Treatment Foster Care Oregon - Adolescents (TFCO-A)

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Treatment Foster Care Oregon - Adolescents (TFCO-A) has been rated by the CEBC in the areas of: Disruptive Behavior Treatment (Child & Adolescent), Higher Levels of Placement, Placement Stabilization Programs and Behavioral Management Programs for Adolescents in Child Welfare.

Target Population: Boys and girls, 12-18 years old, with severe delinquency and/or severe emotional and behavioral disorders who were in need of out-of-home placement and could not be adequately served in lower levels of care

For children/adolescents ages: 12 – 18

For parents/caregivers of children ages: 12 – 18

Brief Description

TFCO-A (previously referred to as Multidimensional Treatment Foster Care - Adolescents) is a model of foster care treatment for children 12-18 years old with severe emotional and behavioral disorders and/or severe delinquency. TFCO-A aims to create opportunities for youths to successfully live in families rather than in group or institutional settings, and to simultaneously prepare their parents (or other long-term placement) to provide them with effective parenting. Four key elements of treatment are (1) providing youths with a consistent reinforcing environment where he or she is mentored and encouraged to develop academic and positive living skills, (2) providing daily structure with clear expectations and limits, with well-specified consequences delivered in a teaching-oriented manner, (3) providing close supervision of youths' whereabouts, and (4) helping youth to avoid deviant peer associations while providing them with the support and assistance needed to establish pro-social peer relationships. TFCO also has versions for preschoolers and children. Treatment Foster Care Oregon for Preschoolers (TFCO-P) is rated separately on this website. Treatment Foster Care Oregon for Children (TFCO-C) has not been tested separately, but has the same elements as TFCO-A except it includes materials more developmentally appropriate for younger children.

Program Goals:

The goals of Treatment Foster Care Oregon - Adolescents (TFCO-A) are:

  • Eliminate or reduce youth problem behaviors
  • Increase developmentally appropriate normative and prosocial behavior in youth
  • Transition youth to a birth family or lower level aftercare resource
  • Improve youth peer associations
  • Improve parent-child interaction and communication
  • Improve youth coping and social skills
  • Improve behavior in school and provide academic support

Essential Components

The essential components of Treatment Foster Care Oregon - Adolescents (TFCO-A) include:

  • Four key components:
    • Provides a consistent, reinforcing environment where the youth is mentored and encouraged to develop academic and positive living skills
    • Provides a daily structure with clear expectations and limits, with well-specified consequences delivered in a teaching-oriented manner
    • Provides close supervision of youths' whereabouts
    • Helps youth avoid deviant peer associations while providing support and assistance needed for youth to establish pro-social peer relationships
  • Other components:
    • Allows only one treatment youth per home; may place sibling groups together depending on symptoms
    • Provides clinical team with stratified roles, led by the Program Supervisor
    • Has Program Supervisor with authority regarding the team & program
    • Includes foster parents as members of the team
    • Views the foster home as primary clinical environment
    • Treats youth symptoms as skill deficits
    • Uses daily contact with foster parent including collection of behavioral data on youth - Parent Daily Report
    • Trains foster parents in TFCO-A prior to placement of a child
    • Gives foster parents access to the Program Supervisor 24 hours a day/7 days a week

Child/Adolescent Services

Treatment Foster Care Oregon - Adolescents (TFCO-A) directly provides services to children/adolescents and addresses the following:

  • Hyperactivity, delinquency, school failure, history of abuse, depressive symptoms, aggression, anxiety, defiance, stealing, social aggression, and general anti-social behavior
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: TFCO-A highly involves the parents or long-term care resource in the treatment throughout services to learn new parenting skills.

Parent/Caregiver Services

Treatment Foster Care Oregon - Adolescents (TFCO-A) directly provides services to parents/caregivers and addresses the following:

  • Lack of parenting skills, conflict issues with children

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Community Agency
  • Foster/Kinship Care
  • Outpatient Clinic
  • School

Homework

Treatment Foster Care Oregon - Adolescents (TFCO-A) includes a homework component:

Biological (or other long-term placement resource) parents are guided in practicing parenting skills outside of the sessions during visits with the child in foster care as well as with other children living in the home.

