Behavioural and Cognitive Behavioural Training Interventions for Assisting Foster Carers in the Management of Difficult Behaviour

There is a lack of evidence about the efficacy of behavioural or cognitive‐behavioural training interventions for foster carers. The programmes are intended to assist foster carers in the management of the difficult behaviour of looked‐after children and to provide competent care. This Campbell/Cochrane systematic review, supported by Nordic Campbell Center, finds no evidence of the efficacy of the programmes. On the contrary, there is a need to further investigate whether such programmes may be harmful to looked‐after children Abstract Background The provision of training for foster carers is now seen as an important factor contributing to the successful outcome of foster care placements. Since the late 1960s, foster carer training programs have proliferated, and few of the many published and unpublished training curricula have been systematically evaluated. The advent of cognitive‐behavioural therapy (CBT) and the research evidence demonstrating its effectiveness as a psychotherapeutic treatment of choice for a range of emotional and behavioural problems, has prompted the development of 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 3, 2006), MEDLINE (January 1966 to September 2006), EMBASE (January 1980 to September 2006), CINAHL (January 1982 to September 2006), PsyclNFO (January 1872 to September 2006), ASSIA (January 1987 to September 2006), LILACS (up to September 2006), ERIC (January 1965 to September 2006), Sociological Abstracts (January 1963 to September 2006), and the National Research Register 2006 (Issue 3). We contacted experts in the field concerning current research. Selection criteria Random or quasi randomised studies comparing behavioural or cognitive‐behavioural‐based training intervention (in a group or one‐to‐one settings or both) versus a no‐treatment or wait‐list control, for foster parents/carers. Data collection & analysis Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Main results Six trials involving 463 foster carers were included. Behavioural and cognitive‐behavioural 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 also show no evidence of effectiveness in measures of behavioural management skills, attitudes and psychological functioning. Analysis pertaining to fostering agency outcomes did not show any significant results. However, caution is needed in interpreting these findings as their confidence intervals are wide. Reviewers’ conclusions There is currently little evidence about the efficacy of behavioural or cognitive‐behavioural training intervention for foster carers. The need for further research in this area is highlighted.