Treatment Foster Care Oregon Prevention (TFCO-P) is a wrap-around, therapeutic intervention for families with a looked-after child between the ages of 3 and 6 years old with a history of placement disruptions due to behavioural or emotional issues. Children are placed with a ‘treatment foster family’ for approximately 9 to 12 months. During this time, a clinical team works intensively with the foster carers and birth family to increase placement stability and support family reunification.
The information above is as offered/supported by the intervention provider.
2 to 5 years old
Individual
Treatment Foster Care Oregon Prevention (TFCO-P, formerly Multidimensional Treatment Foster Care Preschool) is for families with a looked-after child between the ages of 3 and 6 receiving foster care or in a residential placement. Eligible children typically have a history of placement disruptions due to behavioural difficulties that negatively impact their ability to form a positive relationship with their carer or attend school.
TFCO-P is delivered by a clinical team, consisting of a Team Leader (typically a psychologist or social worker), TFCO-P Foster Carers, a Foster Carer Recruiter/Consultant, a Birth Family Coach, a Skills Coach, an Individual Therapist, Administrator, and the Programme Manager.
Children are placed with a ‘treatment foster family’ trained in the TFCO-P model for nine months to a year. TFCO carers are highly trained and supported to offer a nurturing and consistent home environment to the child. Within these warm and structured family environments, children receive positive and consistent reinforcement for appropriate behaviour and age-appropriate consequences for challenging and disruptive behaviour.
While the child is with the TFCO-P parents, family therapy is provided to the biological (or adoptive) family, with the goal of reuniting the child with their parents. During this time, parents are taught the same parenting strategies that are enforced in the TFCO-P foster home. The child also attends a therapeutic playgroup and receives individual therapy and skills training from a member of the TFCO-P team.
The Team Leader coordinates and guides the TFCO intervention for each child, within the foster home, at school, with the biological family and in the move-on family’s home for three months following TFCO.
A primary aim of TFCO-P is family reunification. However, placement stability within a new ‘move-on’ family is also a goal if reunification with the birth family is not possible.
3 to 6 years old
Families with a looked-after child between the ages of 3 and 6 years old who are at risk of placement instability due to emotional and behavioural difficulties
Disclaimer: The information in this section is as offered/supported by the intervention provider.
Science-based assumption
Experiences of abuse and neglect and exposure to trauma substantially increase the risk of children having emotional and behavioural difficulties as they develop.
Science-based assumption
Serious and chronic behavioural problems negatively impact looked after children’s placement stability and ability to successfully attend school.
Science-based assumption
Looked after children with problematic behaviour often require more support than some foster carers can provide.
Intervention
Specially trained and supported foster carers provide a nurturing home for looked after children
Individual therapy is provided to the child
Individual therapy is provided to the biological parents or move on family.
Short-term
The child is better able to form a positive relationship with the foster carer
The child is better able to regulate their behaviour.
Medium-term
The child’s behaviour improves
The child successfully attends school.
Long-term
The child remains in a stable placement
The child is less at risk for behavioural and emotional problems in later childhood
Family reunification is achieved when possible.
Families with a looked-after child between the ages of 3 and 6 years old who are in foster placements or residential placements
Targeted children have complex needs and may have already experienced a number of placement disruptions. Children may present with a wide range of behavioural difficulties, which are likely to be impacting on a number of areas of life such as their relationships with adults and peers and their capacity to manage preschool or school environments.
The main components of TFCO-P are:
Component 1: TFCO Foster Carers deliver the TFCO model directly to the children 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 child in their care, they attend weekly foster carer meeting and complete a daily Parent Daily Report that monitors children’s behaviours and carer stress. The Foster Carers have access to 24/7 support and are provided with regular respite.
Component 2: All children follow a behavioural incentive intervention within the foster placement, developed and overseen by the Team Leader. All children receive weekly Skills Coaching sessions for 1 to 1.5 hours, for the duration of their placement, and for up to three months post-TFCO. Some children attend a weekly Therapeutic Playgroup for 1.5 hours, which focuses on skills for school-readiness.
Component 3: The Birth Family Coach works weekly with the birth family and/or extended family for one hour. They make use of a TFCO parenting intervention to help shape up strengths and skills and improve the quality of contact, and to increase the chances of children being returned home. This work can continue once a child returns home or will be offered to the follow-on placement.
