The aim of this study is to examine the effects of Mentalization Based Therapy (MBT) for foster families in Denmark on child mental health and well-being, parental stress, mental health, and reflective function, parental mind-mindedness and the parent-child relationship.
Children placed in foster care are psychologically and physically vulnerable and show more social, developmental, and behavioral problems than children living with their family of origin. Many foster parents struggle to care for these children, some of whom have experienced serious adversity at a young age. The study examines the effects of Mentalization Based Therapy (MBT) in a cluster-randomized controlled trial with 175 foster families with children aged 4-17 years in 10 Danish municipalities.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
175
The focus is on improving the core components of secure attachment, particularly by developing the reflective functioning for all professionals working with children in out-of-home care, which is subsequently proposed to increase the psychosocial adjustment of the child and decrease emotional and behavioral problems. MBT treatment consists of up to 12 weekly sessions with the foster parents and child covering three core components: 1) psycho-education about mentalizing, trauma, and attachment for foster parents; 2) support for reflective practice in the professional network, and 3) mentalization-based therapy for the foster family \[41\].
The control group will receive the usual care offered to foster families such as supervision
VIVE - The Danish Centre of Social Science Research
Copenhagen, Denmark
Child mental health
The Child Behavior Checklist (CBCL) measures behavioral and emotional problems in children and adolescents. The CBCL consists of 113 questions, scored on a three-point Likert scale (0=absent, 1= occurs sometimes, 2=occurs often). The CBCL is completed by foster parents for all children in the trial, and the Youth Self-Report (YSR) is completed by the foster children or adolescents aged 11 and above. The CBCL is widely used and has proven to be a useful tool for detecting psychopathology in children and shows good results regarding both validity and reliability
Time frame: post-intervention (16 weeks)
Child Mental health
The Child Behavior Checklist (CBCL) measures behavioral and emotional problems in children and adolescents. The CBCL consists of 113 questions, scored on a three-point Likert scale (0=absent, 1= occurs sometimes, 2=occurs often). The CBCL is completed by foster parents for all children in the trial, and the Youth Self-Report (YSR) is completed by the foster children or adolescents aged 11 and above. The CBCL is widely used and has proven to be a useful tool for detecting psychopathology in children and shows good results regarding both validity and reliability
Time frame: Follow-up (6 months post-intervention)
Child well-being
Kidscreen-10 is a 10-item measure of child well-being health-related quality of health). Items are scored from 1 (never) to 5 (always) except for items 1 and 9 (reverse). A higher score is better. Kidscreen-10 is used with families where the target foster child is 8 years old or more.
Time frame: post-intervention (16 weeks)
Child well-being
Kidscreen-10 is a 10-item measure of child well-being health-related quality of health). Items are scored from 1 (never) to 5 (always) except for items 1 and 9 (reverse). A higher score is better. Kidscreen-10 is used with families where the target foster child is 8 years old or more.
Time frame: follow-up (6 months post-intervention)
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Parental reflective function
Parental Reflective Functioning Questionnaire - PRFQ is an 18 item measure of parental reflective function. The PRFQ consists of three subscales with score ranges 6-42: 1) Pre-Mentalizing Modes (PRFQ-PM) 6 items (a low score indicates better function). 2) Certainty about Mental States (PRFQ-CMS) 6 items (a medium score indicates better function). 3) Interest and curiosity in mental states PRFQ-IC 6 items (a high score indicates better function)
Time frame: post-intervention (16 weeks)
Parental reflective function
Parental Reflective Functioning Questionnaire - PRFQ is an 18 item measure of parental reflective function. The PRFQ consists of three subscales with score ranges 6-42: 1) Pre-Mentalizing Modes (PRFQ-PM) 6 items (a low score indicates better function). 2) Certainty about Mental States (PRFQ-CMS) 6 items (a medium score indicates better function). 3) Interest and curiosity in mental states PRFQ-IC 6 items (a high score indicates better function)
Time frame: follow-up (6 months post-intervention)
Parent-child interaction
To assess the foster parent-child relationship, the study uses the video-based system Coding Interactive Behavior (CIB). The CIB is a global rating system for social interactions that includes 22 parent codes, 16 child codes, and 5 dyadic codes rated on a scale of 1 to 5 which can be aggregated into the following composites: sensitivity, intrusiveness, limit setting, involvement, withdrawal, compliance, dyadic reciprocity, and dyadic negative states. The CIB is coded based on a 6-minute parent/child free-play or interaction recorded in the home or at another location if preferred by the family. The CIB system has been validated as an assessment measure in multiple studies of mother-child interactions in both normative and high-risk populations and shows stability over time, predictive validity, and adequate psychometric properties. The video will be with the child and one of the foster parents. The foster parents are free to choose which parent participates.
