Together Facing the Challenge (TFTC)
About This Program
Target Population: Treatment foster parents and agency staff
For parents/caregivers of children ages: 3 – 17
TFTC is a training/consultation approach to improving practice in treatment foster care (TFC). The intervention was built from a naturalistic study of “usual care” TFC to determine what practice components were related to improved outcomes for youth. It also incorporates elements from existing evidence-based treatments to fill identified gaps in usual care practice. The resulting model includes training/consultation for TFC supervisors as well as training for treatment foster parents. TFTC is designed as a train-the-trainer approach, so that TFC administrative/supervisory personnel can learn the model and train treatment foster parents.
This program will provide training on practical parenting and supervisory skills and techniques.
The goals of Together Facing the Challenge (TFTC) are:
- At the end, both therapeutic foster parents and supervisors alike will:
- Build therapeutic relationships
- Perform and teach cooperation skills
- Implement effective parenting techniques (communicate effectively, set expectations, reinforce positive behavior, avoid power struggles, etc.)
- Prepare youth for their future by teaching independence skills
- Create a positive home environment through family fun time, taking care of self, family meetings, etc.
- Improve outcomes for youth served in therapeutic foster care settings
The program representative did not provide information about a Logic Model for Together Facing the Challenge (TFTC).
The essential components of Together Facing the Challenge (TFTC) include:
- Provides comprehensive training for both agency staff and treatment foster care parents in classes of 15-30 participants
- Builds a therapeutic relationship – recognizes the significance of the therapeutic relationship by exhibiting both verbal and non-verbal behaviors that include:
- Showing a genuine interest
- Identifying common ground
- Having a positive attitude
- Being patient, understanding, consistent, and following through
- Explores trauma-informed care – identifies situations in which a child’s traumatic past can impact their ability to form positive relationships; coaches direct care providers on alternative strategies for parenting traumatized youth
- Develops proactive parenting strategies to reinforce prosocial positive behaviors
- Teaches cooperation – is able to balance use of implementing corrective discipline strategies and techniques within the context of a supportive and therapeutic environment
- Addresses thoughts, feelings, and behavior – demonstrates ability to assist child in recognizing, talking about, and dealing with difficult thoughts and feelings that emerge; helps the child to understand how their thoughts and feelings can impact their behavior
- Interrupts the conflict cycle – is able to identify conflicts that take place and demonstrates ability to avoid power struggles and intervene by de-escalating the situation
- Utilizes problem solving techniques - demonstrates ability to use a problem solving model to address a specific problem by defining it clearly, generating multiple solutions, and selecting the solution that presents as the best based on outcomes
- Promotes cultural sensitivity - explores and supports youths’ different aspects of identity, including race, ethnicity, and culture; and assists parents with creating culturally sensitive home environments
- Teaches relevant life skills – demonstrates ability to transform daily living activities into learning opportunities to assist youth in the development of independent living skills
- Takes care of self – is able to recognize the impact that stress has on their life, the ‘warning signs’ that make them aware of it, and the specific strategies they use to manage their stress level while taking time for self on a regularly scheduled basis
Together Facing the Challenge (TFTC) directly provides services to parents/caregivers and addresses the following:
- Treatment Foster Parents of a child or children with emotional and behavioral problems
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: The treatment foster care agency staff provides coaching, supervision, and support to the treatment foster parents.
Training for treatment foster parents typically occurs as a 7-session course with one 2-hour session every-other week
Training for treatment foster parents on all 7 sessions should be completed within 6 months of agency staff attending the 3-Day Train-the-Trainer Event.
This program is typically conducted in a(n):
- Community-based Agency / Organization / Provider
- Public Child Welfare Agency (Dept. of Social Services, etc.)
Together Facing the Challenge (TFTC) includes a homework component:
Treatment foster parents are given home practice assignments at the end of each training session. These are to be completed (with support by treatment foster care supervisors as needed) before the next session so that the material can be reviewed in a group setting at the beginning of the subsequent training.
