Treatment Foster Care Oregon for Preschoolers (TFCO-P)
About This Program
Target Population: Preschool foster children aged 3-6 years old who exhibit a high level of disruptive and antisocial behavior which cannot be maintained in regular foster care, or who may be considered for residential treatment, and their caregivers
For children/adolescents ages: 3 – 6
For parents/caregivers of children ages: 3 – 6
Program Overview
TFCO-P (previously referred to as Multidimensional Treatment Foster Care for Preschoolers) is a foster care treatment model specifically tailored to the needs of 3 to 6-year-old foster children. TFCO-P is designed to promote secure attachments in foster care and facilitate successful permanent placements. TFCO-P is delivered through a treatment team approach in which treatment foster parents receive training and ongoing consultation and support. Children receive individual skills training and participate in a therapeutic playgroup, and family of origin (or other permanent placement caregivers) receive family therapy. TFCO-P emphasizes the use of concrete encouragement for prosocial behavior; consistent, nonabusive limit-setting to address disruptive behavior; and close supervision of the child. In addition, the TFCO-P intervention employs a developmental framework in which the challenges of foster preschoolers are viewed from the perspective of delayed maturation.
Program Goals
The goals of Treatment Foster Care Oregon for Preschoolers (TFCO-P) are:
For children:
- Eliminate or reduce problem behaviors
- Increase developmentally appropriate normative and prosocial behavior
- Transition to the family of origin, an adoptive family, or a lower level aftercare resource
- Improve peer associations
- Improve interaction and communication with parent
- Improve coping and social skills
For parents:
- Improve interaction and communication with child
Logic Model
View the Logic Model for Treatment Foster Care Oregon for Preschoolers (TFCO-P).
Essential Components
The essential components of Treatment Foster Care Oregon for Preschoolers (TFCO-P) include:
- Three Key Mechanisms:
- A proactive approach to reducing problem behavior
- The creation and maintenance of a consistent and reinforcing environment for participating children
- The separation and stratification of program staff roles; using a team approach, specific staff are assigned to supporting foster parents, working with children, facilitating the transition to long-term placement resources and interagency consultation
- Other Components:
- Treatment foster parents are trained in TFCO-P prior to placement of a child.
- Team Leader has authority regarding the team & program.
- One child is allowed per home; may place sibling groups together depending on symptoms.
- Treatment foster parents are members of the team.
- The treatment foster home is viewed as primary clinical environment.
- Children's symptoms are treated as skill deficits.
- A high level of encouragement is balanced with fair & consistent limits.
- Treatment children are closely supervised.
- Adults are taught to be responsive to child cues.
- The Parent Daily Report is administered Monday-Friday in a 10-minute daily phone call with treatment foster parents to collect behavioral data and program contact.
- Treatment foster parents have access to Team Leader 24 hours a day/7 days a week.
- Treatment foster parents have weekly support and training.
Program Delivery
Child/Adolescent Services
Treatment Foster Care Oregon for Preschoolers (TFCO-P) directly provides services to children/adolescents and addresses the following:
- Disruptive, maladaptive behaviors such as aggression, anxiety, depression, hyperactivity, autism spectrum, attachment, enuresis, encopresis, defiance, tantrums and general anti-social behavior including a wide range of diagnoses and also include developmental delays
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: The TFCO-P model highly involves the family of origin or long-term care resource in learning new parenting skills throughout treatment.
Parent/Caregiver Services
Treatment Foster Care Oregon for Preschoolers (TFCO-P) directly provides services to parents/caregivers and addresses the following:
- Lack of parenting skills, conflict issues with children, may experience the cycle and symptoms of trauma
Recommended Intensity:
For treatment foster parent(s), there is typically a minimum of seven contacts per week which consist of five 10-minute contacts, one two-hour group, and additional contacts based on the amount of support or consultation required. For the child in treatment, two contacts per week which consist of a two-hour therapeutic playgroup and a two-hour skills training session. For the family of origin or other long-term placement resource, one contact per week in the form of a one-hour skill-building session.
Recommended Duration:
Designed with an overall treatment duration of 6-9 months
Delivery Settings
This program is typically conducted in a(n):
- Birth Family Home
- Foster / Kinship Care
- Community-based Agency / Organization / Provider
- School Setting (Including: Day Care, Day Treatment Programs, etc.)