Languages

Treatment Foster Care Oregon - Adolescents (TFCO-A) has materials available in languages other than English:

Dutch, Swedish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Office space for a team of approximately 6-8 people: Program Supervisor, Recruiter/Trainer/Parent Daily Report Caller, Family Therapist, Individual Therapist, and 2-3 Skills Trainers
  • Conference room with video recording
  • Internet access for Program Supervisor

Minimum Provider Qualifications

Program supervisor – In addition to a Master's degree in a clinical field and considerable relevant experience in behavior management approaches, this person should possess supervisory skills, considerable organizational abilities, and a thorough understanding of and enthusiastic attitude toward the treatment model.

Family therapist – Master's degree in a clinical field

Individual therapist – Master's degree in a clinical field

Skills trainer(s) – Bachelor's degree in a relevant field

Foster parent Recruiter/Trainer/PDR Caller – This important position should be filled by someone with a thorough understanding of the treatment model and experience in foster parent activities. The specific education level for this position is less important. This position can be filled an experienced (ex-) foster parent.

Foster family – No formal education is required for foster parents. However, foster parents trained in the program should have a basic understanding of child development with reasonable expectations for this population of foster children. It is especially helpful when foster parents have a good sense of humor and do not take behaviors personally.

Consulting psychiatrist – Adequately serve children in the program who need medication prescribed and managed

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Conducted in Eugene, Oregon

Number of days/hours:

5 days for a total of 40 hours

Implementation Information

Since Treatment Foster Care Oregon - Adolescents (TFCO-A) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Treatment Foster Care Oregon - Adolescents (TFCO-A) as listed below:

The training protocol for TFCO includes a planning and readiness process that usually takes several months.

  • No decision is made regarding actual implementation until this process has been successfully completed.
  • During the process, all aspects relevant to a successful implementation are discussed and reviewed. Necessary accommodations and adjustments in procedures and practices are then made.
  • Also, during this process the client is assisted with foster parent recruitment. A sufficient number of foster homes to start operations (4 or 5) must be recruited, licensed, and available for placements before the readiness process is concluded.

Topics reviewed during the readiness process include:

  • Determining program costs and funding
  • Foster parent recruitment
  • Staffing: Team composition, qualifications, FTE and hiring sequence/timing
  • Referrals: Referral criteria, referral mechanisms and procedures
  • Geography: Catchment area and location of foster homes
  • Placement and matching procedures
  • Interface between the program and probation/case workers
  • Integration of psychiatry
  • Logistical issues (daily behavior information gathering and video recording of weekly meetings)
  • Additionally, any site-specific issues are considered

No written materials that further detail this process are available.

Formal Support for Implementation

The program representative did not provide information about formal support for implementation of Treatment Foster Care Oregon - Adolescents (TFCO-A).

Fidelity Measures

There are fidelity measures for Treatment Foster Care Oregon - Adolescents (TFCO-A) as listed below:

  • In the course of executing the model, daily behavior information is gathered for each of the youth. This information (Parent Daily Report (PDR)) is used to track behavior change over time. The collection and use of this information is also used to assess model adherence and outcomes.
  • During the first year of implementation, three structured program reviews are provided so that progress and fidelity can be easily tracked from one review to the next. Once program standards are met, the program applies for program certification with an independent evaluator, the Center for Research to Practice in Eugene, OR.
  • Initial certification is valid for a period of two years and subsequent renewal certifications are valid for three-year periods, provided that a contractual arrangement is in place with TFC Consultants or one of its implementation partners to monitor program fidelity and address model adherence issues. In the absence of such an arrangement, certification is valid for a period of one year.

Implementation Guides or Manuals

There are implementation guides or manuals for Treatment Foster Care Oregon - Adolescents (TFCO-A) as listed below:

There are operational manuals for program supervision, foster parent recruitment, family therapy, child therapy, foster parent training, and skills training. These are not publicly available.

Research on How to Implement the Program

The program representative did not provide information about research conducted on how to implement Treatment Foster Care Oregon - Adolescents (TFCO-A).