Together Facing the Challenge (TFTC) has materials available in a language other than English:
For information on which materials are available in this language, 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:
- DVD or flash drive with PowerPoint and embedded videos
- Training manuals
- Flip chart
- Markers/ writing utensils
Although accommodations needed for training are minimal, for optimal learning to take place consideration should be made regarding comfortable chairs set up around small tables or u-shaped seating with tables to enable participants to engage in hands-on activities and role play scenarios.
Manuals and Training
Prerequisite/Minimum Provider Qualifications
Supervisors should have a Master’s degree or a Bachelor’s degree with at least 2 years of experience in the field. The Treatment Foster Parent must be licensed by their state. No minimum education level is required.
There is a manual that describes how to deliver this program.
There is training available for this program.
- Maureen Murray, LCSW, Associate Professor, Duke University
Services Effectiveness Research Program
phone: (919) 385-0855 or (919) 698-7185
The initial training typically is conducted at a location set up by the agency making the request for the training. Specific information pertaining to scheduling and materials needed are arranged on a site-by-site basis with a contractual agreement specifying the details of the plan.
Recommendations for training
- Group size for agency staff training is typically 15-30 participants.
- Staff training – 3 day intensive seminar (Train-the-Trainer style event)
Number of days/hours:
The agency staff train-the-trainer workshop is conducted over 3 consecutive days. A typical schedule would be 9-4pm with an hour for lunch and two 15 minute breaks. Follow-up consultation with the agency’s TFTC Implementation Team begins after the initial training ends and typically occurs for at least one year.
There are pre-implementation materials to measure organizational or provider readiness for Together Facing the Challenge (TFTC) as listed below:
The Agency Readiness Survey serves not only to prompt the agency staff to reflect on their work culture & their ability to implement our model, but also as the application for training. The survey is located on the program’s website (www.sites.duke.edu/tftc).
Formal Support for Implementation
There is formal support available for implementation of Together Facing the Challenge (TFTC) as listed below:
Follow-up consultation is currently a required element of Together Facing the Challenge. After the 3-day train-the-trainer workshop has been conducted, monthly consultation sessions are scheduled for the first year of implementation. Additional consultation can be arranged as needed.
There are fidelity measures for Together Facing the Challenge (TFTC) as listed below:
Three fidelity measures are required:
- The Training Evaluation Forms for each of the 7 sessions to ensure that agency staff members implement the training with fidelity.
- The Parent Coaching Form assists direct care staff in evaluating program fidelity in the home.
- The Supervisor TFTC Evaluation form assist supervisors in coaching direct care staff
An optional fidelity measure included in the Together Facing the Challenge manual is the Frontline Treatment Provider Scale. It is used by agency staff to assess caregiver's ability to effectively implement the 17 skill areas incorporated into the curriculum.
Southerland, D. G., Farmer, E. M., & Murray, M. E. (2018). Measuring fidelity of empirically supported treatment foster care: Preliminary psychometrics of the Together Facing the Challenge-Fidelity of Implementation Test (TFTC-FIT). Child & Family Social Work, 23(2), 273–280. Child & Family Social Work, 23(2), 273-280. https://doi.org/10.1111/cfs.12415
Implementation Guides or Manuals
There are implementation guides or manuals for Together Facing the Challenge (TFTC) as listed below:
There is a Together Facing the Challenge toolkit that is included in the training. The Foster Parent Manual portion of the toolkit is available in Spanish. The Parent Coaching Form is also available in Spanish.
