Context

In Australia, government policies support therapeutic interventions for children and young people (CYP) with challenging behaviours related to or secondary to disability, who are in out-of-home care. The aims of interventions are to enhance the skills of both CYP and foster caregivers/parents in order to enhance placement stability, community participation and the overall well-being of the CYP. These interventions are costly and time consuming for CYP, their foster caregivers/parents and the professionals/agencies involved, and evaluation of their effectiveness is warranted.

Objectives

To review the effectiveness of current practices and interventions for CYP in out-of-home care who have challenging behaviours related to disabilities.

Data sources

Databases searched included: PsycINFO (1840–September 2010), ERIC (1966–September 2010), MEDLINE (1950–September 2010), CINAHL (1982–September 2010), Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2010), Social Services Abstracts (1979–September 2010), PAIS international (1972–September 2010), PsycARTICLES (1894–September 2010), Sociological abstracts (1952–September 2010).

Study selection

Randomised or quasi-randomised controlled trials (RCT), non-randomised controlled trials, and cohort studies of interventions or programs for CYP with complex psychological and/or behavioural issues, and/or a disability in foster care were included.

Data extraction

Details of study characteristics, population demographics and intervention content were tabulated. Qualitative analysis was performed by two independent raters using the Physiotherapy Evidence Database (PEDro) scale for RCTs and an adapted version of The Downs and Black Checklist for Measuring Study Quality (DB Scale) for non-randomised control trials.

Data synthesis

Four studies met inclusion criteria (two RCTs and two non-randomised control trials). The two RCTS were of moderate methodological quality, each scoring five points (out of a maximum of 10) on the PEDro Scale. The two non-randomised control trials were of similar methodological quality, scoring 14–17 points (out of a maximum of 28) on the adapted Downs and Black Checklist.

Content

The included studies evaluated a variety of interventions which differed considerably with respect to services offered, approach/philosophy, service delivery models and intensity/duration. Two of the four studies were of behaviourally based parent training interventions. Whilst the other two studies also involved parent training, the primary focus of intervention was the implementation of individualised case management plans by key stakeholders in the CYP's life. The frequency of intervention and length of follow-up in the included studies varied greatly. Three of the reviewed studies reported positive outcomes for children and young people, as well as their caregivers/parents, whilst the fourth found no significant change.

Conclusions

Studies generally demonstrated gains from the interventions provided, however the nature and extent of these benefits differed greatly across the various outcomes measured. Further, studies often did not take into account other factors which may have contributed towards the observed outcomes. In light of the complexity of providing services to CYP with behavioural issues and/or disability who are in out-of-home care, the costs associated with these services, and the risks if these are not effective, this review highlights the need the need for further research of the efficacy of support services for this group.

Highlights

We review interventions for youth with challenging behaviour in out-of-home care.

We detail and appraise the studies, their participants, interventions and results.

Interventions may address behaviour, placement stability and education outcomes.

Older males with externalising and delinquent behaviours demonstrate most gains.

Interventions have mixed results for foster carers.