A MEASURE TO ASSESS COMMUNITY-BASED AND CLINICAL INTERVENTION GROUP ENVIRONMENTS. J Community Psychol. 2008 Apr;36(3):271-288. doi: 10.1002/jcop.20193. PMID 19018295
• Gross D, Garvey C, Julion W, Fogg L, Tucker S, Mokros H. Efficacy of the Chicago parent program with low-income African American and Latino parents of young children. Prev Sci. 2009 Mar;10(1):54-65. doi: 10.1007/s11121-008-0116-7. PMID 19067166

• Study Protocol and Statistical Analysis Plan (PDF, 2023-10-04)
• Informed Consent Form (PDF, 2023-10-12)

• Sarah J Beal, PhD, Principal investigator, Cincinnati Children's Hospital Medical Center Cincinnati, OH USA