Relevant Published, Peer-Reviewed Research

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcomes: Permanency and Child/Family Well-Being

Show relevant research...

Chamberlain, P., & Reid, J. B. (1991). Using a specialized foster care treatment model for children and adolescents leaving the state mental hospital. Journal of Community Psychology, 19, 266-276.

Type of Study: Randomized controlled trial
Number of Participants: 20

Population:

  • Age — 9-18 years
  • Race/Ethnicity — Not Specified
  • Gender — Not Specified
  • Status — Participants were youth referred by Oregon State Hospital outreach teams.

Location/Institution: Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Hospitalized youth preparing for community placement were randomly assigned to receive either Specialized Foster Care (SFC) [now called Treatment Foster Care Oregon - Adolescents (TFCO-A)] or care as usual (e.g., residential treatment centers, groups homes or relatives home). Emotional disturbance, social competency, self-reported symptoms and problem behaviors were measured using the Child Global Assessment Scale, the Parent Daily Report Checklist (PDR), the Behavior Symptom Inventory (BSI) and a social interaction task. Results showed that the SFC group was placed in the community more quickly and for more days. In addition, the SFC group had fewer behavioral problems at 3 months than those in the control condition. However, SFC group participants reported more emotional distress during the course of the study. Conclusions are limited by the small sample size.

Length of postintervention follow-up: Approximately 7 months.

*Chamberlain, P., & Reid, J. B. (1998). Comparison of two community alternatives to incarceration for chronic juvenile offenders. Journal of Consulting and Clinical Psychology, 66(4), 624-633.

Type of Study: Randomized controlled trial
Number of Participants: 79

Population:

  • Age — 12-17 years
  • Race/Ethnicity — 85% White, 6% Black, 6% Hispanic, and 3% Native American
  • Gender — 100% Male
  • Status — Participants were boys with histories of chronic delinquency referred for community placement by the juvenile justice system.

Location/Institution: Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Boys were randomly assigned to receive either Multidimensional Treatment Foster Care -Adolescents [now called Treatment Foster Care Oregon - Adolescents (TFCO-A)] or to community-based group care (GC). Data collected for the study included criminal court referrals and self-reported delinquency measured by the Elliott Behavior Checklist. Results of the study indicated that participation in MTFC produced more favorable outcomes than participation in GC. Boys ran away less frequently, completed their programs more often and were referred to detention or training schools less frequently. They had fewer criminal referrals and had fewer self-reported delinquent acts, and violent or serious crimes. Finally they spent more days living with their families in follow up. These differences held even among older youths and those who began exhibiting delinquent behaviors at a younger age. One study limitation includes exclusion of girls from the sample.

Length of postintervention follow-up: 1 year.

Eddy, J. M., & Chamberlain, P. (2000). Family management and deviant peer association as mediators of the impact of treatment condition on youth antisocial behavior. Journal of Consulting and Clinical Psychology, 5(68), 857-863

Type of Study: Randomized controlled trial
Number of Participants: 53

Population:

  • Age — 12-17 years
  • Race/Ethnicity — 85% White, 6% Black, 6% Hispanic, and 3% Native American
  • Gender — 100% Male
  • Status — Participants were boys with histories of chronic delinquency referred for community placement by the juvenile justice system.

Location/Institution: Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study uses the same sample as Chamberlain & Reid, 1998. This is an explanatory study to explore mediators of the effectiveness of Multidimensional Treatment Foster Care - Adolescents [now called Treatment Foster Care Oregon - Adolescents (TFCO-A)] over group care (GC) programs. Data included responses from an interview protocol developed for the study adapted from the Parent Daily Report, criminal referrals and self-reported delinquent acts. Analyses showed that parenting practices (supervision, discipline, positive reinforcement and positive interactions with parents) and limiting association with delinquent peers mediated the effects of program type on outcomes. The strength of the analysis is limited by the small sample size.

Length of postintervention follow-up: 3 months following placement.

*Eddy, J. M., Whaley, R. B., & Chamberlain, P. (2004). The prevention of violent behavior by chronic and serious male juvenile offenders: A 2-year follow-up of a randomized clinical trial. Journal of Emotional and Behavioral Disorders, 12(1), 2-8.

