Treatment Foster Care Oregon for Adolescents (TFCO-A) is an intervention for young people between the ages of 12 and 18 years old with emotional and behavioural problems. Young people are placed with a ‘treatment foster family’ for 9 to 12 months. During this time, a clinical team works intensively with the young person, foster carers, and birth family to increase placement stability and support family reunification.
The information above is as offered/supported by the intervention provider.
12 to 18 years old
Individual
Treatment Foster Care Oregon for Adolescents (TFCO-A, formerly Multidimensional Treatment Foster Care – Adolescence) is for families with a child between the ages of 12 and 18 years old who is at risk of an out-of-home placement in residential care or a secure children’s home because of youth offending behaviours and/or serious emotional problems.
The young person placed with a ‘treatment foster family’ trained in the TFCO-A model. Within these warm and structured family environments, the young person receives positive and consistent reinforcement for appropriate behavior and negative consequences for inappropriate behavior. The young person will typically remain with TFCO-A foster family for nine months to a year.
TFCO-A is delivered by a team of practitioners who provide support to the young person, foster carer, birth family, school, and move-on placement. At the centre of the TFCO intervention is the foster carer and their young person. Young people are placed with a ‘treatment foster family’ trained in the TFCO-A model, for 9 to 12 months. These ‘treatment foster families’ are trained to help reduce young people’s more disruptive behaviour through effective parenting practices and are well supported to minimise stress and maximise their capacity to offer a nurturing and consistent home environment.
TFCO aims to increase a young person’s social, emotional, and relational skills, and therefore reduce the need for more challenging and antisocial behaviours.
The main way this is achieved is via:
Throughout the duration of the TFCO intervention the Birth Family Coach works with the birth and extended family members in regular contact with the TFCO young person to help shape up their strengths and skills. Ultimately, the goal is to stabilise and improve relationships so that a move-on home is more realistic; however, when this is not a possibility the skills are targeted to improve the quality of contact.
The Team Leader coordinates and guides the TFCO intervention for each young person, within the foster home, at school, with the biological family, and in the move-on family’s home for three months following TFCO.
12 to 18 years old
Disclaimer: The information in this section is as offered/supported by the intervention provider.
Science-based assumption
Youth offending and antisocial behaviour during adolescence increases the risk of future criminal behaviour and can significantly interfere with a successful transition to adulthood.
Science-based assumption
Youth offending and antisocial behaviour is often associated ineffective parenting behaviours, difficulties establishing limits and boundaries, and high levels of conflict in parent–child interactions.
Science-based assumption
Families where a child is at risk of an out-of-home placement due to serious behaviour problems and youth offending behaviour.
Intervention
The young person is placed with a treatment foster family
A team of clinicians provide ‘wrap around’ support to the young person, biological parents, and foster parents
A skills coach also advocates for the young person at school and the community.
Short-term
Improved parenting behaviours
Improved young person’s behaviour
Improved family communication.
Medium-term
Improved young person wellbeing
Improved prosocial behaviour
Increased attendance at school or training.
Long-term
Increased likelihood of family reunification
Reduced risk of youth offending
Reduced risk of substance misuse
Reduced risk of criminal behaviour in adulthood.
Young people between the ages of 12 and 18 years old, and their families.
These young people are in foster placements or residential placements and are displaying delinquent behaviour.
TFCO-A is a team-based intervention working with the young person, foster carer, birth family, school, and move-on placement. It usually lasts for 9 to 12 months.
The main components of TFCO-A are:
Component 1: TFCO Foster Carers deliver the TFCO model directly to the young people in their everyday interactions, under the guidance of the TFCO Team Leader. They have two days of TFCO training prior to the first placement. While they have a young person in their care, they attend weekly foster carer meetings, and complete a daily Parent Daily Report that monitors young people’s behaviours and carer stress. The Foster Carers have access to 24/7 support and are provided with regular respite.
