Reaching Optimal Implementation and Mental Health Outcomes for Underserved and Rural Communities in Foster and Kinship Care: Adaptation and Evaluation of the KEEP Model - PROJECT SUMMARY There are alarming disparities in the prevalence of mental health (MH) disorders and suicide between youth with a history of child welfare system (CWS) and their non-CWS-involved peers. Yet few services are designed for these high-risk youth, and even fewer focus on racial and ethnic, and sexual and gender minority (SGM) populations, which bear a disproportionate proportion of the burden of MH disorders and are overrepresented in the CWS. Also underserved in the CWS are rural populations for which few services exist. “Keeping Foster and Kinship Parents Supported and Trained” (KEEP) is an evidence-based intervention that focuses on optimizing the role of foster/kin parents as the agents of positive change for children and youth. The proposed application capitalizes on a current contract with the Oregon Department of Human Services Child Welfare to implement KEEP state wide in Oregon with a focus on increasing access to services for rural and minority youth populations. To help the CWS meet their goal of achieving health equity, adaptations to the KEEP curriculum have been made for minority groups, and KEEP is being delivered in “affinity groups”. Affinity KEEP (A-KEEP) groups are tailored to meet a specific population’s needs and are comprised of parents who all share a common interest, purpose, or key characteristic. To date, A-KEEP groups are being offered for foster/kin parents of populations defined by SGM youth and Native youth, and for Spanish-speaking parents. The curriculum is currently being revised for transracial foster/kin placements where Black/African American youth are placed in homes with one or more White parents. KEEP groups are also offered via web conference for rural foster/kin parents. The current proposal seeks to study N = 500 new families (53% rural and 15% A- KEEP), as part of the ongoing Oregon KEEP implementation, and aggregate existing data from four KEEP studies (N = 2,397) to use propensity score matching to reduce selection bias and strengthen causal inferences that can be drawn from the potential benefits of providing KEEP to underserved rural and minority populations. By leveraging two decades worth of data on the KEEP intervention and using state-of-the-art data harmonization techniques and a quasi-experimental design, this study affords a rigorous evaluation of whether tailoring the KEEP curriculum to minority populations’ specific needs, and providing KEEP to rural foster/kin parents, improves youth MH outcomes (i.e., depression/anxiety, PTSD symptoms, suicidality, and externalizing behaviors) (Aim 1), maximizes uptake and dosage, and improves parenting factors (Aim 2). Further, whether such improvements are mechanisms of action explaining the positive impacts of the intervention on youth MH will be examined (Aim 3), as well as the optimal dosage necessary to improve youth MH outcomes (Aim 4). The proposed study could have a wide reach, impacting our understanding of how to improve and inform equitable delivery of services to youth and families involved in the CWS, and effectively address youth MH disorders and improve care quality and long-term outcomes for a high-risk, underserved population of youth.