Type of Study: Randomized controlled trial
Number of Participants: 79

Population:

  • Age — 12-17 Years
  • Race/Ethnicity — 85% White, 6% Black, 6% Hispanic, and 3% Native American
  • Gender — 100% Male
  • Status — Participants were boys with histories of chronic delinquency referred for community placement by the juvenile justice system.

Location/Institution: Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study used the same sample as Chamberlain & Reid, 1998. Results showed that 24% of the youth in the group care condition had two or more criminal referrals for violent offenses in the 2 years following study entry, versus 5% of youth in the Multidimensional Treatment Foster Care - Adolescents [now called Treatment Foster Care Oregon - Adolescents (TFCO-A)] condition. Those in the MTFC group also self-reported violent behavior levels that were within normal range. Those in the GC condition reported levels 4 to 9 times higher.

Length of postintervention follow-up: 2 years after study entry.

*Leve, L. D., Chamberlain, P., & Reid, J. B. (2005). Intervention outcomes for girls referred from juvenile justice: Effects on delinquency. Journal of Consulting and Clinical Psychology, 73(6), 1181-1185.

Type of Study: Randomized controlled trial
Number of Participants: 81

Population:

  • Age — 13-17 years
  • Race/Ethnicity — 74% Caucasian, 12% Native American, 9% Hispanic, 2% African American, 1% Asian, and 2% Other
  • Gender — 100% Female
  • Status — Participants were girls mandated to community out-of-home care due to chronic delinquency.

Location/Institution: Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Girls were randomly assigned to and Multidimensional Treatment Foster Care -Adolescents [now called Treatment Foster Care Oregon - Adolescents (TFCO-A)] condition or to a group care (GC) control condition. Outcome measures included number of days in locked settings, criminal referrals, caregiver reported delinquency, using the Child Behavior Checklist (CBCL), and self-reported delinquency, using the Elliott Self-Report of Delinquency Scale. The MTFC group had significantly fewer days in locked settings and less caregiver-reported delinquency than the GC group. They also had fewer criminal referrals than GC youth at follow-up, although this did not reach statistical significance. There were no effects of condition on self-reported delinquency although rates were down for both groups at follow-up. Conclusions are limited by a small sample size.

Length of postintervention follow-up: 12 months.

*Leve, L. D., & Chamberlain, P. (2005). Association with delinquent peers: Intervention effects for youth in the juvenile justice system. Journal of Abnormal Child Psychology, 33(3), 339-347.

Type of Study: Randomized controlled trial
Number of Participants: 153

Population:

  • Age — 12-17 years
  • Race/Ethnicity — Boys: 83% Caucasian, Girls: 74% Caucasian
  • Gender — 81 Girls and 72 Boys
  • Status — Participants were referred to out-of-home care by juvenile court judges for chronic delinquency.

Location/Institution: Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Youth were randomly assigned to the Multidimensional Treatment Foster Care -Adolescents [now called Treatment Foster Care Oregon - Adolescents (TFCO-A)] condition or to a group care (GC) condition. Measures included the Describing Friends Questionnaire which assesses association with friends who engage in delinquent behaviors and caregiver reports using the Child Behavior Checklist (CBCL). Analyses suggested the MTFC youth had fewer associations with delinquent peers than did those in the GC condition and that this was carried through to follow-up.

Length of postintervention follow-up: 12 months.

*Chamberlain, P., Leve, L. D., & DeGarmo, D. S. (2007). Multidimesional treatment foster care for girls in the juvenile justice system: 2-year follow-up of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 75(1), 187.

Type of Study: Randomized controlled trial
Number of Participants: 81

Population:

  • Age — 15-19 years
  • Race/Ethnicity — 74% Caucasian, 12% Native American, 9% Hispanic, 2% African American, 1% Asian, and 2% Other
  • Gender — 100% Female
  • Status — Participants were girls mandated for out-of-home care by juvenile court judges due to chronic delinquency.