Component 2: All young people follow an age-appropriate behavioural incentive intervention within the foster placement, developed and overseen by the Team Leader. All young people receive weekly Skills Coaching sessions for 1 to 1.5 hours and weekly hourly sessions with their Individual Worker/Therapist for the duration of their placement, and for up to three months post-TFCO.
Component 3: The Birth Family Coach works weekly with the birth family and/or extended family to help them learn and implement the TFCO parenting intervention. This helps to shape up their own strengths and skills as carers/parents and aims to improve the quality of contact that they have with their child, increasing the chances of young people being returned home. This work can continue once the intervention is completed or will be offered to the follow-on placement.
Component 4: The TFCO team work closely with schools/colleges or work placements to develop interventions for identified adults to deliver.
Young people are placed with a ‘treatment foster family’ trained in the TFCO-A model, for a period that typically lasts 9 to 12 months. These ‘treatment foster families’ are trained to help reduce young people’s more disruptive behaviour through the use of effective parenting practices.
Young people’s skill development is targeted in a number of ways throughout the TFCO intervention:
Timely information sharing with the Team Leader is key to the effective delivery of TFCO and there are a number of mechanisms within the TFCO model that facilitate this:
This intervention is delivered by a clinical team. The team consists of a Team Leader (typically with a master’s qualification or higher in social work or psychology), TFCO-A Foster Carers, a Foster Carer Recruiter/Consultant, a Birth Family Coach), a Skills Coach, Individual Therapist, Administrator, and the Programme Manager.
Practitioners have three to four days of intervention training depending on their role. Booster training of practitioners is recommended.
The TFCO-A clinical team and Foster Carers are required to be trained by the National Implementation Service when they initially set up. Following this, new Foster Carers can be trained by the Team Leader.
It is a requirement that Team Leaders are supervised by one external supervisor, at the National Implementation Service, through weekly one-hour consultations via the telephone.
The National Implementation Service provides consultation to the Team Leader on all aspects of the TFCO-A model, to ensure fidelity to the model. This is not clinical supervision, and the NIS does not hold clinical responsibility for TFCO-A young people.
TFCO-A skills-based supervision is provided by the Team Leader to the rest of the clinical team. This is done via weekly face-to-face meetings for one hour.
TFCO-A team members would still be expected to meet the supervision requirements of the agency they are employed by, that is appropriate for the team members’ professional qualification (e.g. Social Worker or Mental Health Practitioner). This includes clinical supervision, skills-based supervision, and case management.
Intervention fidelity is maintained through the following processes:
Contact person: John Aarons
Email address: johna@tfcoregon.com
Website: https://www.tfcoregon.com/
*Please note that this information may not be up to date. In this case, please visit the listed intervention website for up to date contact details.
TFCO-A’s most rigorous evidence comes from two RCTs which were conducted in United States, consistent with Foundations’ Level 3 evidence strength criteria. Evidence from at least one level 3 study, along with evidence from other studies rated 2 or better qualifies TFCO-A for a 3+ rating.
The first study observed that TFCO-A young people significantly spent significantly few days in youth detention or prison in comparison to young people not receiving the intervention. These young people were also less likely to run away from the foster care placement, be referred for a criminal offence a year following the intervention and report less antisocial behaviour than young people not receiving the intervention.
The second study also observed statically significant reductions in the time spent in youth detention, as well as reductions in self-reported antisocial behaviour in comparison to young people not receiving TFCO-A.
TFCO-A can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome.
