Family-Based Telehealth for Foster Care Support

Overseen By Johanna Folk

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of California, San Francisco

Disqualifiers: Caregiver rights terminated, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

Duration: 9 weeks

300 Participants Needed

Trial Summary

What is the purpose of this trial?

The purpose of this research is to adapt and evaluate the efficacy of an existing family based intervention to be delivered via telehealth to child welfare-involved (CWI) youth and their caregiver of origin.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your healthcare provider.

What data supports the effectiveness of the treatment Family-based Telehealth Intervention for foster care support?

Research shows that telehealth family therapy can be as effective as face-to-face therapy for child behavioral problems and parental depression, and it can even be better than usual treatments or waiting for therapy. Additionally, telehealth services have been found to improve caregiver outcomes and satisfaction in pediatric rehabilitation, and virtual parent-child interaction therapy has reduced child behavior problems and caregiver stress. ^{1 2 3 4 5}

Is family-based telehealth safe for use in foster care support?

Research on family-based telehealth interventions, including those for trauma-focused therapy and autism spectrum disorder, suggests they are generally safe and feasible for use, with no significant safety concerns reported in studies. ^{6 7 8 9 10}

How is the Family-based Telehealth Intervention treatment different from other treatments for foster care support?

The Family-based Telehealth Intervention is unique because it uses telehealth (remote healthcare services via technology) to deliver family therapy, making it more accessible for youth in foster care and their families who face barriers to traditional in-person therapy. This approach focuses on engaging diverse families by considering multi-systemic factors and aims to improve behavioral health outcomes through virtual family support. ^{6 7 11 12 13}

Research Team

Marina Tolou-Shams, PhD

Principal Investigator

University of California, San Francisco

Eligibility Criteria

This trial is for English-speaking caregivers and their foster care youth aged 12-18 with ongoing child welfare involvement. Caregivers must be the youth's caregiver of origin, able to consent, and without cognitive impairments. Youth also need to understand English or Spanish and be capable of giving informed assent.

Inclusion Criteria

I am the primary caregiver for the participating child.

I am proficient in English or Spanish.

I will be caring for a child aged 12-18 who is involved with child welfare.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention Adaptation

Iterative adaptation of the family-based telehealth intervention with feedback from youth and caregiver participants and stakeholder partners

4 weeks

Multiple virtual sessions

Treatment

Delivery of the family-based telehealth intervention to CWI youth and their caregivers

9 weeks

Weekly virtual sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment

3 months

Virtual assessments at 3 months post-intervention

Treatment Details

Interventions

• Family-based Telehealth Intervention

Trial Overview The study tests a family-based intervention delivered through telehealth aimed at improving parent-child relationships and communication among foster care youth and their original caregivers.

Participant Groups

Group I: Family-based Telehealth Treatment Experimental Treatment 1 Intervention

A family-based telehealth intervention.

Family-based Telehealth Intervention is already approved in United States for the following indications:

Approved in United States as Family-based Telehealth Intervention for:

• Mental health support for foster care youth and their caregivers

Who Is Running the Clinical Trial?

University of California, San Francisco

Lead Sponsor

Trials

2,636

Recruited

19,080,000+

Visa Foundation

Collaborator

Trials

1

Recruited

300+

Findings from Research

Telehealth (TH) family therapy shows equivalent efficacy to traditional face-to-face therapy for child behavioral problems and parental depression, based on meta-analyses of 20 studies, indicating it is a viable treatment option.

Existing TH guidelines primarily focus on operational aspects rather than therapeutic processes, suggesting a need for improved guidelines that incorporate effective engagement strategies and risk mitigation for better therapeutic outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring the Efficacy of Telehealth for Family Therapy Through Systematic, Meta-analytic, and Qualitative Evidence. McLean, SA., Booth, AT., Schnabel, A., et al.[2022]

A scoping review of 31 studies on pediatric telehealth interventions found that integrating caregivers into therapy sessions leads to improved outcomes for both caregivers and children.