Component 4: The TFCO team work closely with schools to develop interventions for teachers to deliver. Alternatively, an intervention will be delivered directly to the child from the TFCO team, within the school.
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:
Children’s skill development is targeted in a number of ways throughout the TFCO intervention:
TFCO-P is delivered by a clinical team. The team consists of a Team Leader, TFCO-A Foster, Foster Carer Recruiter/Consultant, Birth Family Coach, 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-P 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-P model, to ensure fidelity to the model. This is not clinical supervision, and the NIS does not hold clinical responsibility for TFCO-P children.
TFCO-P 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.
TFCO-P team members would still be expected to meet the supervision requirements of the agency they are employed by, that is appropriate for the team member’s professional qualification (e.g. Social Worker or Mental Health Practitioner). This includes, clinical, skills, 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-P’s most rigorous evidence comes from single RCT conducted in the United States consistent with Foundations ‘Level 2+ evidence strength criteria.
This study observed statistically significant improvements in TFCO-P parents’ reports of their children’s attachment security, as well as stable cortisol levels in comparison to children not exposed to the intervention. Additionally, TFCO-P caregivers reported significantly less stress in comparison to carers not supported by the intervention.
| Identified in search | 11 |
| Studies reviewed | 1 |
| Meeting the L2 threshold | 1 |
| Meeting the L3 threshold | 0 |
| Contributing to the L4 threshold | 0 |
| Ineligible | 10 |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 137 children aged 2 to 5 years in foster care |
| Race, ethnicities, and nationalities |
|
| Population risk factors | On average, children had spent 171 days in foster care prior to the study |
| Timing | Baseline, and 3-monthly |
| Child outcomes |
|
| Other outcomes | Reductions in caregiver stress (caregiver report) |
| Study rating | 2+ |
| Citations | Study 1a: Fisher, P. A. & Kim, H. K. (2007) Intervention effects on foster preschoolers’ attachment-related behaviors from a randomized trial. Prevention Science. 8, 161–170. Study 1b: Fisher, P. A., Stoolmiller, M., Gunnar, M. R. & Burraston, B. O. (2007) Effects of a therapeutic intervention for foster preschoolers on diurnal cortisol activity. Psychoneuroendocrinology. 32 (8), 892–905. Study 1c: Fisher, P. A. & Stoolmiller, M. (2008) Intervention effects on foster parent stress: Associations with child cortisol levels. Development and Psychopathology. 20 (3), 1003–1021. |
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.
Bruce, J., McDermott, J. M., Fisher, P. A. & Fox, N. A. (2009) Using behavioral and electrophysiological measures to assess the effects of a preventive intervention: A preliminary study with preschool-aged foster children. Prevention Science. 10 (2), 129–140.
Fisher, P. (2015) Review: Adoption, fostering, and the needs of looked after and adopted children. Child and Adolescent Mental Health. 20 (1), 5–12.
Fisher, P. A., Burraston, B. & Pears, K. (2005) The early intervention Foster Care Program: Permanent placement outcomes from a randomized trial. Child Maltreatment. 10, 61–71.
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.
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 .
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.
Jonkman, C. S., Bolle, E. A., Lindeboom, R., Schuengel, C., Oosterman, M., Boer, F. & Lindauer, R. J. (2012) Multidimensional treatment foster care for preschoolers: Early findings of an implementation in the Netherlands. Child and Adolescent Psychiatry and Mental Health. 6 (1), 38.
Jonkman, C. S., Schuengel, C., Lindeboom, R., Oosterman, M., Boer, F. & Lindauer, R. J. (2013) The effectiveness of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) for young children with severe behavioral disturbances: Study protocol for a randomized controlled trial. Trials. 14 (1), 197.
Leve, L., Harold, G. T., Chamberlain, P., Landsverk, J. A., Fisher, P. A. & Vostanis, P. (2012) Practitioner review: Children in foster care – vulnerabilities and evidence-based interventions that promote resilience processes. Journal of Child Psychology and Psychiatry. 53 (12), 1197–1211.
Luke, N., Sinclair, I., Woolgar, M. & Sebba, J. (2014) What works in preventing and treating poor mental health in looked after children? NSPCC.
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.
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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.
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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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