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The Hexagon: An Exploration Tool
The Hexagon can be used as a planning tool to guide selection and evaluate potential programs and practice for use.
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Core Components
Keeping foster and kinship carers supported (KEEP) standard is a support and skills training programme for foster and kinship guardians of children aged 5-12 years. This programme is designed to improve parenting skills for the purpose of enhancing child’s positive behaviours, promoting child well-being, and increasing placement stability.
KEEP standard is delivered to kinship and foster carer groups (7-12 per group) over sixteen weeks by two trained group leaders. Weekly sessions last about 90 minutes and focus on teaching positive parenting strategies (such as warmth and encouragement, positive reinforcement, limit setting, dealing with difficult behaviours, teaching new behaviours, using incentives and managing parental stress), as well as strategies for promoting children’s success in school and friendship. Although KEEP standard is delivered using a manualised curriculum, its sessions are tailored to the needs, priorities and circumstances of group participants. Specific child behaviours information 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, with key concepts presented through role-play and videotapes. Incentives (such as child-care provision and refreshments) can be provided to promote attendance. 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:
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
Remote clinical supervision provided weekly to group leaders by the KEEP team. This is continued until group leader accreditation
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
Group leader accreditation process
Modifiable Components
Keeping foster and kinship carers supported (KEEP) standard is one of three KEEP programmes designed for foster and kinship carers. The other two are 1) KEEP safe for carers of young people aged 12-17, 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).
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
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.
Building Staff Competency
Qualifications Required
Keeping foster and kinship carers supported (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 attend a two-day (non-obligatory) foundation training to enhance their knowledge of the Keeping foster and kinship carers supported (KEEP) programme. Practitioners who will become group leaders are required to attend an additional five-day intensive experiential group training (10-12 per group). 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. After training, practitioners go on to deliver KEEP to foster/ kinship groups, and receive weekly fidelity checks. Practitioners who deliver three foster/ kinship groups and meet performance criteria can apply for 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.
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 child’s development. It teaches foster/ kinship carers the skills for positive re-enforcement and effective limit setting. Application of these skills are expected to grow the child’s positive behaviours, expand child’s strengths, which can translate to decreased child behaviour problems (e.g. anxiety, depression, anti-social behaviours) and placement disruptions.
Preschool: 3 to 5 years - Rating: 4+
Research Design & Number of Studies
The best evidence for KEEP standard programme in children aged 3-5 years comes from two randomized controlled trials (RCTs). The first study was externally conducted, and included 354 foster/ kinship carers of children aged 5-12 years. The children were dependents of Child Welfare Services, and they had been in their current placement for at least one month (Price et al., 2019; Price et al., 2015). The second study was internally conducted and included 700 foster parents of children aged 5-12 years (Chamberlain et al., 2008). The children in the second study were dependents of Child Welfare Services, and were new to foster care, moved from former placements due to disruptions, or re-entering foster care. Both studies were conducted in USA, and included ethnically diverse foster/ kin parents (including African American, Caucasian, Hispanic, and mixed ethnic). Specific data showing the effectiveness for 5-year olds only was not available.
Outcomes Achieved
Compared to the control group who did not receive KEEP, the following outcomes were observed:
Child Outcomes
Significantly decreased child behaviour problems at post assessment (Price et al., 2015; Price et al., 2019), and reduced child behaviour problems at five months post baseline (Chamberlain et al., 2008)
Significantly decreased anxiety/depression scores at post assessment (Price et al., 2019)
Parent Outcomes
Significantly reduced parental stress levels at post-assessment (Price et al., 2015)
Significantly increased proportion positive reinforcement at five months post baseline (Chamberlain et al., 2008)
Key References
Price, J. M., Roesch, S., & Burce, C. M. (2019). The effects of the KEEP foster parent training intervention on child externalizing and internalizing problems. Developmental Child Welfare, 1(1), 5-21
Price , J. M., Roesch, S., Walsh, N. E., & Landsverk, J. (2015). Effects of the KEEP foster parent intervention on child and sibling behavior problems and parental stress during a randomized implementation trial. Prevention Science, 16(5), 685-695
Chamberlain , P., Price, J., Leve, L. D., Laurent, H., Landsverk, J. A., & Reid, J. B. (2008). Prevention of behavior problems for children in foster care: Outcomes and mediation effects. Prevention Science, 9, 17-27
Primary school: 6 to 12 years - Rating: 4+
Research Design & Number of Studies
Evidence outcomes for children aged 6-12 years is the same as for the 3-5 years evidence above.
Need
Comparable Population
Keeping foster and kinship carers supported (KEEP) standard programme is a support and skills training programme for foster and kinship guardians of children aged 5-12 years. This group programme aims to improve parent skills and competence, specifically with regards to optimising child’s development. Evidence of effectiveness comes from randomised controlled trials that included ethnically diverse foster/ kin parents of children aged 5-12 years. The children were dependents of Child Welfare Services in USA, and were in placement.
Is this comparable to the population your organisation would like to serve?
Desired Outcome
Keeping foster and kinship carers supported (KEEP) standard aims to improve parenting skills for the purpose of enhancing child’s positive behaviours, promoting child well-being, and increasing placement stability. Programme delivery is associated with significant improvement across several outcomes, including significantly reduced child behaviour problems, significantly reduced child anxiety/ depression scores, significantly reduced parental stress, and significantly increased parental positive reinforcement.
Is supporting foster and kinship carers to enhance children’s positive behaviours, promote child wellbeing, and increase placement stability a priority for your organisation? Does your organisation have other initiatives in place that effectively and efficiency address the above outcomes?
Need Score
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Fit
Values
Keeping foster and kinship carers supported (KEEP) standard programme is a support and skills training programme for foster and kinship guardians of children aged 5-12 years. This group programme takes a positive parenting approach with the aim of improving parenting skills and competence, specifically with regards to optimising child’s development.
Does this approach align with the key values of your organisation?
Priorities
KEEP Standard is delivered to foster/ kinship guardians of children aged 5-12 years. The programme aims to improve parenting skills for the purpose of enhancing children’s positive behaviours, promoting child wellbeing, and increasing 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 existing guardian training programmes designed to enhance child’s positive behaviours, promote child well-being, and increase placement stability? Are there components addressed by KEEP standard that are not met by existing programmes? Are the existing initiatives effective? Do they fit your current and anticipated future requirements?
Fit Score
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Capacity
Workforce
Keeping foster and kinship carers supported (KEEP) standard is delivered to each group by two practitioners (called group leaders) with experience in working with foster carers 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? 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. Incentives (such as child-care provision and refreshments) can be provided to promote foster/ kinship guardians attendance.
Does your organisation have a consistent venue to deliver the sixteen weekly group sessions to foster/ kinship guardians? Will incentives be provided to boost guardians’ attendance? 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.
Capacity Score
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