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Key overview details

Classification
  • Targeted
Mental Wellbeing Need
  • Supporting Behavioural Challenges
  • Anger/Aggression
  • Conduct Problems
  • Prosocial behaviour
  • Promoting Emotional Wellbeing
  • Emotion Regulation / Emotional literacy
  • Supporting Positive Relationships
  • Parenting
  • Parent-child relationship / Attachment
  • Social Skills / Positive Peer Relationship
Target Age
  • Primary school: 6 to 12 years
  • Adolescents: 13 to 18 years
Provision
Usability Rating
3
Supports Rating
4
Evidence Rating
4

Evidence

4

Fit

Capacity

Supports

4

Usability

3

Need

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Keeping foster and kinship carers supported (KEEP) safe

Summary

Keeping foster and kinship carers supported (KEEP) safe programme is a support and skills training programme for foster/ kinship guardians of young people aged 12-17 years. This programme is designed to improve parenting skills for the purpose of enhancing young peoples’ positive behaviours; boosting young peoples’ social competence and positive relationships; helping them avoid health-risking behaviours; and increasing placement stability. KEEP safe is delivered to kinship/ foster carer groups (8-12 per group) over sixteen weeks in 90 minutes weekly sessions. Two trained group leaders deliver the group sessions using a manualised curriculum, however each session is tailored to the needs and circumstances of group participants. It is delivered in the community, using both didactic and interactive formats, with key concepts demonstrated via role-play and videotapes.

KEEP has been delivered in England.

Website: https://www.oslcdevelopments.org/keep/, https://www.keepfostering.org/

Usability - Rating: 3

Core Components

Keeping foster and kinship carers supported (KEEP) safe (formerly called Middle School Success intervention, MSS) is a support and skills training programme for foster/ kinship guardians of young people aged 12-17 years. The programme focuses on enhancing young people’s positive behaviours; boosting their social competence and positive relationships; helping young people avoid health-risking behaviours; and increasing placement stability.

The KEEP safe programme involves delivery of a caregiver management training to groups of foster parents/ kinship carers/ special guardians (8-12 per group). It is delivered over sixteen weeks in 90-minute weekly sessions by two trained practitioners. The sessions teach behaviour management strategies and positive parenting strategies including techniques for positive reinforcement, limit setting, dealing with difficult behaviours, enhancing warmth and encouragement, promoting school success, and managing parental stress. The sessions also prepare foster parents/ kinship carers to discuss health risking behaviours, sexual activity, and substance use with their young person. Although KEEP safe is delivered using a manualised curriculum, its sessions are tailored to the needs, priorities and circumstances of group participants. Information about specific behaviours is collected from guardians (by phone) on a weekly basis. This information is subsequently integrated into the weekly sessions, enhancing the sessions’ relevance and currency.  The programme manual is structured in a way that enables participants to build on their skills, therefore the sequence of delivery of programme sessions should be adhered to. Free sessions, without a predetermined agenda, are also built into the manual to allow practitioners to manage spill-overs from previous sessions, and to review past topics. Makeup sessions (in the form of home visits or video calls) are offered to guardians who have missed group sessions.

KEEP is typically delivered in a community centre (e.g. schools, community church, local authority office) using didactic and interactive formats. Programme activities include role-plays, games, and discussions. Booster sessions that are delivered over eight weeks are offered a year after completion of the sixteen week groups. The booster sessions re-emphasise the same skills taught in the programme, and are tailored to the current home situation.

Fidelity

Programme fidelity is maintained by adherence to the strategies listed below:

  1. Uploading recorded footage of all group sessions on the KEEP secure website for fidelity rating and feedback. Recorded sessions are uploaded for review up until practitioner accreditation
  2. Remote clinical supervision provided weekly to group leaders by the KEEP team. This is continued until group leader accreditation
  3. Parents Daily Report (PDR) call to foster/ kinship carers, completed once a week over sixteen weeks. Information collected during the PDR call is incorporated into the programme sessions
  4. Facilitator accreditation process

Modifiable Components

Keeping foster and kinship carers supported (KEEP) safe is one of three KEEP programmes designed for foster and kinship carers. The other two are 1) KEEP standard for carers of young people aged 5-12 years, and 2) KEEP prevention for carers of children aged 3-6 years. Fidelity to the KEEP model requires the incorporation of the experiences of each parent’s home into the group discussions. Specific child behaviours information is collected weekly and integrated into the sessions to enhance sessions’ relevance. KEEP group discussions are therefore always reflective of the needs of the children that are cared for by guardians in the group. KEEP is available in English and Spanish, and has been delivered in Denmark, Sweden, England, and across the USA. KEEP programme developers are open to making adaptations in order to enhance programme relevance to the culture that the programme is being delivered.

KEEP is a less intensive version of Treatment Foster Care Oregon (a programme that provides residential placements for children and youth with severe emotional/behavioural problems).

Supports - Rating: 4

The suite of Keeping foster and kinship carers supported (KEEP) programmes (KEEP safe, KEEP standard and KEEP prevention) were developed in Oregon by Dr. Patricia Chamberlain (lead model developer) in collaboration with co-model developers. Implementation and operation support is provided by Oregon Social Learning Center Developments, Inc. Oregon, USA.

