Outcomes

KEEP has been rigorously tested: 6 randomized controlled trials, independent replications, outside evaluations, and numerous studies published in peer-reviewed journals.

Outcomes for Children & Adolescents:

  • Lower rates of emotional and behavioral problems
  • Shorter lengths of stay in care
  • Lower rates of placement disruptions for youth with multiple previous placements
  • More frequent reunification with family
  • Less substance use (for adolescents)
  • Lower rates of health-risking sexual behavior (for adolescents)

Outcomes for Foster & Kinship Parents:

  • Higher rates of positive parenting
  • Lower rates of discipline
  • Lower rates of turnover
  • Spillover of positive effects to other children in the home

Outcomes for the Child Welfare System/Workforce:

  • Longer tenure for foster parents providing care
  • Fewer days in care

Research

KEEP® originated from Treatment Foster Care Oregon (TFCO), formerly Multidimensional Treatment Foster Care (MTFC), a program developed as a family-based alternative for teenagers with chronic delinquency and mental health problems. Instead of relying on group or residential care centers outside of their communities, children and teenagers in TFCO are placed in well-trained supported foster homes and provided with an array of therapeutic services. Numerous well-controlled, randomized studies have shown that outcomes for youth in TFCO compared very favorably to those who had been placed in group or residential care. For information on TFCO, see http://www.tfcoregon.com/.

Given these results, the developers wanted to know if parts of the TFCO model could be used with the foster and kinship parents who work in state child welfare systems. These early questions ultimately led to development of KEEP.

A small experiment in Oregon funded by the U.S. Department of Health and Human Services Children’s Bureau showed that, when compared to foster parents who received case work services as usual, parents who participated in a KEEP® group had fewer placement breakdowns, had children with lower levels of behavioral and emotional problems, and provided foster care for a longer period of time (i.e., they didn’t drop out from providing care).

A larger randomized effectiveness trial funded by the National Institute of Mental Health (NIMH) in San Diego showed that, compared to case work services as usual, parents who participated in KEEP had children who were reunified more frequently with biological or adoptive parents and were less likely to disrupt from their foster care placements. The effects for preventing disruption were strongest for children who had been placed in multiple previous foster homes. Children in the KEEP foster homes also had lower rates of behavior problems than children in the “as usual” control condition. (Note: The peer reviewed research reports on these outcomes may be found below under Publications.)

After the NIMH trial ended in 2005, the San Diego Health and Human Services continued to implement KEEP as part of its regular services to foster and kinship parents. In 2007 the National Association of Counties named San Diego County an Achievement Award Winner for its work on KEEP “…in recognition of an effective and innovative program which contributes to and enhances county government in the United States.”

Recent evaluations in England and in Maryland have shown positive results on decreasing placement disruption rates and child behavioral and emotional problems.


IMPLEMENTATION STORIES

Mid-term Review of KEEP Implementation in Denmark 

Oxford Research has prepared a mid-term evaluation of the implementation of KEEP across five municipalities in Denmark, which began in 2015. Initial findings show that the program is effective in reducing parental stress and children’s behavioral problems. The evaluation also focuses on the implementation process with recommendations for sites intending to implement KEEP in the future.

Best Practice

KEEP® and KEEP SAFE™ have been recognized by several independent clearinghouses and registries for promising and evidence-based practices.

Publications

The effectiveness of KEEP® programs has been demonstrated in trials funded by the US Department of Health and Human Services and the National Institute of Mental Health. Details of these findings are available in these peer reviewed research reports and other resources.

Peer-Reviewed Publications

Buchanan, R., Bennett, K., & Chamberlain, P. (2019). KEEP SAFE: Supporting the caregiver-teen relationship to improve health outcomes for teens in child welfare. In T. LaLiberte, K. Barry, & K. Walthour (Eds.), Child Welfare 360° (pp. 24). St. Paul, MN: Center for Advanced Studies in Child Welfare, University of Minnesota. Retrieved from https://cascw.umn.edu/portfolio-items/understanding-substance-use-and-interventions-in-child-welfare-cw360/.

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 Welfare1(1), 5–21.

Chamberlain, P. (2017). Towards creating synergy among policy, procedures, and implementation of evidence-based models in child welfare systems: Two case examples. Clinical Child and Family Psychology Review20, 78-86.