Homework
This program does not include a homework component.
Resources Needed to Run Program
The typical resources for implementing the program are:
- Office space for a team of approximately 6-8 people:
- Team Leader
- Recruiter/Trainer/Parent Daily Report Checklist Caller
- Family Therapist
- 2-3 Skills Trainers/Playgroup Assistants/Playgroup Leader
- Treatment Foster Parent Consultant
- 1-2 treatment rooms with video recording
- Meeting room with ability to record
- Internet access for Team Leader
Manuals and Training
Prerequisite/Minimum Provider Qualifications
Team Leader – In addition to a Master's level education 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. The team leader must be available to the foster parents and treatment team members 24 hours a day, 7 days a week.
Treatment Foster Parent Consultant/Recruiter/Trainer – While a formal post-secondary education is not necessary for this position, this person must have knowledge of foster parents and a clear understanding of the model. Prior experience as a foster parent or as an adoptive parent of older children is strongly desirable.
Family Therapist – Master's level education in a clinical field. Knowledge of Parent Management Training or related behaviorally based parenting techniques is highly desirable.
Playgroup Leader – Bachelor's level education in a relevant field. The playgroup leader is responsible for organizing, preparing, and executing the playgroup curriculum. This person is also responsible for leading the assistants for playgroup. The playgroup leader is also an Skills Coach for children in the program.
Skills Coach – Bachelor's level education in a behavioral sciences field, or a combination of education, training, and/or work experience in a behavioral sciences field that totals at least three years, preferred. Since skills coaching activities take place outside of the office, mileage reimbursements and reimbursements for modest entertainment, food, and beverage expenses are typically associated with these activities. Two Skills Coaches will also hold the position of playgroup assistants.
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. It may be filled by an experienced (ex-) foster parent.
Treatment Foster family – No formal education is required for treatment foster parents. However, treatment foster parents trained in the program should have a basic understanding of child development with reasonable expectations for this population of treatment foster children. It is especially helpful when treatment 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.
Manual Information
There is a manual that describes how to deliver this program.
Training Information
There is training available for this program.
Training Contact:
- John Aarons
TFC Consultants, Inc.
johna@tfcoregon.com
phone: (541) 343-2388 x1 or (541) 870-9015
Training Type/Location:
Conducted in Eugene, Oregon
Number of days/hours:
5 days for a total of 40 hours
Implementation Information
Pre-Implementation Materials
There are pre-implementation materials to measure organizational or provider readiness for Treatment Foster Care Oregon for Preschoolers (TFCO-P) 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 treatment foster parent recruitment. A sufficient number of treatment foster homes to start operations (3-5) 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
- Treatment 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 treatment foster homes
- Placement and matching procedures
- Interface between the program and community stakeholders
- 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
There is formal support available for implementation of Treatment Foster Care Oregon for Preschoolers (TFCO-P) as listed below:
Implementation of Treatment Foster Care Oregon includes the following phases:
- Feasibility phase:
- A thorough review of the circumstances in implementing organization and community
- Upfront training of clinical staff and TFCO parents
- A prolonged period of consultation services and technical assistance
- A plan for perpetual model adherence monitoring
- A feasibility check:
- Done by telephone or e-mail
- Discussion of the topics listed in the TFCO Feasibility Review
- No charge for feasibility review activities
- Readiness phase
- Starts if the feasibility indicates that the right circumstances exist for a TFCO program
- Preparations for a team begin
- Obstacles to a successful program addressed prior to the start of services
- Areas for further planning and coordination identified
- Timeline for implementation developed
- The readiness topics include:
- Staffing
- Establishment of the placement criteria
- Referral mechanisms
- The understanding and support of relevant systems, agencies, and funders in community
- Planning for and supporting initial TFCO parent recruitment:
- Use of the TFCO Cost Calculator - A customizable Excel tool and reviewed line by line during the initial readiness process to establish that adequate funding is available for the program.
- Readiness contacts conducted via a series of video/conference calls, usually lasting 1 - 2 hours:
- Address one or several readiness topics depending on the pace of program development and the success of problem-solving barriers
- Call summaries provided in writing and sent via e-mail
- Readiness process typically lasts approximately six months
- As of January 2023, cost of the readiness assessment was $9,010, payable prior to the first conference call.
