***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A growing number of children in the UnitedStates are being placed into foster care . Past studies indicate that effective case manager interventions havehelped foster families with a variety of different problems . This study enrolled a r and omlyselected sample of 130 children under age four who hadbeen newly placed into foster care . The purpose of this study was to identify the services needed by foster care families and determine which servicesrequire the most case manager effort . Consistent withother research , many foster care children in this study exhibited developmental , medical and psychosocial concerns . Nevertheless , we found that it wasservices aim ed at the foster care parents , rather thanthe foster care children , that required the mostlabor-intensive case management services The lack of prepared and available foster parents for children with prenatal substance effects is of increasing concern to the child welfare field . The research study reported here evaluated a multimodal inservice training program design ed to enhance the competency of foster parents caring for infants with prenatal substance effects , and to promote an intent to foster such infants . Findings suggest that future foster parent training efforts in this area should focus on knowledge and skill attainment AIMS To evaluate the impact of training foster carers  on  children 's emotional and behavioural functioning .  METHODS In a r and omised controlled trial in 17 Scottish local council areas , with immediate and nine month follow up , 182 children and their foster families were r and omly allocated to either st and ard services alone or st and ard services plus extra training for foster carers on communication and attachment . Main outcome measures were child psychopathology , attachment disorder , self esteem , and cost of foster care . RESULTS Over 60 % of children had measurable psychopathology at baseline . The training was perceived as beneficial by participants . Scores for parent reported psychopathology and attachment disorders decreased by around 5 % , self esteem increased by 2 % , and costs by 22 % in the intervention group . Results were non-significant . CONCLUSIONS Despite being well received by foster carers , the training was not sufficient to make a useful impact on the high level of psychopathology . This group may warrant more intensive interventions This study was undertaken to assess the effects of holding therapy on children who have a history of aggressive and delinquent behaviors . The study design was a prospect i ve , pre-post , quasi-experimental controlled study . The subjects were recruited through the Attachment Center at Evergreen , Colorado . Eligible subjects were adopted children between the ages of 5–14 years , living in the present adopted home for at least one year . All children had a history of aggressive and delinquent behaviors , which prompted the contact with Evergreen . Findings result ed in significant decrease in the outcome variable for the treatment group within this study OBJECTIVE To determine the effectiveness of an intervention design ed to improve outcomes for infants and toddlers in foster care . METHOD Records were review ed for all children who were adjudicated as in need of care in a specific parish in Louisiana between 1991 and 1998 . This period included 4 years before and 4 years after a comprehensive intervention was implemented . Children adjudicated between 1991 and 1994 were the comparison group , and those adjudicated between 1995 and 1998 were the intervention group . RESULTS After the intervention , more children were freed for adoption and fewer children were returned to their birth families than before the intervention . There was no difference in length of time in care before and after the intervention . With regard to the same child returning in a subsequent incident of maltreatment , relative risk reduction for the intervention group ranged from 53 % to 68 % . With regard to the same mother maltreating another child subsequently , relative risk reduction for the intervention group ranged from 63 % to 75 % . CONCLUSIONS A comprehensive preventive intervention for maltreated infants and toddlers in foster care substantially reduced rates of recidivism but had no effect on length of time in care This article describes group parent training procedures for a sample of 42 foster mothers . Half of the foster mothers were trained in behavioral child-rearing skills  , and the other half received reflective group counseling for 8 weeks . Comparison of the two modes of training showed that reflectively counseled mothers improved primarily in parent attitudes , whereas behaviorally trained mothers improved primarily in actual use of appropriate behavioral skills , reporting reductions in problematic child behavior and improvements in overall family functioning . The future use of a combination approach is addressed , as are suggestions regarding how to motivate foster parents and improve their attendance rates . Throughout the 1970s the use of parent counseling and training has grown as a means of employing parents as therapists for their children 's problem behaviors . Tavormina ( 1974 ) discussed two major topics of parent counseling : ( a ) reflective counseling , which emphasizes parental awareness , underst and ing , and acceptance of the child 's feelings , and ( b ) behavioral counseling , which emphasizes actual observable behavior and the environmental variables that maintain certain behavior patterns . In a comparison of the relative effectiveness of the two procedures ( Tavormina , 1975 ) , both had beneficial effects relative to the notreatment control condition , but the behavioral method result ed in a significantly greater magnitude of improvement across attitude and behavior change dimensions . Tavormina 's ( 1975 ) study trained biological mothers of retarded children , and the present study represents an extension of that study to foster mothers , who differ from other parents along several dimensions . First , these parents are charged with the duty of managing children who are wards of the state , yet they have consistently been implicated as being neither economically nor therapeutically prepared to manage the children entrusted to their care ( Levitt , 1973 ) . Second , foster children as 
    Output:
    
MAIN RESULTS Training interventions evaluated to date appear to have very little effect on outcomes relating to looked-after children , assessed in relation to psychological functioning , extent of behavioural problems and interpersonal functioning .
Results relating to foster carer(s ) outcomes indicate some improvements in measures of behavioural management skills , attitudes and psychological functioning .
Analysis pertaining to fostering agency outcomes did not show any significant results .
Inconclusive evidence exists about the efficacy of CBT-based training intervention for foster carers .