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Early Intervention for Foster Children

Early Intervention for Foster Children. Philip A. Fisher, Ph.D. Oregon Social Learning Center. Random Assignment. MTFC-P intervention. 60. 57. Regular foster care. Community comparison group (60). The Early Intervention Foster Care Study, 1999-.

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Early Intervention for Foster Children

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  1. Early Intervention for Foster Children Philip A. Fisher, Ph.D. Oregon Social Learning Center

  2. Random Assignment MTFC-P intervention 60 57 Regular foster care Community comparison group (60) The Early Intervention Foster Care Study, 1999- Outcomes at 6 mo intervals thru middle childhood N= 117 Preschool Aged Foster Children

  3. Overall sample characteristics Mean age at first foster placement 3.4152 Age at first placement Number of living transitions at study start Child 3 Child 2 Child 1 Adrift in the foster care system Birth 1yr 2yrrs 3yrs 4yrs 5yrs 6yrs 7yrs

  4. Child 6 Child 4 Child 5 When foster care works… Birth 1yr 2yrrs 3yrs 4yrs 5yrs 6yrs 7yrs

  5. Percent of placement failures based on number of prior placements 90 80 70 60 50 40 30 20 10 0 % 1 2 3 4 5 6 7+ Number of placements (adapted from Fisher, Burraston, & Pears, 2005)

  6. Anxiety and affective disorders HPA axis dysregulation associated with early life stress (downregulation via chronic stress)

  7. Some, but not all, foster children show altered HPA axis function Delaware Oregon Bruce, Fisher, Pears, & Levine (submitted) Dozier et al. (2007)

  8. Severity neglect in low, average, and high morning cortisol groups Relation between Neglect and Morning Cortisol Levels 3 3 2.5 2.5 F(2, 114) = 4.27, p < .05 F(2, 114) = 4.27, p < .05 2 2 1.5 1.5 Severity of Neglect Severity of Neglect 1 1 0.5 0.5 0 0 Low Low Average Average High High Morning Cortisol Level Morning Cortisol Level Bruce, Fisher, Pears, & Levine (under review) Neglect is the primary form of maltreatment associated with HPA dysregulation

  9. ADHD Substance abuse Prefrontal Cortex Regions • Inhibitory control • Working memory • Planning • Decision-making in context of rewards and consequences

  10. 6.00 r = -.22, p = .02 5.00 4.00 3.00 2.00 1.00 0.00 -2.00 -1.50 -1.00 -0.50 0.00 0.50 1.00 1.50 Executive Functioning Association Between # of Prior Placements and Executive Functioning # of placements

  11. Neurobiological vulnerabilities from early stress for foster children HPA system Prefrontal cortex Disrupted daily rhythm Impaired executive function Severity of neglect # of placements • Neurobiologically informed interventions • Interventions with neurobiological targets

  12. Early intervention in foster care works

  13. Foster Parent Consultant Family Therapist ‘Daily Report’ Caller STAFF Child Therapist Behavioral Skills Trainer Child Psychiatrist Home Preschool/school Case Manager Contexts Community MTFC-P emphasizes 3 domains: Caregiver-Child Relationship Case Management Child Needs

  14. Foster parent support & consultation services Pre-placement training Weekly group meeting 24/7 on call support Child treatment services Parenting support for birth/adoptive families Daily Report telephone check-in w/caregiver Clearly specified staff roles & responsibilities 5 Key Program Components

  15. HPA Plasticity Therapeutic intervention

  16. Group effects on morning cortisol levels across time for all children Reg foster care MTFC-P Comm-unity Comp Fisher, Gunnar, Dozier, Bruce, & Pears (2007), Annals NYAS

  17. CC MTFC-P Correct Incorrect Correct Incorrect Correct Incorrect Intervention effects on executive functioning:Feedback negativity at Fz (prefrotnal center electrode site) RFC 16 14 Group: F(2, 31) = 1.80, ns Interaction: F(2, 31) = 5.11, p < .05 12 10 8 6 4 2 0 -200 -100 0 100 200 300 400 500 600 700 800 -2 -4 -6 Bruce, Martin-McDermott, Fisher, & Fox (under review) -8 -10 -12

  18. Conditional probability of caregiver stress given child behavior problems 0.35 RFC TFC 0.30 0.25 Caregiver Stress 0.20 0.15 0.10 2 4 6 8 10 12 14 Month Fisher & Stoolmiller (in press)

  19. MTFC-P Caregiver stress levels are directly related to children’s cortisol levels Fisher & Stoolmiller (2007) Caregiver stress Morning Cortisol

  20. Change in attachment (% secure behavior)

  21. Intervention begins Child 7 Child 8 Child 9 Early intervention improves permanency outcomes Birth 1yr 2yrrs 3yrs 4yrs 5yrs 6yrs 7yrs

  22. Successful permanent placements for children with 4 or more prior placements at study start • Regular foster care 9 of 23 (39%) • MTFC-P 23 of 29 (79%)

  23. Acknowledgements NIMH MTFC-P StudyKatherine PearsJackie BruceKristen Greenley Hyoun Kim NIMH Early Experience, Stress Neurobiology & Prevention Science NetworkMegan Gunnar Paul PlotskyGig LevineSteve SuomiNathan FoxSeth PollakMary Dozier Charles Neal James BlackMar Sanchez Delia VasquezRon Barr_ NIDA Transdisciplinary Prevention CenterJohn ReidPatti Chamberlain Leslie LeveDavid DeGarmoMike Stoolmiller Rebecca Fetrow NIH Institutes NIMH, NIDA, NICHD

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