Research on How to Implement the Program
Research has been conducted on how to implement Together Facing the Challenge (TFTC) as listed below:
Murray, M., & Culver, T. (2014). From theory to practice: One agency’s experience with implementing an evidence-based model. Journal of Child and Family Studies, 23(5), 844–853. https://doi.org/10.1007/s10826-013-9738-x
Murray, M. E., Kohoury, D. Y., & Farmer, E. M. Z. (2018). Is more better? Examining whether enhanced consultation & coaching improves implementation. American Journal of Orthopsychiatry, 88(3), 376–385. https://doi.org/10.1037/ort0000296
Relevant Published, Peer-Reviewed Research
Child Welfare Outcome: Child/Family Well-Being
Farmer, E. M. Z., Burns, B. J., Wagner, H. R., Murray, M., & Southerland, D. G. (2010). Enhancing “usual practice” treatment foster care: Findings from a randomized trial on improving youth outcomes. Psychiatric Services, 6, 555–561. https://doi.org/10.1176/ps.2010.61.6.555
Type of Study:
Randomized controlled trial (randomized at agency level)
Number of Participants: 247 youth and their treatment parents
- Age — 2–21 years (Mean=13 years)
- Race/Ethnicity — 57% African American, 33% White, and 10% Other
- Gender — 45% Female
- Status — Participants were youth served by 14 treatment foster care agencies during the 18-month recruitment period.
Location/Institution: Southeastern states in the U.S.A.
(To include basic study design, measures, results, and notable limitations)
This article reports on the effectiveness of Together Facing the Challenge to enhance treatment foster care (TFC) in usual care agencies. The study was designed to examine whether additional training and consultation to staff and treatment foster parents improved outcomes for youths. Half of the agencies were randomly assigned to the Together Facing the Challenge condition and received study-provided training and consultation. Agencies in the control group continued to provide training and treatment as usual. Measures utilized included the Strengths and Difficulties Questionnaire (SDQ), Parent Daily Report, and the Behavioral and Emotional Rating Scale. Results indicated that compared with youths in the control group, youths in the Together Facing the Challenge group showed improvement on the three focal domains—symptoms, behaviors, and strengths. Effects were significant for all outcomes at six months. Effects for behaviors remained significant by 12 months. Limitations include generalizability limited to youth in treatment foster care settings.
Length of postintervention follow-up: 10.5 months after the end of training.
The following studies were not included in rating Together Facing the Challenge (TFTC) on the Scientific Rating Scale...
Murray, M. E., Khoury, D. Y., Farmer, E. M. Z., & Burns, B. J. (2018). Is more better? Examining whether enhanced consultation/coaching improves implementation. American Journal of Orthopsychiatry. Advance online publication. https://doi.org/10.1037/ort0000296
The purpose of this study was to compare the previously tested standard consultation versus enhanced consultation that incorporated more of a coaching approach. Random assignment was done at the agency level, with three agencies assigned to the control condition (“traditional” Together Facing the Challenge (TFTC) with previously examined levels of consultation), and three agencies assigned the intervention condition (“enhanced” TFTC with expanded consultation/coaching). Measures utilized include the Evidence-Based Practice Attitude Scale (EBPAS), the Training and Supervisor Questionnaire, the Supervisor Assessment of Treatment Parents, the Trusting Relationships Questionnaire (TRQ), and a subset of questions from Project KEEP. Results indicate enhanced coaching/consultation was associated with improvements in the small- to medium-effect size range. Limitations include the study being conducted on a small number of agencies over a relatively short period of time, small sample size, and the lack of youth-level outcomes.
Farmer, E. M. Z., Burns, B. J., & Murray, M. (2009). Enhancing treatment foster care: An approach to improve usual care practice. Report on emotional and behavioral disorders in youth, Report on Emotional and Behavioral Disorders in Youth, 9, 79-84.
Murray, M., Farmer, E. M. Z., Southerland, D. S., & Ballentine, K. (2010). Enhancing and adapting treatment foster care: Lessons learned in trying to change practice. Journal of Child and Family Studies, 19(4), 393-403.
Date Research Evidence Last Reviewed by CEBC: February 2021
Date Program Content Last Reviewed by Program Staff: August 2021
Date Program Originally Loaded onto CEBC: April 2011