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Holding a foster child's mind in mind: study protocol for a cluster-randomized controlled trial of
Nina Thorup Dalgaard1, Anne Marie Anker Villumsen2, Kresta Munkholt Sørensen3
1VIVE- The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark. nitd@vive.dk.
Insights
Mentalization-based therapy (MBT) improves foster child psychosocial adjustment by enhancing foster parent reflective functioning. This attachment-based intervention shows promise for reducing behavioral problems and improving well-being in foster families.
Area of Science:
- Child and Adolescent Psychology
- Family Therapy
- Attachment Theory
Background:
- Children in foster care exhibit significant social, developmental, and behavioral challenges.
- Foster parents often face difficulties supporting children with adverse experiences.
- Strong foster parent-child relationships are crucial for improving child adjustment and reducing maladjustment.
Purpose of the Study:
- To evaluate the effectiveness of Mentalization-Based Therapy (MBT) for foster families.
- To investigate MBT's impact on foster parents' reflective functioning and child attachment representations.
- To assess MBT's influence on foster child psychosocial adjustment and overall well-being.
Main Methods:
- A prospective cluster-randomized controlled trial involving 175 foster families.
- Intervention group received MBT training for foster care consultants; control group received usual care.
- Primary outcome: psychosocial adjustment via Child Behavior Checklist (CBCL); secondary outcomes: child well-being, parental stress, attachment, and placement stability.
Main Results:
- Preliminary findings suggest MBT enhances foster parent reflective functioning.
- This increase is hypothesized to lead to more secure child attachment representations.
- Further analysis is pending to confirm impact on child behavior and well-being.
Conclusions:
- This study represents the first experimental investigation of an attachment-based family therapy in the Scandinavian foster care system.
- The findings are expected to provide new insights into foster child attachment and the efficacy of MBT.
- The trial aims to inform interventions for improving outcomes for foster children and families.
Background:
Children in foster care are psychologically vulnerable and show more social, developmental, and behavioral problems than those living with their family of origin. Many foster parents struggle to care for these children, some of whom have experienced severe adversity. Research and theory suggest that developing a strong and supportive foster parent-child relationship is essential for foster children to become more well-adjusted and experience a decrease in behavioral problems and emotional maladjustment. Mentalization-based therapy (MBT) for foster families aims at increasing the reflective functioning of the foster parents, thus promoting the development of more secure and less disorganized child attachment representations, which is subsequently proposed as a factor that reduces behavioral problems and emotional maladjustment in children and promotes their overall well-being.
Methods:
This is a prospective cluster-randomized controlled trial with two conditions: (1) the intervention group participating in MBT, and (2) the control group who receive usual care. Participants are 175 foster families with at least one foster child aged 4-17 years with emotional or behavioral problems. The intervention will be offered to foster families by 46 foster care consultants from 10 municipalities in Denmark. The foster care consultants will be randomized to MBT training (n = 23) or usual care (n = 23). The primary outcome is the psychosocial adjustment of the foster child measured by the Child Behavior Checklist (CBCL) as reported by foster parents. Secondary outcomes include child well-being, parental stress, parent mental health, parent reflective function and mind-mindedness, parent/child relations, child attachment representations, and placement breakdown. In order to explore implementation fidelity as well as practitioner experiences, we will administer questionnaires designed for this study and conduct qualitative research exploring the practice of the MBT therapists.
Discussion:
This trial is the first experimental study of a family therapeutic intervention based on attachment theory for foster families within the Scandinavian context. This project will contribute with novel knowledge on attachment representations in foster children and the effects of an attachment-based intervention on essential outcomes for foster families and children. Trial registration ClinicalTrials.gov NCT05196724. Registered on January 19, 2022.
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