Romanian foster care: equipping carers to help challenging children
Romania’s social care system has seen a sea change for the better over the last two decades. Foster care has largely replaced Ceausescu-era orphanages characterized by shocking levels of overcrowding, sexual and physical abuse, and inadequate medical treatment.
January 15, 2013 / Prevention Action
Still, the new system isn’t all roses. Many foster families struggle to relate to children who are likely to have serious behavioral and emotional problems – often as a legacy of being institutionalized or living in an abusive or neglectful home. However, a version of cognitive behavioral therapy for foster parents may provide some of the help they need, a recent study suggests.
A program consisting of five half-day sessions improved child behavior problems and reduced foster parents’ emotional distress by teaching parents first how to regulate their emotions, and then how to use better parenting skills.
Acceptance first, skills second
These findings came from a Romanian trial of a “short enhanced cognitive-behavioral parent training” (CBPT) intervention, a parenting program that has a slightly unusual approach.
The unusual component is the first piece. Typically, parenting programs focus on improving parenting skills in areas such as appropriate discipline techniques. However, this CBPT program sets these important skills aside at first. Rather, the initial focus is on reducing parental stress and building emotion-regulation strategies to cope with the challenges of raising a foster child who might have experienced abuse or multiple foster placements or been institutionalized.
This first stage of therapy emphasizes the importance of helping parents to identify and control their thoughts and emotional reactions related to children’s problematic behaviors. They learn to work on accepting themselves and the child unconditionally, and to challenge and regulate their own frustration and anger.
Only after foster parents go through this first stage are they taught practical skills to manage the children’s behavior. In this second stage, the parents are taught how to communicate effectively with the children and how to solve problems when the situation gets challenging.
The Romanian study: five short sessions on four themes
The study randomly assigned 97 foster parents to either the intervention or the control group. The treatment was based on both cognitive-behavioral theory and parenting research.
The intervention was comprised of four themes: psychoeducation about child development, learning about the role of cognitions in parental distress, identifying strategies for emotion regulation and stress reduction, and exploring disciplining, problem-solving, and monitoring techniques.
Foster parents received five sessions structured on the theory above, the first four on a weekly basis for four hours, plus a follow-up session three months later.
Parents reported on their own demographic characteristics, well-being, and parenting practices, and their adolescents’ behavior. Also, information related to placement disruptions was obtained from Child Protection and Social Assistance files.
Better child outcomes + better parent outcomes = same placement disruptions?
The researchers found that children whose foster parents participated in the intervention group exhibited lower levels of externalizing problems than those whose parents were in the control group.
Also, these same carers were less stressed and showed more improvements in parenting practices than those who did not get the intervention.
However, the rate of placement disruption was the same for both groups. In other words, improving children’s behavior and foster parents’ stress levels didn’t seem to keep foster families together – even though child behavior is known to relate to placement disruption.
The Romanian authors explain these surprising results by pointing to other factors, aside from the behavioral problems, that might influence a child moving from one family to another. Namely, the child’s placement disruptions history may also play a role, or maybe more time is needed to be able to see any effects on placement disruption.
For further research
Although the intervention had immediate effects on both parental and child behavior, results should be interpreted with caution. Once the intervention showed positive preliminary results, Romanian child services decided to assign the control group to the intervention as well. Therefore, at follow up, even though it appears that the effects of the intervention were kept constant, there was no longer a comparison group to establish this.
Also, the intervention was effective as a whole, but it is not possible to say whether it was the extra emotion-regulation strategy, the parenting skills component, or the combination of the two that produced the positive effects.
This study demonstrated that Romanian child policy is moving towards better and more evidence-based initiatives in improving foster children’s lives. However, more research will be needed to understand how to prevent child placement disruptions.
Gavita, O. A., Bujoreanu, S., David, D., Tiba, A., & Ionutiu, D. R. (2012). The efficacy of a short cognitive-behavioral parent program in the treatment of externalizing behavior disorders in Romanian foster care children: Building parental emotion-regulation through unconditional self- and child-acceptance strategies. Children and Youth Services Review, 34, 1290-1297.