- Implementation Support Services:
- During the first two years of implementation, the following services are provided. Services listed are for one team serving up to 10 active placements.
- Recruitment Consultation – Consultation and guidance on the recruitment of TFCO homes
- Stakeholders Presentation/Training and Implementation Planning Meeting (to be held at implementing agency)
- Stakeholders Presentation - An overview and of the model is presented to stakeholders, including administrators, program staff, any TFCO parents that may have been identified, as well as representatives from relevant outside entities, such as schools, mental health, child welfare and foster care certification agency. Discussion of questions, concerns and barriers.
- Planning Meeting – A clear and specific implementation plan, including timelines, is finalized for staffing, training, TFCO parent licensing and placements.
- Clinical training (Eugene, OR) – The duration of training is role dependent:
- Team Leaders attend 5 days
- Therapists attend 4 days
- Recruiter/Trainer/PDR caller attends 3 days
- Recommended that a program manager also attend
- A representative of a funding or referring agency may also attend
- TFCO parent training (held at implementing agency) – TFC Consultants conducts the first TFCO parent training. This is a two-day training. Subsequent TFCO parent trainings are conducted by implementing agency’s TFCO Recruiter/Trainer.
- FOCUS PDR training – Training in the web-based behavior data tracking system is conducted for the TFCO Parent Daily Report (PDR) caller, Team Leader. and the identified backup PDR caller.
- Use of the FOCUS PDR-system – Use of the web-based behavior information system, which contains daily behavioral information on each TFCO youth in placement, for up to 10 active placements at any one time. Remote technical assistance is included.
- Weekly Consultation – A consultant is assigned to the implementing agency’s TFCO program and provides weekly telephone consultation to the Team Leader. The consultation includes:
- Review of each TFCO youth, their treatment plan and progress
- Staff supervision and role adherence
- Program functioning
- Systems issues
- Overall implementation
- Video recordings of program meetings from the previous week viewed by consultant and feedback provided within each call
- Begins when the first referrals are expected.
- Site visits – The consultant will come to implementing agency for five two-day visits over the first two years.
- Visits can include:
- Attendance at the TFCO parent and clinical meeting, Booster training (not to replace regular TFCO training)
- Problem-solving
- In-the-moment consultation and support
- Consultant will work with the implementation site to create a visit agenda and determine the timing of site visits however they are generally provided every three months after consultation calls have begun.
- Implementation Reviews – Five periodic reports are provided to the program director or administrator that includes information regarding:
- Implementation progress
- Program staff performance
- Model adherence
- Other relevant issues
- Fidelity Assessments – At the end of each of the first two years, a TFCO team is assessed across seven implementation domains. Areas that do not yet meet fidelity will be identified and follow-up assistance provided in these areas.
Fidelity Measures
There are fidelity measures for Treatment Foster Care Oregon for Preschoolers (TFCO-P) as listed below:
- Fidelity assessments are conducted at planned intervals during the implementation phase and post-certification by trained TFCO Consultants/Clinicians and a trained Program Evaluation Specialist. Fidelity assessment and certification measures include examination of the following components to determine how closely aligned they are to TFCO recommended practices:
- Therapy delivery rate
- Program behavioral components (Parent Daily Report data on secure TFCC Inc. database
- Team submitted copies of youth behavior charts and school cards)
- Video review of treatment parent meeting content as well as meeting attendance
- Video review of clinical team meeting content as well as meeting attendance
- Team training and staffing plans
Fidelity Measure Requirements:
Fidelity measures are required to be used.
Implementation Guides or Manuals
There are implementation guides or manuals for Treatment Foster Care Oregon for Preschoolers (TFCO-P) as listed below:
Manual information:
- TFC Consultants, Inc. (n.d.). Implementation guidebook. Author.
This guidebook is available to clients once they have signed a service agreement with TFC Consultants. Information packets outlining the general steps, consultation support, and costing, are available upon request.
