Intervention Fidelity and Temporal Changes to Relationship Quality Among Siblings in Foster Care: Implications for a Personalized Approach to Prevention and Intervention

Background

A growing body research suggests the sibling relationship is a critical protective factor for youth in foster care, yet a limited number of interventions exist for sibling groups and few studies have examined how, for whom, and under what conditions do sibling interventions yield promising results. This gap in knowledge limits the ability of the field to provide effective mental and behavioral health care to a population of youth facing considerable long-term risks.

Purpose

This study investigated whether youth comprehension and engagement with a 12-session relational intervention was associated with six and eighteen-month improvements in sibling relationship quality for early and middle-adolescent sibling dyads in foster care.

Methods

160 youth nested in 80 dyads from the treatment condition of an RCT participated in a 12 session intervention designed to strengthen sibling’s individual and interpersonal skills. Following each session interventionists completed a standardized form which assessed depth of coverage, youth engagement, and comprehension of session content for both older and younger siblings. Fidelity was assessed across seven content domains including: sibs for life, positive thinking, activity planning, cooperation, problem solving, managing feelings, and adult allies. Fidelity constructs were positively valued on a six-point scale from 0=no engagement/comprehension to 5=complete engagement/comprehension (Alpha range=.56-.94). Sibling relationship quality was assessed using a multiple-method, multiple informant construct comprised of seven items from four reporting sources.

Analysis

Changes to sibling relationship quality were modeled by subtracting baseline scores from 6 and 18-month assessments. A series of hierarchical linear models examined the relationship between intervention comprehension, engagement, and changes to relationship quality at six and eighteen months. Analyses were nested at the sibling group level.

Results

Differential comprehension and engagement with the intervention was associated with temporal changes to the sibling relationship at six and eighteen-months. The sibling dyad accounted for 72% and 77% of the variance respectively. At six months, comprehension of cooperation (Y02=-1.57,SE=.17,p<.01), problem solving (Y02=-.25,SE=.11,p<.01) were significant. By 18-months, engagement with activity planning (Y02=.42,SE=.14,p<.01) accounted for long term improvements to relationship quality.

Discussion

Findings suggest comprehension of problem solving and cooperation were responsible for initial dips in sibling relationship quality at six months, however the relationship rebounded by 18-months and youth engagement with activity planning was responsible for these improvements. This suggests a temporal dimension to the intervention, and early challenges observed among participants may be a necessary precondition to subsequent long-term relational gains. Implications for intervention with early and middle-adolescent aged siblings in foster care will be provided.