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Interventions for 0-5 year old children: New Developments. Philip A Fisher, PhD, University of Oregon & OSLC. Stress!. Solutions for Stress. Experience Shapes Brain Architecture by Over-Production Followed by Pruning (700 synapses formed per second in the early years).
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Interventions for 0-5 year old children: New Developments Philip A Fisher, PhD, University of Oregon & OSLC
Experience Shapes Brain Architecture by Over-Production Followed by Pruning (700 synapses formed per second in the early years) birth 6 years 14 years
Toxic Stress Changes Brain Architecture Typical neuron— many connections Normal Toxic stress Damaged neuron— fewer connections Prefrontal Cortex and Hippocampus Sources: Radley et al. (2004) Bock et al. (2005)
Solutions for stress: MTFC-P • MTFC-P foster kids have more normal cortisol levels • Mechanisms: • Reduces foster parent stress associated with child behavior problems • Foster parents more able to tolerate children’s misbehavior • Children feel safer during major transition periods
Walker, H. (1994). Social skills in school-age children and youth: Issues and best practices in assessment and intervention. Topics in Language Disorders, 14(3), 70-82
Philip A. Fisher, PhD Professor of Psychology, University of Oregon Eugene, OR 97403-1227 tel. 541-346-4968 email philf@uoregon.edu Senior Research Scientist, Oregon Social Learning Center 10 Shelton McMurphey Blvd., Eugene, OR 97401 tel. 541-485-2711 fax 541-485-7087 email philf@oslc.org
Effects of Foster Care Interventions: ERP Feedback Negativity study using a color flanker task
Color Flanker Task: 4 Combinations Congruent Incongruent Green Red
Community Intervention Correct Incorrect Correct Incorrect Correct Incorrect PILOT STUDY of intervention effects attention to feedbackFeedback negativity at Fz (prefrotnal center electrode site) Group: Interaction: F(2, 31) = 1.80, ns F(2, 31) = 5.11, p < .05 Reg Foster Care 16 14 12 10 8 Limitations: No pre-intervention measures, small subsample of overall RCT sample, variation in how long intervention group receiving services 6 4 2 0 -200 -100 0 100 200 300 400 500 600 700 800 -2 -4 -6 -8 -10 Bruce, Martin-McDermott, Fisher, & Fox (2009) -12
Figure 1. Replication of intervention effects on FRN from randomized clinical trial of foster care intervention. Grand average waveforms for the feedback-related negativity (FRN) at Fz for correct (gray line) and incorrect trials (black line). Note. The feedback stimuli were presented at 0 ms, and the baseline window was at –150 to –50 ms relative to the feedback stimuli. Pre Intervention Post Intervention Reg Foster Care FRN FRN Intervention FRN FRN
Compensatory process interventions • Implicit Assumption: Rather than focusing on the affected neural systems, it may be more effective to recruit alternative systems and develop competencies based on these systems • Pros: May be effective with individuals who do not show responsiveness to other interventions; some evidence from neurorehabilitation literature • Cons: Largely untested
Patterns of brain activation during a go-no go task for community and foster children Foster care (n=8) Normal control (n=8) Fisher, Bruce, et al., in press
“One perspective on individual differences in memory capacity views variation in terms of the number of 'slots' that are available for short-term storage. However, apparent capacity differences might also be explained by variations in the efficiency with which information is selected to fill this limited workspace. A useful analogy for understanding the difference between these two ideas is the difference between the space that is available in an exclusive nightclub and the effectiveness of the bouncer who grants admission. From this perspective, high-capacity individuals may have a better bouncer rather than a larger nightclub...” Awh & Vogel, 2008 Nature Neuroscience
Possible Mechanism: MTFC Mitigates the Effects of Problem Behavior on Risk for Disrupted Placement Fisher et al. (in press)
Sample for Economic Analysis • 117 children enrolled in the RCT of MTFC-P, including n=57 intervention and n=60 regular foster care • Children were between 3-6 years old at enrollment and entering a new placement • Placement instability subsample: Children entering study with 4 or more prior placements (RFC=23, MTFC-P=29)
Cost effectiveness methodology • MTFC-P intervention costs. The total cost of MTFC-P was estimated from clinical trial records and study staff estimates. Study accounting records provided payroll costs, cost of facilities and overhead, and information on purchases of goods and services. Study staff members estimated the time to complete each intervention task. The cost of staff supervision, time to develop treatment plans for the child and family, and staff training were also included. • RFC costs. Staff members from the child welfare agency provided estimates of time spent delivering RFC services. When agency-reported costs for delivering RFC services were not available, published unit costs were used. • Nonprotocol health and social services : For services provided outside of MTFC-P or RFC programs, comprehensive profiles of usual care services were created from a carregiver-report survey designed for this study.
Table 1. Unadjusted mean (SD) costs (2008 USD) at 24 mo. post-randomization, full sample Abbreviations: RFC, regular foster care; MTFC-P, Multidimensional Treatment Foster Care for Preschoolers. Significance tests adjusted for differences in gender, number of placements prior to start of study, and baseline severity. *P < .05; **P < .005.
Table 1. Unadjusted mean (SD) costs (2008 USD) at 24 mo. post-randomizatoin for instability subsample Abbreviations: RFC, regular foster care; MTFC-P, Multidimensional Treatment Foster Care for Preschoolers. Significance tests adjusted for differences in gender, number of placements prior to start of study, and baseline severity. *P < .05; **P < .005.
Cost Effectiveness Plane $10,000 Higher cost, worse outcome Higher cost, better outcome II I $5,000 Incremental total costs $0 IV III -$5,000 Lower cost, better outcome Lower cost, worse outcome -$10,000 Incremental proportion of permanent placements (TFC-RFC)