Implementation Cost
There have been studies of the costs of implementing Treatment Foster Care Oregon for Preschoolers (TFCO-P) which are listed below:
Saldana, L., Campbell, M., Leve, L., & Chamberlain, P. (2019). Long-term economic benefit of Treatment Foster Care Oregon (TFCO) for adolescent females referred to congregate care for delinquency. Child Welfare, 97(5), 179–195. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717599/
Research on How to Implement the Program
Research has been conducted on how to implement Treatment Foster Care Oregon for Preschoolers (TFCO-P) as listed below:
Brown, C. H., Chamberlain, P., Saldana, L., Padgett, C., Wang, W., & Cruden, G. (2014). Evaluation of two implementation strategies in 51 child county public service systems in two states: Results of a cluster randomized head-to-head implementation trial. Implementation Science, 9, Article 134. https://doi.org/10.1186/s13012-014-0134-8
Chamberlain, P., & Saldana, L. (2014). Practice-research partnerships that scale-up, attain fidelity, and sustain evidence-based practices. In P. C. Kendall & R. S. Beidas (Eds.), Dissemination and implementation of evidence-based practices in child and adolescent mental health (pp. 127–142). Oxford University Press.
Chamberlain, P., & Saldana, L. (2015). Scaling up Treatment Foster Care Oregon: A randomized trial of two implementation strategies. In M. J. Van Ryzin, K. L. Kumpfer, G. M. Fosco, & M. T. Greenberg (Eds.), Family-based prevention programs for children and adolescents: Theory, research, and large-scale dissemination (pp. 186-205). Psychology Press.
Saldana, L. Chamberlain, P., Bradford, W. D., Campbell, M., & Landsverk, J. (2014). The cost of implementing new strategies (COINS): A method for mapping implementation resources using the stages of implementation completion. Children and Youth Services Review, 39, 177–182. https://pubmed.ncbi.nlm.nih.gov/33281198/
Saldana, L., Campbell, M., Leve, L.D., & Chamberlain, P. (2020). Long-term economic benefit of Treatment Foster Care Oregon (TFCO) for adolescent females referred to congregate care for delinquency. Child Welfare, 97(5), 179–195. https://pubmed.ncbi.nlm.nih.gov/33281198/
Wang, W., Saldana, L., Brown, C. H., & Chamberlain, P. (2010). Factors that influenced county system leaders to implement an evidence-based program: A baseline survey within a randomized controlled trial. Implementation Science, 5, Article 72. https://doi.org/10.1186/1748-5908-5-72
Relevant Published, Peer-Reviewed Research
Child Welfare Outcomes: Permanency and Child/Family Well-Being
Fisher, P. A., Gunnar, M. R., Chamberlain, P., & Reid, J. B. (2000). Preventive intervention for maltreated preschool children: Impact on children’s behavior, neuroendocrine activity, and foster parent functioning. Journal of the American Academy of Child & Adolescent Psychiatry, 39(11), 1356–1364. https://doi.org/10.1097/00004583-200011000-00009
Type of Study:
Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants:
30
Population:
- Age — EIFC: Mean=5.35 years; RFC: Mean=4.40 years; Community Sample: Mean=4.48 years
- Race/Ethnicity — EIFC: 80% Caucasian; RFC: 100% Caucasian; Community Sample: 70% Caucasian
- Gender — Not specified
- Status — Participants were youth referred for special placement due to placement disruptions, youth to be placed in regular foster care, and nonmaltreated youth living with their biological families.
Location/Institution: Oregon
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to describe the results of a pilot study that evaluated the effectiveness of the Early Intervention Foster Care (EIFC) program [now called Treatment Foster Care Oregon for Preschoolers (TFCO-P)] in the period immediately following a child’s placement in a new foster home. Participants were assigned to either an EIFC group, a regular foster care group (RFC), or a community sample comparison group. Measures utilized include the Child Caregiver Interviewer Impressions Form, the Parent Daily Report, and the Early Childhood Inventory. Child stress response was also measured by sampling salivary cortisol levels. Results indicate that at baseline the RFC group were developmentally delayed relative to the community sample. At follow-up the EIFC group did not differ from the community sample in parenting strategies, while the RFC group was significantly lower. The EIFC group also showed improvement in behavioral adjustment and salivary cortisol levels more similar to normal. Limitations include small group sizes and lack of random assignment to groups.
Length of controlled postintervention follow-up: 12 weeks.
