Adaptation and Evaluation of the KEEP Model

Not Applicable

• Conditions: Depression, Anxiety; Post Traumatic Stress Disorder; Suicide and Self-harm; Externalizing Behavior
• Interventions: Behavioral: Non-Affinity KEEP; Behavioral: KEEP

• Registration Number: NCT05816421
• Lead Sponsor: Oregon Social Learning Center

Brief Summary

This study capitalizes on an opportunity to formally evaluate local adaptations of "Keeping Foster and Kinship Parents Supported and Trained" (KEEP), an evidence-based foster parent intervention, to reduce mental health disparities among child welfare-involved youth and improve care quality and long-term outcomes for Native, Hispanic/Latino, Black/African American, and sexual and gender minority youth. The knowledge gained from the study will impact all current and future large-scale implementations of KEEP and will bolster our scientific understanding the impact of KEEP on youth mental health outcomes.

Detailed Description

This study capitalizes on a contract with the Oregon Department of Human Services Child Welfare to implement KEEP state wide in Oregon with a focus on increasing access to services for minority youth populations. To help the child welfare system meet their goal of achieving health equity, adaptations to the KEEP curriculum have been made for minority groups, and KEEP is being delivered in "affinity groups". Affinity KEEP groups are tailored to meet a specific population's needs and are comprised of parents who all share a common interest, purpose, or key characteristic. To date, Affinity KEEP groups are being offered for foster/kin parents of populations defined by sexual and gender minority youth and Native youth, and for Spanish-speaking parents. The curriculum is currently being revised for transracial foster/kin placements where the youth and one or more parents are of a different race/ethnicity. The current proposal seeks to study N = 166 new families, as part of the ongoing Oregon KEEP implementation, and aggregate existing data from four KEEP studies to use propensity score matching to reduce selection bias and strengthen causal inferences that can be drawn from the potential benefits of providing KEEP to underserved minority populations. By leveraging two decades worth of data on the KEEP intervention and using state-of-the-art data harmonization techniques and a quasi-experimental design, this study affords a rigorous evaluation of whether tailoring the KEEP curriculum to minority populations' specific needs, and providing KEEP to foster/kin parents, improves youth mental health outcomes (i.e., depression/anxiety, post-traumatic stress disorder symptoms, suicidality, and externalizing behaviors) (Aim 1). The study could have a wide reach, impacting our understanding of how to improve and inform equitable delivery of services to youth and families involved in the child welfare system, and effectively address youth mental health disorders and improve care quality and long-term outcomes for a high-risk, underserved population of youth.

Study Timeline

• Study Start: 2022-05-16
• Study First Submitted: 2022-11-17
• Status Verified: 2023-03
• Study First Submitted QC: 2023-04-14
• Last Update Submitted: 2023-04-17
• Study First Posted: 2023-04-18
• Last Update Posted: 2023-04-20
• Primary Completion: 2024-04-30
• Study Completion: 2024-04-30

Recruitment & Eligibility

• Status: ENROLLING_BY_INVITATION
• Sex: All
• Target Recruitment: 166

Inclusion Criteria

Foster/resource parents who have been recruited to attend KEEP and have a focal youth for the intervention that:

• is a dependent of Child Welfare Services in the state of Oregon
• is between the ages of 4 and 21 years.

Exclusion Criteria

Foster/resource parents who have been recruited to attend KEEP and have a focal youth for the intervention that:

• is younger than 4 years of age.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Non-Affinity KEEP	Non-Affinity KEEP	Parents attending a Non-Affinity KEEP group.
Affinity KEEP	KEEP	Affinity KEEP groups are tailored to meet a specific population's needs and are comprised of parents who all share a common interest, purpose, or key characteristic. The four types of Affinity KEEP groups for this study include: * foster/kin parents of sexual and gender minority youth * foster/kin parents of Native youth * transracial placements where the youth and one or more parents are of a different race/ethnicity * groups delivered in Spanish

Primary Outcome Measures

Name	Time	Method
Mean change in youth externalizing behaviors	Baseline and 6-months post-baseline	Psychometric scoring techniques will be used to harmonize items across multiple KEEP studies and instruments. Specifically, moderated nonlinear factor analysis will be utilized to estimate externalizing behavior factor scores that account for differential item functioning and impact across the set of study- and person-level covariates. Youth externalizing behaviors will be measured via parent report using items from the Child Behavior Checklist and Parent Daily Report at baseline and 6-months post-baseline.
Mean change in youth post traumatic stress disorder (PTSD) symptoms	Baseline and 6-months post-baseline	Psychometric scoring techniques will be used to harmonize items across multiple KEEP studies and instruments. Specifically, moderated nonlinear factor analysis will be utilized to estimate PTSD symptoms factor scores that account for differential item functioning and impact across the set of study- and person-level covariates. Youth PTSD symptoms will be measured via parent report using items from the Child Behavior Checklist and Parent Daily Report at baseline and 6-months post-baseline.
Mean change in youth self harming behaviors and suicidal ideation	Baseline and 6-months post-baseline	Measured via parent report using the Child Behavior Checklist at baseline and 6-months post-baseline
Mean change in youth depression and anxiety symptoms	Baseline and 6-months post-baseline	Psychometric scoring techniques will be used to harmonize items across multiple KEEP studies and instruments. Specifically, moderated nonlinear factor analysis will be utilized to estimate depression and anxiety symptoms factor scores that account for differential item functioning and impact across the set of study- and person-level covariates. Youth depression and anxiety symptoms will be measured via parent report using items from the Child Behavior Checklist and Parent Daily Report at baseline and 6-months post-baseline.

Trial Locations

Locations (1)

Oregon Social Learning Center; 🇺🇸 Eugene, Oregon, United States