Mitigating HPA axis dysregulation associated with placement changes in foster care

Fisher, Philip A.; Ryzin, Mark J. Van; Gunnar, Megan R.

doi:10.1016/j.psyneuen.2010.08.007

Cited by 112 publications

(112 citation statements)

References 38 publications

(48 reference statements)

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“…Nine studies [183][184][185][186][187][188][189][190][191][192][193][194][195][196][197][198] examined the effects of these models of care. Five studies [183][184][185][186][187][188]190,191,194,198 measured psychological distress, five studies 189,192,194,197,198 looked at behavioural outcomes, four studies 190,191,194,195,197 explored social functioning, three studies 190,191,197 measured cognitive performance, two studies 194,198 examined addiction behaviour, one study 190,191 examined resilience and two studies 190,191 looked at placement stability.…”

Section: Intensive Service Modelsmentioning

confidence: 99%

“…treatment foster care 145,[183][184][185][186][187][188][189][190][191][192][193] 2. therapeutic residential or day-care services [194][195][196][197] 3. co-ordinated care. 198 In this context, treatment foster care is used to describe a number of intensive interventions targeted at children in foster care, rather than -as is sometimes done -as the name of an intervention.…”

Section: Intensive Service Modelsmentioning

confidence: 99%

See 1 more Smart Citation

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Macdonald

Livingstone

Hanratty

et al. 2016

Health Technol Assess

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BackgroundChild maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems.ObjectivesTo synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment.Study designFor effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views.ParticipantsChildren and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months.InterventionsAny psychosocial intervention provided in any setting aiming to address the consequences of maltreatment.Main outcome measuresPsychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability.MethodsYoung Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible.ResultsWe identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive–behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) –0.44 (95% CI –4.43 to –1.53)], depression [mean difference –2.83 (95% CI –4.53 to –1.13)] and anxiety [SMD –0.23 (95% CI –0.03 to –0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist–child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself.ConclusionsIt is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions.LimitationsStudies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses.Future workStudies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes.Study registrationThis study is registered as PROSPERO CRD42013003889.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Intensive Service Modelsmentioning

confidence: 99%

Section: Intensive Service Modelsmentioning

confidence: 99%

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Macdonald

Livingstone

Hanratty

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…Although physiological reactivity in humans can be altered in the short term by psychosocial interventions (34,35), including in children exposed to maternal deprivation (36,37), we are unaware of experimental research examining whether random assignment to a caregiving environment alters patterns of physiological reactivity later in development. Finally, although a sensitive period exists during which the environment has particularly strong influences on stress response system development in animals, studies that can rigorously identify such a period in humans are lacking.…”

mentioning

confidence: 99%

Causal effects of the early caregiving environment on development of stress response systems in children

McLaughlin

Sheridan

Tibu³

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

357

330

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Disruptions in stress response system functioning are thought to be a central mechanism by which exposure to adverse early-life environments influences human development. Although early-life adversity results in hyperreactivity of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis in rodents, evidence from human studies is inconsistent. We present results from the Bucharest Early Intervention Project examining whether randomized placement into a family caregiving environment alters development of the autonomic nervous system and HPA axis in children exposed to early-life deprivation associated with institutional rearing. Electrocardiogram, impedance cardiograph, and neuroendocrine data were collected during laboratorybased challenge tasks from children (mean age = 12.9 y) raised in deprived institutional settings in Romania randomized to a highquality foster care intervention (n = 48) or to remain in care as usual (n = 43) and a sample of typically developing Romanian children (n = 47). Children who remained in institutional care exhibited significantly blunted SNS and HPA axis responses to psychosocial stress compared with children randomized to foster care, whose stress responses approximated those of typically developing children. Intervention effects were evident for cortisol and parasympathetic nervous system reactivity only among children placed in foster care before age 24 and 18 months, respectively, providing experimental evidence of a sensitive period in humans during which the environment is particularly likely to alter stress response system development. We provide evidence for a causal link between the early caregiving environment and stress response system reactivity in humans with effects that differ markedly from those observed in rodent models.childhood adversity | early-life stress | HPA axis | autonomic nervous system | stress reactivity D isruptions in stress response system functioning are thought to be a central mechanism by which exposure to adverse early-life environments influences human development. This idea is borne out in rodent models, where the effects of early-life adversity on the development of stress response systems have been well characterized. Exposure to early-life adversityinvolving repeated and prolonged separation of a pup from its mother-results in hyperreactivity of the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis in adolescence and adulthood and elevations in anxiety, fearful behaviors, and hypervigilance (1-4). Stress exposure in mature rodents is associated with immediate, but not lasting, changes in stress response systems (5, 6), suggesting the presence of an early sensitive period when exposure to adverse environments results in long-term changes in physiological stress response system functioning.