Fisher, P. A., Burraston, B., & Pears, K. (2005). The Early Intervention Foster Care program: Permanent placement from a randomized trial. Child Maltreatment, 10(1), 61–71. https://doi.org/10.1177/1077559504271561
Type of Study:
Randomized controlled trial
Number of Participants:
90
Population:
- Age — 3–6 years
- Race/Ethnicity — EIFC: 79% White, 18% Hispanic/Latino, and 3% Native American; RFC: 92% White, 4% Hispanic/Latino, and 4% Native American
- Gender — EIFC: 66% Male; RFC: 60% Male
- Status — Participants were foster children needing a new placement.
Location/Institution: Oregon
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report on permanent placement outcomes from the Early Intervention Foster Care (EIFC) program [now called Treatment Foster Care Oregon for Preschoolers (TFCO-P)]. Participants were randomly assigned to be placed in EIFC or in regular foster care (RFC). Measures utilized include type and number of placements, time in foster care before permanent placement, and failure of a permanent placement. Results indicate that children in EIFC had significantly fewer failed permanent placements than children in RFC. The number of prior placements was positively associated with the risk of failed permanent placements for children in the comparison condition but not in the EIFC condition. The authors note that the small sample size did not allow for more detailed analysis of placement type and factors affecting placements. Limitations include small sample size and maltreatment information involved only basic data on the reason for the most recent foster placement.
Length of controlled postintervention follow-up: Approximately 15 months.
Fisher, P., Gunnar, M. R., Dozier, M., Bruce, J., & Pears, K. C. (2006). Effects of therapeutic interventions for foster children on behavioral problems, caregiver attachment, and stress regulatory neural systems. Annals of the New York Academy of Sciences, 1094(1), 215–225. https://doi.org/10.1196/annals.1376.023
Type of Study:
Randomized controlled trial
Number of Participants:
177
Population:
- Age — 3–5 years
- Race/Ethnicity — Not specified
- Gender — Not specified
- Status — Participants were foster children entering a new placement.
Location/Institution: Oregon
Summary:
(To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fisher, Burraston, & Pears (2005). The purpose of the study was to present evidence suggesting that foster children who show altered hypothalamic-pituitary-adrenal (HPA) axis activity show improvements in neurobehavioral functioning in the context of therapeutic caregiver-based interventions designed to address these underlying deficits. Participants were randomly assigned to receive Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) [now called Treatment Foster Care Oregon for Preschoolers (TFCO-P)] or to a regular foster care condition. Measures utilized include collection of salivary cortisol levels for assessing child stress response. Results indicate that children in the MTFC-P group showed significantly better morning cortisol levels (associated with stress adaptation) than did those in regular foster care at a measurement period of 8–9 months after entering care. Limitations include small sample size, and non-generalizable to children outside of foster care.
Length of controlled postintervention follow-up: Not specified.
Fisher, P. A., & Kim, H. K. (2007). Intervention effects on foster preschoolers’ attachment-related behaviors from a randomized trial. Prevention Science, 8(2), 161–170. https://doi.org/10.1007/s11121-007-0066-5
Type of Study:
Randomized controlled trial
Number of Participants:
117
Population:
- Age — 3–5 years
- Race/Ethnicity — Across groups: 89% European American, 5% Latino, 5% Native American, and 1% African American
- Gender — Regular Foster Care: 58% Male; MTFC-P: 49% Male
- Status — Participants were foster preschoolers entering a new placement.
Location/Institution: Oregon
Summary:
(To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fisher, Burraston, & Pears (2005). The purpose of the study was to examine change in attachment related behaviors among foster preschoolers participating in a randomized trial of the Multidimensional Treatment Foster Care Program for Preschoolers (MTFC-P) [now called Treatment Foster Care Oregon for Preschoolers (TFCO-P)]. Participants were randomly assigned to MTFC-P or to a regular foster care condition. Measures utilized include collection of salivary cortisol levels for assessing child stress response. Results indicate that children in the MTFC-P group showed significantly better morning cortisol levels (associated with stress adaptation) than did those in regular foster care at a measurement period of 8–9 months after entering care. Limitations include small sample size and non-generalizable to children outside of foster care.
Length of controlled postintervention follow-up: Not specified.
