Searching for effective interventions for foster children under stress: a meta-analysis Hans W. H. Van Andel*, Hans Grietens†, Johan Strijker†, Rutger J. Van der Gaag‡ and Erik J. Knorth† *Department of Child and Adolescent Psychiatry and Developmental Disorders, GGZ Dimence, Deventer, †Centre for Special Needs Education and Youth Care, University of Groningen, Groningen, and ‡University Medical Centre St. Radboud and Karakter UMC, Child and Adolescent Psychiatry, Nijmegen, The Netherlands ABSTRACT Foster children experience a lot of stress because of their life histories and changes in their family circumstances, such as foster care place- ment. It is important that foster parents recognize the early signs of stress in foster children and learn how to act in a non-threatening and understanding manner. Family-based interventions may help in this. In this paper, we report on a meta-analysis of studies (n = 19) of the effectiveness of such interventions. All studies used a pre-test/post- test design. Both problem behaviour in foster children and the parent- ing skills of foster parents improved by 30%; however, none of the interventions were specifically intended to help young children (<4 years) to cope with stress. The importance of interventions for young foster children is discussed, as well as the necessary elements these interventions should include. Correspondence: Hans Van Andel, Department of Child and Adolescent Psychiatry and Developmental Disorders, GGZ Dimence, Pikeursbaan 3, Deventer 7411GT, The Netherlands E-mail: h.vanandel@dimence.nl Keywords: foster care, intervention, meta-analysis, pre-school children, problem behaviours, stress Piet Strijker has passed away in July 2010. Accepted for publication: April 2012 INTRODUCTION Children growing up in a hostile environment with a caregiver who neglects or abuses them are at risk of developing deviant attachment patterns and of being traumatized (Frame 2002; Juffer et al. 2005). Neglect and abuse can lead to a child being removed from its primary rearing environment, which in itself is stress- ful (Frame 2002). In most countries, family foster care is preferred to residential placement, and for this reason the number of children in foster care is relatively high (Clyman et al. 2002). In the Netherlands, for instance, more than 24 000 children are living in family foster care for shorter or longer periods, and the number of young children being placed in foster care is increasing (Pleegzorg [Foster Care] Nederland 2011). Many children in foster care do suffer from severe behav- ioural problems, and these problems are often a reason for ending the placement (mentioned by 36% of foster parents) (Rhodes et al. 2001). Moreover, 32–50% of foster parents are unwilling to accept a foster child with serious destructive behaviour (Cox et al. 2003; Strijker 2009). However, many foster parents are willing to accept children with serious problem behaviour if additional guidance and support are offered by foster care services, such as a family- based intervention that helps them cope with the child’s behavioural problems. Increasing risk of problem behaviour Foster children are at increased risk of developing long-term problems related to the regulation of behav- iour, including externalizing behaviour, substance abuse and criminal behaviour (Clausen et al. 1998; Pottick et al. 2005). Foster parents are often unaware of the child’s stress, as they do not know the child well enough, and they also may be unprepared or inad- equately trained to react to signs of stress. This has a negative impact on the relationship with the child, increasing the risk that the foster child will be stressed for a very long time, which in turn increases the risk of early breakdown and the development of social, doi:10.1111/j.1365-2206.2012.00885.x 1 Child and Family Social Work 2012 © 2012 Blackwell Publishing Ltd