Children placed in foster care have often been subject to serious maltreatment and neglect (Kohl, Edleson, English, & Barth[
1]; Oswald, Heil & Goldbeck[
2]). Although placement in foster care usually protects them against further exposure to child maltreatment, children have often been psychologically scarred by these experiences and as a consequence show behavioral problems (Minnis, Everett, Pelosi, Dunn & Knapp[
3], Pears, Kim & Fisher[
4]) and attachment problems (Smyke, Dumitrescu & Zeanah[
5]; Zeanah, Scheeringa, Boris, Hellers, Smyke, & Trapani[
6]). Placement in foster care most often implies that children are separated from the biological parent, which may evoke negative reactions as well. All this jeopardizes the success of foster care placements and placement failure may start a vicious circle in which the chance of another failure increases with every breakdown (Rubin, O’Reilly, Luan & Localio[
7]; Oosterman, Schuengel, Slot, Bullens & Doreleijers[
8]). The final option, institutional placement, is wrought with its own risk for pathological outcomes, e.g. compared to children in foster care institutionalized children show more cognitive delays (Nelson, Zeanah, Fox, Marshall, Smyke & Guthrie[
9]), attachment disturbances (Smyke, Zeanah, Gleason, Drury, Fox, Nelson, Guthrie[
10]) and developmental delays (Curtis, Alexander & Lunghofer[
11]). To stop this vicious circle, these children and their foster parents need intensive support (Chamberlain, Price, Reid, Landsverk, Fisher & Stoolmiller[
12]). Especially children with very severe behavioral problems are in need of spezialized foster care interventions[
13]. These children are at high risk for placement instability (Aarons, James, Monn, Raghavan, Wells & Leslie[
14]), because they have problems that may be too taxing for regular foster parents. To help foster parents provide these high-risk children with the positive and stimulating setting they need, foster parents need to learn effective behavioral management strategies and learn to provide emotional support (Fisher, Burraston & Pears[
15]). To address these needs, a multidimensional treatment program for preschool foster children has been designed Chamberlain & Fisher[
16].
Multidimensional treatment foster care for preschoolers
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) combines foster care placement with evidence-based treatment of behavioral problems. Foster parents are taught effective strategies to promote positive behavior and effective limit setting for problem behavior. Concurrently children receive individually tailored behavioral interventions, focusing on problem-solving skills and prosocial behavior. Although MTFC-P is quite successful in the U.S. (see Table
1) and transportability of the MTFC model for older children has been shown in Swedish context (Westermark, Hansson and Olssen[
17]), the efficacy of the preschool version has not been replicated in other countries where implementation challenges and cultural differences may play a role. The implementation of (MTFC-P) in the Netherlands offers an opportunity for such a replication.
Table 1
Review of publications towards MTFC-P
Fisher, Burraston & Pears | US [2005] | 3-6 years | 24 months | fewer placement |
Fisher, Stoolmiller, Gunnar & Burraston, | US [2007] | 3-6 years | 12 months | more normalized diurnal cortisol segregation |
Fisher & Kim | US [2007] | 3-6 years | 12 months | less resistant behavior increased secure attachment |
Fisher, Kim & Pears | US [2009] | 3-5 years | 12 months | more successful permanency attempts |
The aim of this study was to preliminary and on a small-scale assess the implementation of MTFC-P in the Netherlands and test whether children enrolled in the MTFC-P program achieve desired outcomes, i.e. less problem behavior. Therefore, we addressed the following hypothesis: “the time in the MTFC-P intervention predicts a decline in problem behavior”, as this is the desired outcome for children assigned to MTFC-P.