Fisher, P. A., & Stoolmiller, M. (2008). Intervention effects on foster parent stress: Associations with child cortisol levels. Development and Psychopathology, 20(3), 1003–1021. https://doi.org/10.1017/S0954579408000473
Type of Study:
Randomized controlled trial
Number of Participants:
177 (117 Regular Foster Care and 60 Community Comparison Group)
Population:
- Age — 3–6 years
- Race/Ethnicity — Across groups: 89% European American, 5% Latino, 5% Native American, and 1% African American
- Gender — MTFC-P group: 49% Male; Regular Foster Care: 58% Male; Community Comparison: 53% Male
- Status — Participants were foster children entering new placements.
Location/Institution: Pacific Northwest, United States
Summary:
(To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fisher, Burraston, & Pears (2005). The purpose of the study was to examine whether diurnal cortisol activity was associated with caregiver self-reported stress in response to child problem behavior in a sample of foster care children who were part of a larger efficacy trial to evaluate Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) [now called Treatment Foster Care Oregon for Preschoolers (TFCO-P)]. Participants were randomly assigned to intervention or regular foster care comparison groups. The community care children were not randomized to different conditions. Measures utilized include the Parent Daily Report (PDR). Results indicate that there were immediate reductions in caregiver stress that were sustained through 12 months post baseline in the intervention condition. In contrast, caregivers in the regular foster care condition showed higher rates of stress across time and increased stress sensitivity to child problem behaviors. Among caregivers in regular foster care, higher self-reported stress was associated with lower morning cortisol levels and more blunted diurnal cortisol activity. Limitations include small sample size and reliance on only morning and evening cortisol samples.
Length of controlled postintervention follow-up: Not specified.
Fisher, P. A., Kim, H. K., & Pears, K. C. (2009). Effects of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) on reducing permanent placement failures among children with placement instability. Children and Youth Services Review, 31(5), 541–546. https://doi.org/10.1016/j.childyouth.2008.10.012
Type of Study:
Randomized controlled trial
Number of Participants:
52
Population:
- Age — 3–5 years
- Race/Ethnicity — 90% European American
- Gender — 27 Male and 25 Female
- Status — Participants were foster children entering new placements.
Location/Institution: Pacific Northwest, United States
Summary:
(To include basic study design, measures, results, and notable limitations)
The study used a subset of the same sample as Fisher, Burraston, & Pears (2005). The purpose of the study was to examine the effects of a therapeutic intervention for foster preschoolers with histories of placement instability on permanency outcomes, and to determine whether the intervention's effectiveness on these outcomes varied based on prior maltreatment experiences. Participants were randomly assigned to receive Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) [now called Treatment Foster Care Oregon for Preschoolers (TFCO-P)] or to a regular foster care (RFC) condition. Measures utilized include records of the child’s history of permanent placement attempts during the 24 months of the study, and severity of maltreatment history. Results indicate that the groups did not differ on permanency attempt rates, but that the MTFC-P group had more than twice as many successful permanency attempts, defined as no subsequent changes during the first 24 months of the study. No effects of maltreatment history were found. Limitations include small sample size, and the longitudinal timeframe over which permanency outcomes were examined.
Length of controlled postintervention follow-up: Approximately 15 months.
Pears, K. C., Fisher, P. A., Bruce, J., Kim, H. K., & Yoerger, K. (2010). Early elementary school adjustment of maltreated children in foster care: The roles of inhibitory control and caregiver involvement. Child Development, 81(5), 1550–1564. https://doi.org/10.1111/j.1467-8624.2010.01491.x
Type of Study:
Randomized controlled trial
Number of Participants:
177 (117 Regular Foster Care and 60 Community Comparison Group)
Population:
- Age — 3–6 years
- Race/Ethnicity — Foster Care: 85% European American, 8% Latino, 6% Native American, and 1% African American; Community Comparison: 79% European American, 5% African American, 7% Latino, 7% Native American, and 2% Pacific Islander
- Gender — Foster Care: 53% Male; Community Comparison: 54% Male
- Status — Participants were foster children entering new placements.