Location/Institution: Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study used the same sample as Leve, Chamberlain and Reid, 2005. Girls were randomly assigned to the Multidimensional Treatment Foster Care - Adolescents [now called Treatment Foster Care Oregon - Adolescents (TFCO-A)] condition or to a group care (GC) control condition. Delinquency as-of follow-up was assessed using a combination of number of criminal referrals, number of days in locked settings, and self-reported delinquency, as measured by the Elliott General Delinquency Scale. Findings show that the one-year effects for MTFC were maintained at 2 years on all measures. The study also showed that older girls showed less delinquency over time for both the MTFC and GC conditions.

Length of postintervention follow-up: 2 years.

Westermark, P. K., Hansson, K., & Olsson, M. (2011). Multidimensional Treatment Foster Care (MTFC): results from an independent replication. Journal of Family Therapy, 33(1), 20-41.

Type of Study: Randomized controlled trial
Number of Participants: 25

Population:

  • Age — 12-18 years
  • Race/Ethnicity — 26 Swedish and 9 Immigrant
  • Gender — 18 Boys and 17 Girls
  • Status — Participants were youth with antisocial disorder.

Location/Institution: Socialhogskolan, Lund University and Familjeforum AB

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examines outcomes for Swedish antisocial youths who received either treatment in Multidimensional Treatment Foster Care (MTFC) [now called Treatment Foster Care Oregon – Adolescents (TFCO-A)] or treatment as usual (TAU). Measures utilized include the Child Behavior Checklist (CBCL), the Youth Self Report (YSR), the Symptom Checklist-90 (SCL-90), and the Global Severity Index (GSI). Results indicate that youth treated in the MTFC program consistently showed statistically significant positive treatment effects compared to the youth exposed to TAU. Limitations include small sample size and generalizability to other ethnic group.

Length of postintervention follow-up: 6, 12, and 24 months.

Green, J. M., Biehal, N., Roberts, C., Dixon, J., Kay, C., Parry, E., & ... Sinclair, I. (2014). Multidimensional Treatment Foster Care for Adolescents in English care: Randomised trial and observational cohort evaluation. The British Journal Of Psychiatry, 204(3), 204-214.

Type of Study: Modified randomized controlled trial
Number of Participants: 219

Population:

  • Age — 10-17 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were youth in foster care at risk of breakdown in placement.

Location/Institution: England

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study is to examine the efficacy of Multidimensional Treatment Foster Care for Adolescents (MTFC-A) [now called Treatment Foster Care Oregon – Adolescents (TFCO-A)] compared with treatment as usual (TAU) for young people at risk in foster care in England. Participants were randomly allocated into a pool of cases from which appropriate individual placements could be made. Participants consenting to the RCT were randomly allocated to an offer of MTFC-A or to usual care. The MTFC-A treatment group included 112 participants and the TAU group included 107 participants. Measures utilized include the Parent Daily Report (PDR), the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), the Children’s Global Assessment Scale (CGAS), Child Behavior Checklist (CBCL), and Youth Self Report (YSR). Results indicate both MTFC-A and usual care groups tended towards improved functioning over time, but there was no evidence that use of MTFC-A resulted in better overall outcomes than usual care on the primary outcome of adaptive functioning or on secondary education or offending outcomes. Limitations include the imbalance in the observational cohort which creates an imbalance in the analysis, issues with how the participants were randomized, and lack of follow-up.

Length of postintervention follow-up: None.

References

Chamberlain, P. (1994). Family connections. Eugene, OR: Northwest Media, Inc.

Chamberlain, P. (2003). Treating chronic juvenile offenders: Advances made through the Oregon multidimensional treatment foster care model. Washington, DC: American Psychological Association.

Chamberlain, P., & Mihalic, S. F. (1998). Multidimensional treatment foster care: Blueprints for Violence Prevention, Book Eight. Blueprints for Violence Prevention Series (D. S. Elliott, Series Editor). Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado.

Contact Information

Name: John Aarons
Agency/Affiliation: TFC Consultants, Inc.
Website: www.tfcoregon.com
Email:
Phone: (541) 343-2388 x204

Date Research Evidence Last Reviewed by CEBC: January 2017

Date Program Content Last Reviewed by Program Staff: April 2016

Date Program Originally Loaded onto CEBC: May 2007