Fewer days spent in lock up
A year later
Improvement index
Interpretation
Study
Fewer days spent in lock up
A year later
Improvement index
Interpretation
Study
Reduced running away from placements
A year later
Improvement index
Interpretation
Study
Reduced rates of criminal referrals
A year later
Improvement index
Interpretation
Study
Reduced delinquent behaviour
A year later
Improvement index
Interpretation
Study
Reduced delinquent behaviour
A year later
Improvement index
Interpretation
Study
| Identified in search | 23 |
| Studies reviewed | N/A |
| Meeting the L2 threshold | 0 |
| Meeting the L3 threshold | 2 |
| Contributing to the L4 threshold | 0 |
| Ineligible | 21 |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 79 males aged 12 to 17 years old, all with a history of chronic delinquency |
| Race, ethnicities, and nationalities |
|
| Population risk factors | All the young people had a history of serious and chronic delinquency and were referred for community placements by the juvenile justice system over a four-year period. The participant had an average of 13.5 prior criminal referrals and more than four felonies. Around half of the study population were from single parent family. Around a quarter of the study participants’ parents were convicted of crime. More than 60% of study participants were reported to be chronically absent from school. More than 70% of the sample had previously run away from placement. |
| Timing | Baseline and post-intervention |
| Child outcomes |
|
| Other outcomes | None |
| Study rating | 3 |
| Citations | 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. |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 81 girls aged 13 to 17 years old mandated to community-based out-of-home care due to problems with chronic delinquency. |
| Race, ethnicities, and nationalities |
|
| Population risk factors | 68% of the girls had been residing in a single-parent family, and 32% of the girls lived in families with an income of less than $10,000. Girls had a lifetime average of 11.9 criminal referrals each, and 70% of the girls had at least one prior felony. |
| Timing | Baseline and post-intervention |
| Child outcomes |
|
| Other outcomes | None |
| Study rating | 3 |
| Citations | 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. |
The following studies were identified for this intervention but did not count towards the intervention’s overall evidence rating. An intervention receives the same rating as its most robust study or studies.
Bergström, M. & Höjman L. (2015) Is multidimensional treatment foster care (MTFC) more effective than treatment as usual in a three-year follow-up? Results from MTFC in a Swedish setting. European Journal of Social Work. 18.
Chamberlain, P. (1990) Comparative evaluation of specialized foster care for seriously delinquent youths: A first step. Community Alternatives: International Journal of Family Care. 2, 21–36.
Chamberlain, P. (1997) The effectiveness of group versus family treatment settings for adolescent juvenile offenders. Paper presented at the Society for Research on Child Development Symposium, Washington, D.C., 3 April.
Chamberlain, P., Leve, L. D. & DeGarmo, DS. (2007) Multidimensional 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), 187–193.
Chamberlain, P., Ray, J. & Moore, K. (1996) Characteristics of residential care for adolescent offenders: A comparison of assumptions and practices in two models. Journal of Child and Family Studies. 5, 285–297.
Chamberlain, P. & Reid, J.B. (1994) Differences in risk factors and adjustment for male and female delinquents in Treatment Foster Care. Journal of Child and Family Studies. 3, 23–39.
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. 68, 857–863.
Eddy, J., Whaley, R. & 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 Disorder. 12 (1), 2–8.
Green, J., Biehal, N., Roberts, C., Dixon, J., Kay, C., Parry, E., Rothwell, J., Roby, A., Kapadia, D., Scott, S. & Sinclair, I. (2014) Multidimensional Treatment Foster Care for Adolescents in English care: Randomised trial and observational cohort evaluation. British Journal of Psychiatry. 204 (3) 214–221.
Harold, G., Kerr, D., Van Ryzin, M., DeGarmo, D., Rhoades, K. & Leve L. (2013) Depressive symptom trajectories among girls in the juvenile justice system: 24-month outcomes of an RCT of Multidimensional Treatment Foster Care. Prevention Science.
Holmes, L., Ward, H. & McDermid, S. (2012) Calculating and comparing the costs of multidimensional treatment foster care in English local authorities. Children and Youth Services Review. 34, 11, 2141–2146.
Kerr, D. C. R., Leve, L. D. & Chamberlain, P. (2009) Pregnancy rates among juvenile justice girls in two randomized controlled trials of Multidimensional Treatment Foster Care. Journal of Counseling and Clinical Psychology. 77 (3), 588–593.