Location/Institution: Pacific Northwest, United States
Summary:
(To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fisher, Burraston, & Pears (2005). The purpose of the study was to discuss whether disparities in school adjustment can be observed in maltreated foster children as early as kindergarten and first grade. All foster care children were part of a larger efficacy trial to evaluate Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) [now called Treatment Foster Care Oregon for Preschoolers (TFCO-P)]. Participants were randomly assigned to MTFC-P or comparison groups at study entry. The community care children were not randomized to different conditions. The study also sought to identify factors that mediate the association between a history of maltreatment and foster placement and early school. Measures utilized include The Teacher Social Competence, the Loneliness and Social Dissatisfaction Questionnaire for Young Children–Teacher Version, the Walker-McConnell Scales of Social Competence and School Adjustment, and the Seattle Personality Questionnaire. Results indicate that the maltreated foster children performed more poorly in academic and social-emotional competence than the community controls. Inhibitory control fully mediated the association of maltreatment and foster placement with academic competence, whereas inhibitory control and caregiver involvement mediated their association with social-emotional competence. Limitations include small sample size.
Length of controlled postintervention follow-up: Not specified.
Fisher, P. A., Van Ryzin, M. J., & Gunnar, M. R. (2011). Mitigating HPA axis dysregulation associated with placement changes in foster care. Psychoneuroendocrinology, 36(4), 531–539. https://doi.org/10.1016/j.psyneuen.2010.08.007
Type of Study:
Randomized controlled trial
Number of Participants:
117
Population:
- Age — 3–6 years
- Race/Ethnicity — Regular Foster Care: 93% Caucasian; Treatment Foster Care: 83% Caucasian
- Gender — RRegular Foster Care: 58% Male; Treatment Foster Care: 49% Male
- Status — Participants were foster children entering new placements.
Location/Institution: Pacific Northwest
Summary:
(To include basic study design, measures, results, and notable limitations)
The study uses the same sample as Fisher, Burraston, & Pears (2005). The purpose of the study was to examine whether placement changes (i.e., moving between foster homes or from a foster home to a permanent placement) were associated with more blunted daily cortisol rhythms and whether a caregiver-based intervention exerted a protective effect in this context. Participants were randomly assigned to MTFC-P [now called Treatment Foster Care Oregon for Preschoolers (TFCO-P)] or comparison groups at study entry. Measures utilized include placement data and monthly salivary cortisol samples collected twice daily on 2 consecutive days. Results indicate that MTFC-P mitigates the dysregulating effects of placement changes on children’s diurnal hypothalamic-pituitary-adrenal (HPA) axis activity. Limitations included small sample size, and a lack of clarity regarding which intervention components were most effective at stabilizing morning-to-evening cortisol decreases.
Length of controlled postintervention follow-up: Not specified.
Fisher, P. A., Stoolmiller, M., Mannering, A. M., Takahashi, A., & Chamberlain, P. (2011). Foster placement disruptions associated with problem behavior: Mitigating a threshold effect. Journal of Consulting and Clinical Psychology, 79(4), 481–487. https://doi.org/10.1037/a0024313
Type of Study:
Randomized controlled trial
Number of Participants:
117
Population:
- Age — 3–6 years
- Race/Ethnicity — Regular Foster Care: 93% Caucasian; Treatment Foster Care: 83% Caucasian
- Gender — Regular Foster Care: 58% Male; Treatment Foster Care: 49% Male
- Status — Participants were foster children entering new placements.
Location/Institution: Pacific Northwest
Summary:
(To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fisher, Burraston, & Pears (2005). The purpose of the study was to discuss the effects of placement disruptions on foster children. Participants were randomly assigned to Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) [now called Treatment Foster Care Oregon for Preschoolers (TFCO-P)] or comparison groups at study entry. Measures utilized include the Parent Daily Report Checklist. Problem behavior and placement disruptions were examined in 60 children in regular foster care and 57 children in MTFC-P. Foster caregivers reported on problem behaviors 6 times over 3 months. Placement disruptions were tracked over 12 months. Results indicate that the regular foster care children with 5 or fewer problem behaviors were at low risk for disruption, but their risk increased 10% for each additional problem behavior. MTFC-P appeared to mitigate this “threshold effect”, the number of problem behaviors did not predict risk of placement disruption in the treatment foster care group. Limitations include lack of generalizability to other types of children in foster care or more ethnically diverse populations.
Length of controlled postintervention follow-up: Not specified.
