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Treatment Foster Care Oregon - Adolescents (TFCO-A)

Topic Areas
Scientific Rating
Child Welfare Relevance
Alternatives to Long-Term Residential Care Programs
1  — Well-Supported by Research Evidence
High
Behavioral Management Programs for Adolescents in Child Welfare
1  — Well-Supported by Research Evidence
High
Disruptive Behavior Treatment (Child & Adolescent)
1  — Well-Supported by Research Evidence
High
Placement Stabilization Programs
1  — Well-Supported by Research Evidence
High
Resource Parent Programs
1  — Well-Supported by Research Evidence
High
Educational Interventions for Children and Adolescents in Child Welfare
3  — Promising Research Evidence
High

About This Program

Target Population: Boys and girls, 12-17 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, and their caregivers

For children/adolescents ages: 12 – 17

For parents/caregivers of children ages: 12 – 17

Program Overview

TFCO-A (previously referred to as Multidimensional Treatment Foster Care - Adolescents) provides foster care treatment for children 12-17 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 they are 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:

For Youth:

  • Eliminate or reduce problem behaviors
  • Increase developmentally appropriate normative and prosocial behavior
  • Transition to a family of origin or lower-level aftercare resource
  • Improve peer associations
  • Improve interaction and communication with parent/caregiver
  • Improve coping and social skills
  • Improve behavior in school

For Caregivers:

  • Improve interaction and communication with youth

Logic Model

View the Logic Model for Treatment Foster Care Oregon - Adolescents (TFCO-A).

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 treatment foster home; may place sibling groups together in TFCO-P and TFCO-C depending on symptoms
    • Provides clinical team with stratified roles, led by the Team Leader
    • Has Team Leader with authority regarding the team & program
    • Includes treatment foster parents as members of the team
    • Views the treatment foster home as primary clinical environment
    • Treats youth symptoms as skill deficits
    • Uses daily contact with treatment foster parent including collection of behavioral data on youth - Parent Daily Report
    • Trains treatment foster parents in the TFCO-A model prior to placement of a child
    • Gives treatment foster parents access to the 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 - Adolescents (TFCO-A) directly provides services to children/adolescents and addresses the following:

  • Trauma, 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, interrupt the course of 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 youth in treatment, two contacts per week which consist of a weekly individual therapy for one hour and weekly individual skills training in a two-hour session. For the family of origin or other long-term placement resource, one contact per week in the form of a one-hour family therapy 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
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Other
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

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

Family of origin (or other long-term placement resource) is 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 a language other than English:

Swedish

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:

  • Office space for a team of approximately 6-8 people: Team Leader, Recruiter/Trainer/Parent Daily Report Caller, Family Therapist, Individual Therapist, and 2-3 Skills Trainers
  • 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 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 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

Treatment 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.

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.

Program Manual(s)

Manuals include:

  • Team Leader Manual
  • Treatment Foster Parent Recruiter/Trainer/PDR Caller Manual
  • Family Therapist Manual
  • Individual Therapist Manual
  • Skills Trainer Manual

Manuals are available through the TFCO-A training. Please contact the program representative listed at the bottom of the page for more information.

Training Information

There is training available for this program.

Training Contact:
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 - 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 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 - Adolescents (TFCO-A) 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 - Adolescents (TFCO-A) 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 - Adolescents (TFCO-A) 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 - Adolescents (TFCO-A) 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 - Adolescents (TFCO-A) 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://doi.org/10.1016/j.childyouth.2013.10.006

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

The CEBC reviews all of the articles that have been published in peer-reviewed journals as part of the rating process. When there are more than 10 published, peer-reviewed articles, the CEBC identifies the most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The articles chosen for Treatment Foster Care Oregon – Adolescents (TFCO-A) are summarized below:

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(3), 266–276. https://doi.org/10.1002/1520-6629(199107)19:33.0.CO;2-5

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 basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the effects of providing treatment in a Specialized Foster Care (SFC) program for children and adolescents who had been previously hospitalized. Participants 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). Measures utilized include the Child Global Assessment Scale, the Parent Daily Report Checklist (PDR), the Behavior Symptom Inventory (BSI) and a social interaction task. Results indicated 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. Limitations include conclusions are limited by the small sample size, and reliance on self-reported measures.