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.
Leve, L. D. & Chamberlain, P. (2007) A randomized evaluation of Multidimensional Treatment Foster Care: Effects on school attendance and homework completion in juvenile justice girls. Research on Social Work Practice. 17 (6), 657–663.
Leve, L. D., Kerr, D. C. R. & Harold, G. T. (2013) Young adult outcomes associated with teen pregnancy among high-risk girls in a randomized-controlled trial of Multidimensional Treatment Foster Care. Journal of Child & Adolescent Substance Abuse. 22 (5), 421–434.
Rhoades, K. A., Chamberlain, P., Roberts, R. & Leve, L. D. (2013) MTFC for high-risk adolescent girls: A comparison of outcomes in England and the United States. Journal of Child & Adolescent Substance Use. 22 (5), 435–449.
Rhoades, K. A., Leve, L. D., Harold, G., Kim, H. K. & Chamberlain, P. (2014) Drug use trajectories after a randomized controlled trial of MTFC: Associations with partner drug use. Journal of Research on Adolescence. 24 (1), 40–54.
Sinclair, I., Parry, E., Biehal, N., Fresen, J., Kay, C., Scott, S. & Green, J. (2016) Multi-dimensional Treatment Foster Care in England: Differential effects by level of initial antisocial behaviour. European Journal of Child and Adolescent Psychiatry. 25, 843–852.
Smith, D. K., Chamberlain, P. & Eddy, J.M. (2010) Preliminary support for Multidimensional Treatment Foster Care in reducing substance use in delinquent boys. Journal of Child & Adolescent Substance Abuse. 19 (4), 343–358.
Van Ryzin, M. J. & Leve, L. D. (2012) Affiliation with delinquent peers as a mediator of the effects of Multidimensional Treatment Foster Care for delinquent girls. Journal of Consulting and Clinical Psychology. 80 (4), 588–596.
Westermark, P. K., Hansson, K. & Olsson, M. (2011) Multidimensional Treatment Foster Care (MFTC): Results from an independent replication. Journal of Family Therapy. 33, 20–41.
Note on provider involvement: This provider has agreed to Foundations’ terms of reference (or the Early Intervention Foundation's terms of reference), and the assessment has been conducted and published with the full cooperation of the intervention provider.
Rated 1: Set up and delivery is low cost, equivalent to an estimated unit cost of less than £100.
Rated 2: Set up and delivery is medium-low cost, equivalent to an estimated unit cost of £100–£499.
Rated 3: Set up and delivery is medium cost, equivalent to an estimated unit cost of £500–£999.
Rated 4: Set up and delivery is medium-high cost, equivalent to an estimated unit cost of £1,000–£2,000.
Rating 5: Set up and delivery is high cost. Equivalent to an estimated unit cost of more than £2,000.
Set up and delivery cost is not applicable, not available, or has not been calculated.
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Supporting children’s mental health and wellbeing: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing child maltreatment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Enhancing school achievement & employment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing crime, violence and antisocial behaviour: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing substance abuse: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing risky sexual behaviour & teen pregnancy: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
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Rated 2: Has preliminary evidence of improving a child outcome from a quantitative impact study, but there is not yet evidence of causal impact.
Rated 2+: Meets the level 2 rating and the best available evidence is based on a study which is more rigorous than a level 2 standard but does not meet the level 3 standard.
Rated 3: Has evidence of a short-term positive impact from at least one rigorous study.
Rated 3+: Meets the level 3 rating and has evidence from other studies with a comparison group at level 2 or higher.
Rated 4: Has evidence of a long-term positive impact through at least two rigorous studies.
Rated 4+: Meets the level 4 rating and has at least a third study contributing to the Level 4 rating, with at least one of the studies conducted independently of the intervention provider.
Rating has a *: The evidence base includes mixed findings i.e., studies suggesting positive impact alongside studies, which on balance, indicate no effect or negative impact.
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