Lynch, F. L., Dickerson, J. F., Saldana, L., & Fisher, P. A. (2014). Incremental net benefit of early intervention for preschool-aged children with emotional and behavioral problems in foster care. Children and Youth Services Review, 36, 213–219. https://doi.org/10.1016/j.childyouth.2013.11.025
Type of Study:
Randomized controlled trial
Number of Participants:
117
Population:
- Age — 3–5 years
- Race/Ethnicity — 89% European American
- Gender — 67 Female and 50 Male
- Status — Participants were preschoolers in foster care.
Location/Institution: Oregon
Summary:
(To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fisher, Burraston, & Pears (2005). The purpose of the study was to assess net benefit of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) [now called Treatment Foster Care Oregon for Preschoolers (TFCO-P)] compared to regular foster care (RFC). Participants were randomly assigned to MTFC-P or RFC. Measures utilized include the Child Caregiver Interviewer Impressions Form, the Parent Daily Report, the Early Childhood Inventory, and the quality-adjusted life years (QALYS). Results indicate that MTFC-P significantly increased permanent placements for the placement instability sample. Average total cost for the new intervention sample was significantly less than for RFC (full sample: $27,204 vs. $30,090; placement instability sample: $29,595 vs. $36,061). Limitations include sample size was relatively small, limited racial and ethnic diversity, and the intervention was conducted in only one site.
Length of controlled postintervention follow-up: 12–15 months.
Jonkman, C. S., Schuengel, C., Oosterman, M., Lindeboom, R., Boer, F., & Lindauer, R. J. (2017). Effects of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) for young foster children with severe behavioral disturbances. Journal of Child and Family Studies, 26(5), 1491–1503. https://doi.org/10.1007/s10826-017-0661-4
Type of Study:
Study 1: Randomized controlled trial; Study 2: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants:
108
Population:
- Age — 3–7 years
- Race/Ethnicity — Not specified
- Gender — 64% Male
- Status — Participants were children in permanent foster care placement.
Location/Institution: Netherlands
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the relative efficacy of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) [now called Treatment Foster Care Oregon for Preschoolers (TFCO-P)] on multiple outcomes against treatment as usual in the Netherlands (TAU; Study 1), and regular foster care (RFC; Study 2). Participants were randomly assigned to MTFC-P or treatment foster care as usual (TAU). Measures utilized include the Child Behavioral Checklist (CBCL), the Teacher Report Form (TRF), and the Parent Daily Report. Outcomes of Study 1 were evaluated using a randomized controlled design and quasiexperimental design, outcomes of Study 2 according to nonequivalent group comparison. Results indicate that for outcomes related to Study 1, no evidence was found for relative efficacy of MTFC-P over TAU. A treatment effect was found on trauma symptoms, in favor of TAU. Results indicate that for outcomes of Study 2 that whereas caregiving stress and secure base distortions were significantly more severe at baseline in MTFC-P compared to RFC, posttreatment differences were no longer significant. However, percentages of symptoms of disinhibited attachment and attachment disorder were nearly equal between groups at baseline, while posttreatment percentages indicated significantly more symptoms in MTFC. In addition, for Study 2 results revealed a significant difference in the severity of externalizing problems posttreatment, in favor of RFC. Limitations include sample size was relatively small, treatment compliance was not examined, absence of a control group for Study 2 without active treatment, and absence of a follow-up measurement to examine long-term effects.
Length of controlled postintervention follow-up: None.
Additional References
Chamberlain, P., & Fisher, P. A. (2003). An application of MTFC for early intervention. In P. Chamberlain (Ed.), Treating chronic juvenile offenders: Advances made through the Oregon MTFC model (pp. 129-140). Washington, DC: American Psychological Association.
Fisher, P. A., Ellis, B. H., & Chamberlain, P. (1999). Early intervention foster care: A model for preventing risk in young children who have been maltreated. Children's Services: Social Policy, Research, and Practice, 2, 159-182.
Contact Information
- John Aarons
- Agency/Affiliation: TFC Consultants, Inc.
- Website: www.tfcoregon.com
- Email: johna@tfcoregon.com
- Phone: (541) 343-2388
Date Research Evidence Last Reviewed by CEBC: February 2023
Date Program Content Last Reviewed by Program Staff: January 2023
Date Program Originally Loaded onto CEBC: May 2007