Support for Organisation / Practice

Implementation Support

A three-month readiness period is encouraged to enable the KEEP team provide pre-implementation and implementation support to the implementing site. The KEEP team provide organisations with the KEEP implementation manual, programme readiness checklist, and work with leadership at the site to provide other support (e.g. with hiring/ identifying of facilitators, and learning the fidelity monitoring system). The KEEP team also provide practitioner training, weekly clinical supervision (delivered until group leader accreditation), fidelity monitoring, and guidance for adhering to the KEEP programme model.

Licence Requirements

There are no licence requirements for programme delivery.

Start-up Costs

KEEP programme implementation cost is relative to the size/ scope of implementation. Organisations are advised to contact the KEEP team for detailed cost information.

Building Staff Competency

Qualifications Required

KEEP is delivered to each group by two practitioners (called group leaders) with experience working with foster carers and in group facilitation. Practitioners typically have a willingness to deliver a manualised intervention, and are usually from within the community. Practitioners can come from diverse backgrounds/ occupation, including child welfare case workers, therapists, former foster parents, or carers. A supervisor has overall responsibility for the programme and oversees the group leaders. Depending on the agency structure, the supervisor can be the programme director, senior manager, or mid-level manager.

Training Requirements

All organisation staff can attend a two-day (non-obligatory) foundation training to enhance their knowledge of the programme. Practitioners who will become group leaders are required to attend a five-day intensive experiential group training (10-12 per group). Practitioners who receive this initial five days training can go on to deliver Keeping foster and kinship carers supported (KEEP) standard programme. Practitioners who want to deliver the KEEP safe programme are required to attend an additional three days training to enhance the delivery of the programme content to older children. The KEEP team recommend training for at least three group leaders/ facilitators per organisation to enhance the robustness of the programme on the implementing site. To become accredited in KEEP safe, accredited KEEP standard group leaders (who have received the additional three days KEEP safe training) are required to deliver one KEEP safe foster/kinship group. Group leaders who meet performance criteria can apply for KEEP safe accreditation. Accredited group leaders can carry on running group sessions, with twice yearly fidelity checks. In order to enhance programme efficiency and sustainability, accredited group leaders can become local KEEP trainers and coaches. To achieve this, accredited group leaders are required to attend an additional five days of training, and lead on one group leader training.

Supervision Requirements

The programme supervisor oversees and supports the KEEP team delivering the groups. Supervision is typically provided by a practitioner higher up in the implementing organisation. Group leaders also receive remote clinical supervision with KEEP team, and this is continued until group leader accreditation.

Evidence - Rating: 4

Theory of Change

Keeping foster and kinship carers supported (KEEP) is based on social learning theory. The programme aims to improve parent skills and competence, specifically with regards to optimising youth development. It teaches foster and kinship carers the skills for positive re-enforcement and effective limit setting. Applications of these skills are expected to grow the young people’s positive behaviours, and expand youth’s strengths, which can translate to decreased youth behaviour problems (e.g. anxiety, depression, anti-social behaviours), and reduced health-risking behaviours, as well as increased placement stability, and enhanced youth social competences and positive relationships.

Primary school: 6 to 12 years - Rating: 4

Research Design & Number of Studies

The best evidence for KEEP safe programme in children aged 6-12 years come from two internally conducted randomized controlled trials (RCTs). The first study included 100 girls (in 4th -6th grades, mean age 11.54 years), and their foster carers (Smith et al., 2011; Kim and Leve 2011; Kim et al., 2013). The second RCT included 259 male and female youth (aged 11-17 years) and their foster parents (Kim et al., 2017). Participants included in both studies were recruited through the child welfare system, and were of diverse ethnic origins. Separate outcomes for 12-year olds only was not available.

Outcomes Achieved

Compared to the control group who did not receive the intervention, the following outcomes were observed:

Child Outcomes

  • Significantly reduced internalising and externalising behaviours at 6 months post-baseline (Smith et al., 2011)
  • Significantly increased prosocial behaviours at 12 months post-baseline (Kim and Leve, 2011)
  • Significantly decreased placement changes at 12 months post-baseline (Kim and Leve, 2011)
  • Significantly reduced substance use at 18 months post-baseline (Kim et al., 2017), and 36 months post-baseline (Kim and Leve, 2011)
  • Significantly reduced health-risking sexual behaviours at 36 months post-baseline (Kim et al., 2013)
  • Significantly higher relationship quality at 6 months post-baseline (Kim et al., 2017)
  • Significantly reduced association with deviant peers at 12 months post-baseline (Kim et al., 2017)

Parent Outcomes

None

Key References

Smith, D. K., Leve, L. D., & Chamberlain, P. (2011). Preventing internalizing and externalizing problems in girls in foster care as they enter middle school: Impact of an intervention. Prevention Science, 12(3), 269-277

Kim, H. K., & Leve, L. D. (2011). Substance use and delinquency among middle school girls in foster care: A three-year follow-up of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 79(6), 740-750

Kim, H. K., Pears, K. C., Leve, L. D., Chamberlain, P., & Smith, D. K. (2013). Intervention effects on health-risking sexual behavior among girls in foster care: The role of placement disruption and tobacco and marijuana use. Journal of Child & Adolescent Substance Abuse, 22(5), 370-387

Kim, H. K., Buchanan, R., & Price, J. M. (2017). Pathways to preventing substance use among youth in foster care. Prevention Science, 18(5), 567-576

Adolescents: 13 to 18 years - Rating: 4

Research Design & Number of Studies

Evidence outcomes for KEEP safe in children aged 13-18 years is the same as for the 6-12 years evidence above.