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“…15,17 Another study found that placement changes predicted dysregulation in cortisol for the control group only. 18 Our study adds to the growing body of literature by examining the impact of a child-focused intervention on permanency and placement outcomes. The Fostering Healthy Futures (FHF) program is a 9-month preventive intervention for preadolescent children aged 9 to 11 who were recently placed in foster care because of child maltreatment.…”

Section: Discussionmentioning

confidence: 98%

RCT of a Mentoring and Skills Group Program: Placement and Permanency Outcomes for Foster Youth

2012

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Children in foster care are at elevated risk for adverse outcomes. Placement instability and failure to achieve timely permanence exacerbate that risk. A handful of studies have found that parent-management training is effective in promoting placement stability and timely permanence. WHAT THIS STUDY ADDS:Unlike parent-management training, youth focused interventions have not been systematically evaluated for their impact on placement and permanency outcomes. A mentoring and skills group intervention for preadolescents in foster care demonstrated better placement and permanency outcomes, especially for high-risk subgroups.abstract OBJECTIVE: To examine the impact of a mentoring and skills group intervention for preadolescent children in foster care on placement stability and permanence at 1-year postintervention. METHODS:A randomized controlled trial was conducted with 9-to 11-year-old children who were maltreated and placed in foster care (n = 54 control; n = 56 intervention). State child welfare records provided information on number of placement changes, placement in residential treatment, and case closure (ie, permanency). Rates of adoption and reunification were also examined. Analysis was by intention to treat. RESULTS:After controlling for baseline functioning and preintervention placement history, intervention youth were 71% less likely to be placed in residential treatment (odds ratio [OR] = 0.29, 95% confidence interval [CI] 0.09-0.98). There were no significant treatment differences in predicting placement changes or permanency for the total sample. Among a subsample of children living in nonrelative foster care at baseline, intervention youth had 44% fewer placement changes (incidence ratio = 0.56, 95% CI 0.34-0.93), were 82% less likely to be placed in a residential treatment center (OR = 0.18, 95% CI 0.03-0.96), and were 5 times more likely to have attained permanency at 1 year postintervention (OR = 5.14, 95% CI 1.55-17.07). More intervention youth had reunified 1-year postintervention [x 2 (1, N = 78) = 3.99; P , .05], and the pattern of findings suggested that intervention youth had higher rates of adoption. A significant interaction [x 2 (1, N = 110) = 5.43; P = .02] demonstrated that the intervention attenuated the impact of baseline behavior problems on placement changes. CONCLUSIONS:The findings suggest that participation in a 9-month mentoring and skills group intervention leads to greater placement stability and permanence, especially for children in nonrelative foster care. Pediatrics 2012;130:e33-e39

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Mitigating HPA axis dysregulation associated with placement changes in foster care

Cited by 112 publications

References 38 publications

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Causal effects of the early caregiving environment on development of stress response systems in children

RCT of a Mentoring and Skills Group Program: Placement and Permanency Outcomes for Foster Youth

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