Chamberlain, P., Feldman, S. W., Wulczyn, F., Saldana, L., & Forgatch, M. (2016). Implementation and evaluation of linked parenting models in a large urban child welfare system. Child Abuse & Neglect, 53, 27-39.

Greeno, E.J., Lee, B.R., Uretsky, M.C., Moore, J.E., Barth, R.P., & Shaw, T.V. (2016). Effects of a foster parent training intervention on child behavior, caregiver stress, and parenting style. Journal of Child and Family Studies, 25, 1991-2000.

Greeno, E.J., Uretsky, M.C., Lee, B.R., Moore, J.E., Barth, R.P., & Shaw, T.V. (2016). Replication of the KEEP Foster and Kinship Parent Training program for youth with externalizing behaviors. Children and Youth Services Review 61, 75-82.

Roberts, R., Glynn, G., & Waterman, C. (2016). ‘We know it works but does it last?’ The implementation of the KEEP foster and kinship carer training programme in England. Adoption and Fostering, 40(3), 247-263.

Ek, A., Chamberlain, K. L., Ejderhamn, J., Fisher, P. A., Marcus, C., Chamberlain, P., & Nowicka, P. (2015). The More and Less Study: a randomized controlled trial testing different approaches to treat obesity in preschoolers. BMC Public Health, 15, 735-751.

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, 685-695.

Buchanan, R., Chamberlain, P., Price, J. M., & Sprengelmeyer, P. (2013). Examining the equivalence of fidelity over two generations of KEEP implementation: A preliminary analysis. Children and Youth Services Review, 35, 188–193.

Kim, H. K., Pears, K. C., Leve, L. D., Chamberlain, P. C., & 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 and Adolescent Substance Abuse, 22, 370-387.

Goldhaber-Fiebert, J. D., Bailey, S. L., Hurlburt, M. S., Zhang, J., Snowden, L. R., Wulczyn, F., Landsverk, J., & Horwitz, S. M. (2012). Evaluating Child Welfare policies with decision-analytic simulation models. Administration & Policy in Mental Health, 39, 466-477.

Lewis, K., & Chamberlain, P. (2012). What works in treatment foster care. In P. A. Curtis (Ed.), What works in Child Welfare (pp. 217–233). Washington DC: CWLA Press.

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, 740-750.

Chamberlain, P., & Lewis, K. (2010). Promoting placement stability through parent-mediated intervention. In T. LaLiberte & E. Snyder (Eds). Child Welfare 360⁰ (pp. 19–20). Center for Advanced Studies in Child Welfare (CASCW), School of Social Work, College of Education and Human Development: University of Minnesota.

DeGarmo, D. S., Chamberlain, P., Leve, L. D., & Price, J. (2009). Foster parent intervention engagement moderating child behavior problems and placement disruption. Research on Social Work Practice, 19(4), 423-433.

Price, J., Chamberlain, P., Landsverk, J., & Reid, J. (2009). KEEP foster parent training intervention: Model description and effectiveness. Child & Family Social Work, 14, 233–242.

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.

Chamberlain, P., Price, J., Reid, J. B., & Landsverk, J. (2008). Cascading implementation of a foster and kinship parent intervention. Child Welfare, 87(5), 27-48.

Price, J. M., Chamberlain, P., Landsverk, J., Reid, J., Leve, L., & Laurent, H. (2008). Effects of a foster parent training intervention on placement changes of children in foster care. Child Maltreatment, 13, 64-75.

KEEP in the News

Brown, J. (2019, Sep 3). New funds expand foster parent support program statewide. The Register-Guard. Retrieved from: https://www.registerguard.com/news/20190819/new-funds-expand-foster-parent-support-program-statewide

Dowsett, L. (2019, May 3). Advocates, workers rally in Salem for foster care. Street Roots. Retrieved from https://news.streetroots.org/2019/05/03/advocates-workers-rally-salem-foster-care

Baccaglini, B. (2016, May 2). Innovative program reduces the number of children in foster care. HuffPost. Retrieved from https://www.huffpost.com/entry/innovative-program-reduce_b_9821356

Greeno, E.J., Chamberlain, P., & Uretsky, M.C. (2016, March 14). Findings from a parenting intervention for foster and kinship families. inSocialWork Podcast Series®. Podcast retrieved from http://www.insocialwork.org/episode.asp?ep=187