Fit

Values

Keeping foster and kinship carers supported (KEEP) safe is a support and skills training programme for foster and kinship guardians of young people aged 12-17 years. This group programme takes a positive parenting approach with the aim to improve parenting skills and competence, specifically with regards to optimising young peoples’ development.

  • Does this approach align with the key values of your organisation?

Priorities

Keeping foster and kinship carers supported (KEEP) safe is delivered to foster/ kinship guardians of young people aged 12-17 years. The programme aims to promote strategies to enhance young peoples’ positive behaviours; boost their social competence and positive relationships; help young people avoid health-risking behaviours; and increase placement stability.

  • Is your service looking to deliver an intervention that focuses on improving parenting skills of foster/kinship guardians?
  • Is a parent targeted intervention a priority for your service, or would a child focused intervention be a better fit?
  • Is a programme that is delivered in group format suitable for your organisation?

Existing Initiatives

  • Does your organisation have an existing support and skills training programme for foster/ kinship guardians of young people aged 12-17 years?
  • Are there components addressed by KEEP safe that are not met by existing programmes?
  • Are the existing initiatives effective?
  • Do they fit your current and anticipated future requirements?
Capacity

Workforce

Keeping foster and kinship carers supported (KEEP) safe is delivered to each group by two practitioners (called group leaders) with experience in working with foster cares and in group facilitation. Practitioners can be from diverse backgrounds/ occupations including child welfare case workers, therapists, former foster parents, or carers. A supervisor has overall responsibility for the programme, and they can be the programme director, senior manager, or mid-level manager within the implementing organisation. Practitioners who will become group leaders are required to attend a five-day intensive experiential group training prior to delivering the programme. The KEEP team recommend training for at least three group leaders/ facilitators per organisation. Does your organisation have practitioners who are available and interested in learning and delivering this programme?

  • Does your organisation have practitioners who are available and interested in learning and delivering this programme?
  • Can your organisation support the time commitment required for practitioner training and accreditation?

Technology Support

Key KEEP concepts are presented through role-play and videotapes, equipment will be required to enable this (e.g. video player, projector, monitor/TV/ projector screen). To enhance programme fidelity, recorded footage of KEEP group sessions are uploaded onto the KEEP secure website for review. In addition, Parents Daily Report (PDR) calls are completed to foster/ kinship carers once a week (over sixteen weeks), and group leaders receive weekly remote clinical supervision that is maintained until group leader accreditation.

  • Does your organisation have technology to demonstrate key KEEP concepts in groups sessions?
  • Is there available technology to remotely consult with the KEEP team, as well as to record and upload videos for review?
  • Can weekly PDR calls to carers be supported?

Administrative Support

Keeping foster and kinship carers supported (KEEP) is delivered in a community setting. Makeup sessions (in form of home visits or video calls) are offered to guardians who have missed group.

  • Does your organisation have a consistent venue to deliver the sixteen weeks group sessions to foster/ kinship guardians?
  • Is there administrative capacity to offer make-up sessions to guardians?

Financial Support

Keeping foster and kinship carers supported (KEEP) programme implementation cost is relative to the size/ scope of implementation. Organisations are advised to contact the KEEP team for detailed cost information.

Need

Comparable Population

KEEP safe is delivered to foster and kinship guardians of young people aged 12-17 years. Evidence of effectiveness comes from two Randomised Controlled Trials (RCTs) that included children (mean age 11.54 years in one study, and aged 11-17 years in the second study) and their foster parents. All participants were recruited through the child welfare system.

  • Is this comparable to the population your organisation would like to serve?

Desired Outcome

KEEP safe aims to promote strategies to enhance young peoples’ positive behaviours; boost their social competence and positive relationships; help young people avoid health-risking behaviours; and increase placement stability. Programme delivery is associated with significant improvements across several outcomes including significantly reduced internalising and externalising behaviours, substance use, health-risking sexual behaviours, and placement changes. KEEP safe is also associated with significantly improved social behaviours and relationship quality.

  • Is supporting foster and kinship carers to enhance young people’s positive behaviours, increase placement stability, and promote positive development a priority for your service?
  • Does your organisation have other initiatives in place that effectively and efficiency address the above outcomes?
Developer Details

Dr. Patricia Chamberlain (Lead KEEP model developer)

keep@oslc.org.

https://www.oslcdevelopments.org/keep/, https://www.keepfostering.org/