Early Intervention for Foster Children

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Early Intervention for Foster Children

• Philip A. Fisher, Ph.D.
• Oregon Social Learning Center

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The Early Intervention Foster Care Study, 1999-
Outcomes at 6 mo intervals thru middle
childhood
N 117 Preschool Aged Foster Children
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Adrift in the foster care system
Birth 1yr 2yrrs 3yrs
4yrs
5yrs
6yrs 7yrs
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When foster care works
Birth 1yr 2yrrs 3yrs
4yrs
5yrs
6yrs 7yrs
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(adapted from Fisher, Burraston, Pears, 2005)
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HPA axis dysregulation associated with early life
stress
(downregulation via chronic stress)
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Some, but not all, foster children show altered
HPA axis function
Delaware
Oregon
Bruce, Fisher, Pears, Levine (submitted)
Dozier et al. (2007)
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Neglect is the primary form of maltreatment
associated with HPA dysregulation
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Prefrontal Cortex Regions

• Inhibitory control
• Working memory
• Planning

• Decision-making in context of rewards and
  consequences

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Association Between of Prior Placements and
Executive Functioning
of placements
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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

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Early intervention in foster care works
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MTFC-P emphasizes 3 domains
Child Needs
Caregiver-Child Relationship
Case Management
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5 Key Program Components

• 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

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HPA Plasticity
Therapeutic intervention
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Group effects on morning cortisol levels across
time for all children
MTFC-P
Reg foster care
Comm-unity Comp
Fisher, Gunnar, Dozier, Bruce, Pears (2007),
Annals NYAS
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Intervention effects on executive
functioningFeedback negativity at Fz
(prefrotnal center electrode site)
RFC
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Group F(2, 31) 1.80, ns Interaction F(2, 31)
5.11, p 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)
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-10
-12
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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)
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Caregiver stress levels are directly related to
childrens cortisol levels Fisher Stoolmiller
(2007)
Caregiver stress
Morning Cortisol
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Change in attachment ( secure behavior)
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Early intervention improves permanency outcomes
Birth 1yr 2yrrs 3yrs
4yrs
5yrs
6yrs 7yrs
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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)

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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