Caregivers reported high satisfaction and acceptability of telehealth services, highlighting the importance of measuring caregiver engagement and outcomes in future pediatric rehabilitation telehealth research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Measuring Caregiver Outcomes in Pediatric Rehabilitation Telehealth Services: A Scoping Review. Tkach, MM., Earwood, JH.[2023]

The pilot study successfully transitioned Parent-Child Interaction Therapy (PCIT) to a virtual model (I-PCIT) for 86 families during the COVID-19 pandemic, showing significant improvements in child behavior and caregiver stress, with medium to large effect sizes.

Collaboratively developed training strategies for therapists, such as online communities and training materials, were linked to the most significant positive outcomes for both children and caregivers, highlighting effective methods for virtual service delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rapid, Full-Scale Change to Virtual PCIT During the COVID-19 Pandemic: Implementation and Clinical Implications. Garcia, D., Blizzard, AM., Peskin, A., et al.[2022]

In a study involving 40 racially and ethnically diverse children aged 3-5 with disruptive behavior disorders, Internet-delivered parent-child interaction therapy (I-PCIT) showed a higher treatment response rate (70%) compared to standard clinic-based PCIT (55%) after treatment.

I-PCIT not only resulted in significant improvements in children's symptoms and reduced parental burden but also had fewer perceived barriers to treatment, indicating it may be a more accessible option for families.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Remotely delivering real-time parent training to the home: An initial randomized trial of Internet-delivered parent-child interaction therapy (I-PCIT). Comer, JS., Furr, JM., Miguel, EM., et al.[2022]

Telehealth can effectively train parents in naturalistic teaching strategies to enhance communication skills in children with autism, as demonstrated in a study with five parent-child dyads.

Parents achieved high fidelity in training and reported positive experiences, while children showed variable improvements in communication and increased positive affect, making this approach a cost-effective alternative to traditional training methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of a telehealth platform on ABA-based parent training targeting social communication in children with autism spectrum disorder. Ferguson, J., Dounavi, K., Craig, EA.[2022]

Family-based telehealth interventions show promise in addressing the behavioral health needs of youth in foster care, who often face significant barriers to accessing treatment.

The authors propose a framework to enhance engagement in clinical research for these interventions, emphasizing the importance of understanding the multi-systemic factors that affect youth and family participation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Ecodevelopmental Framework for Engaging Diverse Youth in Foster Care and Their Families Into Technology-Based Family Intervention Research Trials. Folk, JB., Gill, H., Ordorica, C., et al.[2023]

Telehealth Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) significantly reduced posttraumatic stress symptoms in young people in care, with a notable average score decrease from 25.64 to 13.57 after treatment, indicating its efficacy.

Despite the positive outcomes, the study revealed low completion rates for the telehealth TF-CBT program, suggesting that barriers still exist that hinder treatment completion for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining the Feasibility of Telehealth Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) with Young People in Foster Care. Martin, AN., McLeigh, JD., Lamminen, LM.[2023]

The ImPACT Online program, which trains parents to use evidence-based interventions for children with autism spectrum disorder via telehealth, showed a 25.8% registration rate among families referred to the program, indicating potential for wider dissemination.

While parents in the open trial reported high satisfaction with the program, they engaged at a lower rate compared to those in controlled trials, suggesting that additional support strategies may be necessary to enhance participation and effectiveness in community settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Self-Directed Telehealth Parent-Mediated Intervention for Children With Autism Spectrum Disorder: Examination of the Potential Reach and Utilization in Community Settings. Ingersoll, B., Shannon, K., Berger, N., et al.[2018]

A study involving 129 foster-parent-child dyads showed that both brief and extended versions of Parent-Child Interaction Therapy (PCIT) significantly reduced parenting stress and improved parenting behaviors, demonstrating the efficacy of this intervention in a community-based setting.

The brief PCIT intervention was found to be as effective as the extended version, suggesting that shorter training can still provide substantial support to foster parents, making it a practical option for integration into existing care services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhancing Foster Parent Training with Parent-Child Interaction Therapy: Evidence from a Randomized Field Experiment. Mersky, JP., Topitzes, J., Janczewski, CE., et al.[2020]

A qualitative needs assessment involving 7 participants (3 intervention leaders and 4 youth) identified key areas for adapting a trauma-based intervention for online delivery, focusing on safety, participation, and learning.

