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The Early Intervention Foster Care Program: A Glass Half Full

Fisher, Burraston, and Pears (2005) are to be praised for the randomized clinical trial they conducted examining the efficacy of the Early Intervention Foster Care (EIFC) Program. The Adoption and Safe Families Act of 1997 mandates, with some exceptions, that permanency be achieved for maltreated children who have been in out-of-home care for 15 of the last 22 months but provides no guidelines to states on how to achieve this goal. Fisher and colleagues’ work provides a database to begin to develop best practice guidelines for permanency-focused interventions for children removed from their parents’ care, but it is only a start. Fisher et al. (2005) reported a permanent placement success rate of 90% (26/29) for the EIFC condition and 64% (16/25) for the regular foster care (RFC) control group. These rates were calculated without using the entire sample. They were generated using only the children who attained permanent placements by the 2-year follow-up—62% (29/47) of the EIFC group and 58% (25/43) of the RFC group. Permanent placements were actually only achieved and maintained for 55% (26/47) of the EIFC sample and 37% (16/43) of the RFC cohort. When the full sample of children with 2-year data is used to calculate permanency rates, the difference between the two treatments is no longer statistically significant (χ = 2.96, df = 1, p = .085). The EIFC Program includes (a) 20 hours of parent management training for caregivers, (b) daily telephone calls from staff to monitor child behavior, (c) weekly support meetings with program staff and other foster parents, (d) weekly home visits, (e) 24/7 emergency back-up; and (f) a multidisciplinary team that includes a consulting psychiatrist. The severity of the mental health needs of children in foster care necessitates such an intensive approach, yet the data suggest that something is missing from the package, because permanency was not attained in almost half the cases by 2 years postremoval. In the discussion section of their article, Fisher and colleagues (2005) reported that attachment problems frequently lead to placement disruption. Attachment problems and trauma-specific symptomatology (e.g., nightmares, flashbacks) are not a primary focus of EIFC interventions and may be important to target more systematically in future iterations of the EIFC program. Problems experienced by birth parents were also not a primary focus of the EIFC intervention. In our experience (DeSena et al., 2005; Grasso, CrouseArtus, Billingslea, Douglas-Palumberi, & Kaufman, 2005) and consistent with the work of others in the field (National Center on Addiction and Substance Abuse, 1999), the majority of parents involved with protective services meet criteria for substance abuse disorders. It is standard practice in most states for protective service workers to refer parents for treatment for these problems. In our prospective longitudinal follow-up study of 126 children removed from their parents’ care, this strategy resulted in only approximately 50% of the parents with substance abuse disorders receiving treatment for these problems by 1-year follow-up. In addition, untreated substance abuse problems were associated with prolonged out-ofhome stays, revictimization, and reentry into care for many of the children in our study. Empirically validated addiction interventions exist, but these have yet to be routinely integrated into permanency planning approaches for families involved with protective services. Adult trauma, mental health, and domestic violence are other issues that complicate the outcomes of these cases and require targeted intervention in permanency initiatives, with intensive outreach to facilitate treatment engagement. The outcomes of the children in the EIFC group were better than the children in RFC—but the glass is only half full. More program development and rigorous evaluation studies are needed to develop best practices for serving maltreated children and their