Time frame: post-intervention (16 weeks)
Attachment
The Story Stem Assessment Profile (SSAP) is a narrative-based measure, for the assessment of internal representations in children between the ages of 4 and 11 years old. Using a standard doll family and play materials, the interviewer enacts the beginning of a story (a story stem) and asks the child to complete the story using the provided play materials. The method allows the child to enact the story in a playful manner creating a narrative based on both verbal and nonverbal inputs, offering a unique insight into the child's perception of the nature and quality of relationships. The short version of the SSAP entails a set of 7 story stems, which introduce the beginning of a story for the child to complete, within which lies "an inherent dilemma." The SSAP has demonstrated robust psychometric properties and has been validated with children in out-of-home-care the UK.
Time frame: post-intervention (16 weeks)
Parental stress
The Parenting Stress Scale (PSS) \[52,53\] is an 18 item measure of parenting stress that is rated on a five-point scale (Strongly disagree, Disagree, Undecided, Agree, Strongly agree). Total score range 18-90, where a low score indicates less stress
Time frame: post-intervention (16 weeks)
Parental stress
The Parenting Stress Scale (PSS) \[52,53\] is an 18 item measure of parenting stress that is rated on a five-point scale (Strongly disagree, Disagree, Undecided, Agree, Strongly agree). Total score range 18-90, where a low score indicates less stress
Time frame: follow-up (6 months post-intervention)
Parent mental health
The WHO-5 index is a short questionnaire assessing emotional well-being in adults during the previous 2 weeks. It consists of five positively formulated items. The degree to which these feelings were present in the last 2 weeks is scored on a 6-point Likert-type scale ranging from 0 (not present) to 5 (constantly present). Item scores are summated and transformed to a 0-100 scale, with lower scores indicating poorer well-being. The WHO-5 index has been cross-culturally validated and has proven to be psychometrically sound.
Time frame: post-intervention (16 weeks)
Parent mental health
The WHO-5 index is a short questionnaire assessing emotional well-being in adults during the previous 2 weeks. It consists of five positively formulated items. The degree to which these feelings were present in the last 2 weeks is scored on a 6-point Likert-type scale ranging from 0 (not present) to 5 (constantly present). Item scores are summated and transformed to a 0-100 scale, with lower scores indicating poorer well-being. The WHO-5 index has been cross-culturally validated and has proven to be psychometrically sound.
Time frame: follow-up (6 months post-intervention)
Parental mind-mindedness
To assess representational Mind-mindedness we will use the mind-mindedness interview, addressing the foster carer's tendency to spontaneously think of the child as a psychological being. The foster carers will be asked to describe their child, and their answers are coded following the manual. The number of produced sentences about the child's mental characteristics (instead of sentences related to the child's behavior, physical or situational aspects) provides an indication of the level of the caregiver's mental representation of the child, or "representational mind-mindedness".
Time frame: post-intervention (16 weeks)
Parental mind-mindedness
To assess representational Mind-mindedness we will use the mind-mindedness interview, addressing the foster carer's tendency to spontaneously think of the child as a psychological being. The foster carers will be asked to describe their child, and their answers are coded following the manual. The number of produced sentences about the child's mental characteristics (instead of sentences related to the child's behavior, physical or situational aspects) provides an indication of the level of the caregiver's mental representation of the child, or "representational mind-mindedness".
Time frame: follow-up (6 months post-intervention)
Perception of the family
the general functioning subscale of the Family Assessment Device (FAD) is a 6-item subscale to measure the perception of the family function. It is scored on a 4-point Likert scale. Items are summed to a total subscale score
Time frame: post-intervention (16 weeks)
Perception of the family
the general functioning subscale of the Family Assessment Device (FAD) is a 6-item subscale to measure the perception of the family function. It is scored on a 4-point Likert scale. Items are summed to a total subscale score
Time frame: follow-up (6 months post-intervention)