Usability testing with 10 participants (5 intervention leaders and 5 youth) showed that while the adapted online format was generally acceptable, there is a need for clearer guidance on safety processes to enhance the intervention's effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adaptation of the trauma group intervention 'Teaching Recovery Techniques' for online delivery: A participatory design and usability study. Pérez-Aronsson, A., Thell, M., Lampa, E., et al.[2022]

Telepractice early intervention (EI) for families of young children with developmental disabilities can enhance engagement and potentially improve therapy outcomes through better collaboration and communication among multidisciplinary teams.

Preparation and training for both professionals and families are crucial for effective engagement in telepractice, as they help address unique challenges and improve the overall quality of remote early intervention services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring engagement in telepractice early intervention for young children with developmental disability and their families: a qualitative systematic review. Retamal-Walter, F., Waite, M., Scarinci, N.[2023]

A systematic review of 12 studies on telebehavioral interventions for family caregivers of individuals with traumatic brain injury (TBI) showed that most interventions significantly improved caregiver outcomes like depression and anxiety, with 10 studies reporting clinically meaningful effect sizes.

Despite the positive results, the studies had limitations such as methodological bias and a lack of diverse samples, indicating that further research is needed to understand how caregiver demographics and injury severity affect outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telebehavioral Interventions for Family Caregivers of Individuals With Traumatic Brain Injury: A Systematic Review. Coxe, KA., Liu, C., Moore, M.[2021]

Telepractice videoconferencing technology can effectively deliver home visitation services, allowing families to receive evidence-based support from the comfort of their homes, which enhances accessibility.

A study involving semi-structured interviews with 15 providers identified key engagement strategies for maintaining family participation in telehealth home visitation, including effective communication of benefits and the ability to transition between telehealth and in-person services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Strategies for implementation of virtual home visitation in the United States. Traube, DE., Taylor, A., Cederbaum, JA., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Exploring the Efficacy of Telehealth for Family Therapy Through Systematic, Meta-analytic, and Qualitative Evidence. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Measuring Caregiver Outcomes in Pediatric Rehabilitation Telehealth Services: A Scoping Review. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Rapid, Full-Scale Change to Virtual PCIT During the COVID-19 Pandemic: Implementation and Clinical Implications. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Remotely delivering real-time parent training to the home: An initial randomized trial of Internet-delivered parent-child interaction therapy (I-PCIT). [2022]

5. United States pubmed.ncbi.nlm.nih.gov

The impact of a telehealth platform on ABA-based parent training targeting social communication in children with autism spectrum disorder. [2022]

6. Switzerland pubmed.ncbi.nlm.nih.gov

An Ecodevelopmental Framework for Engaging Diverse Youth in Foster Care and Their Families Into Technology-Based Family Intervention Research Trials. [2023]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Examining the Feasibility of Telehealth Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) with Young People in Foster Care. [2023]

8. Canada pubmed.ncbi.nlm.nih.gov

Self-Directed Telehealth Parent-Mediated Intervention for Children With Autism Spectrum Disorder: Examination of the Potential Reach and Utilization in Community Settings. [2018]

9. United States pubmed.ncbi.nlm.nih.gov

Enhancing Foster Parent Training with Parent-Child Interaction Therapy: Evidence from a Randomized Field Experiment. [2020]

10. Netherlands pubmed.ncbi.nlm.nih.gov

Adaptation of the trauma group intervention 'Teaching Recovery Techniques' for online delivery: A participatory design and usability study. [2022]

11. England pubmed.ncbi.nlm.nih.gov

Exploring engagement in telepractice early intervention for young children with developmental disability and their families: a qualitative systematic review. [2023]

12. United States pubmed.ncbi.nlm.nih.gov

Telebehavioral Interventions for Family Caregivers of Individuals With Traumatic Brain Injury: A Systematic Review. [2021]

13. England pubmed.ncbi.nlm.nih.gov

Strategies for implementation of virtual home visitation in the United States. [2022]