Length of controlled 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. https://doi.org/10.1037/0022-006X.66.4.624

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 basic study design, measures, results, and notable limitations)
The purpose of the study was to determine the relative effectiveness of group care (GC) and Multidimensional Treatment Foster Care (MTFC) [now called Treatment Foster Care Oregon – Adolescents (TFCO-A)] compared in terms of their impact on criminal offending, incarceration rates, and program completion. Participants were randomly assigned to receive either MTFC or to community-based group care (GC). Measures utilized include data collected for the study from criminal court referrals and self-reported delinquency measured by the Elliott Behavior Checklist. Results indicate 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. Limitations include lack of generalizability due to exclusion of girls from the sample, and small sample size.

Length of controlled 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 68(5), 857–863. https://doi.org/10.1037/0022-006X.68.5.857

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 basic study design, measures, results, and notable limitations)
The study used the same sample as Chamberlain & Reid (1998). The purpose of the study was to explore the influence of family management skills (i.e., supervision, discipline, and positive adult-youth relationship) and deviant peer association on youth antisocial behavior within the context of a randomized clinical trial contrasting Multidimensional Treatment Foster Care [now called Treatment Foster Care Oregon – Adolescents (TFCO-A)] and services-as-usual group care. Participants were randomly assigned to receive either Multidimensional Treatment Foster Care -Adolescents or to community-based group care (GC). Measures utilized include responses from an interview protocol developed for the study adapted from the Parent Daily Report, criminal referrals, and self-reported delinquent acts. Results indicate 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. Limitations include small sample size, the reduced number of participants available for the mediation analyses, and length of follow-up.

Length of controlled 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. https://doi.org/10.1177/10634266040120010101

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 basic study design, measures, results, and notable limitations)
The study used the same sample as Chamberlain & Reid (1998). The purpose of the study was to examine the ability of Multidimensional Treatment Foster Care (MTFC) [now called Treatment Foster Care Oregon – Adolescents (TFCO-A)] to prevent subsequent violent offending relative to services as-usual group home care (GC). Participants were randomly assigned to receive either MTFC or to community-based group care (GC). Measures utilized include data collected for the study from criminal court referrals and self-reported delinquency measured by the Elliott Behavior Checklist. Results indicate that 24% of the youth in the GC condition had two or more criminal referrals for violent offenses in the 2 years following study entry, versus 5% of youth in the MTFC 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. Limitations Include samples that include greater diversity in ethnicity are needed to examine the efficacy of MTFC in non-Caucasian ethnic groups, and an examination of the effectiveness of interventions to reduce mood disorders in girls who engage in delinquent behavior is also warranted.

Length of controlled 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. https://doi.org/10.1037/0022-006X.73.6.1181

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, 2% Other, and 1% Asian
  • Gender — 100% Female
  • Status — Participants were girls mandated to community out-of-home care due to chronic delinquency.

Location/Institution: Oregon

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the 12-month outcomes of a randomized intervention trial for girls with chronic delinquency. Participants were randomly assigned to Multidimensional Treatment Foster Care -Adolescents (MTFC) [now called Treatment Foster Care Oregon - Adolescents (TFCO-A)] or to a group care (GC) control condition. Measures utilized include reports on number of days in locked settings and criminal referrals, the Child Behavior Checklist (CBCL), and the Elliott Self-Report of Delinquency Scale. Results indicate that 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. Limitations include small sample size and lack of generalizability due to gender.

Length of controlled 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. https://doi.org/10.1007/s10802-005-3571-7

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

Population:

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

Location/Institution: Oregon

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine data from two randomized intervention trials (one male sample and one female sample) with delinquent adolescents placed either in Multidimensional Treatment Foster Care (MTFC) [now called Treatment Foster Care Oregon - Adolescents (TFCO-A)] or in group care (GC). Participants were randomly assigned to the MTFC condition or to a GC condition. Measures utilized include the Describing Friends Questionnaire, and the Child Behavior Checklist (CBCL). Results indicate that 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. Limitations include small sample size and the use of identical measures for both sexes, though some variables and constructs may uniquely contribute to the development of delinquency for each sex.

Length of controlled postintervention follow-up: 12 months.

Chamberlain, P., Leve, L. D., & DeGarmo, D. S. (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. https://doi.org/10.1037/0022-006X.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, 2% Other, and 1% Asian
  • 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 basic study design, measures, results, and notable limitations)
The study used the same sample as Leve, Chamberlain and Reid, 2005. The purpose of the study was to report on a 2-year follow-up of girls with serious and chronic delinquency who were enrolled in a randomized clinical trial conducted from 1997 to 2002 comparing Multidimensional Treatment Foster Care (MTFC) [now called Treatment Foster Care Oregon - Adolescents (TFCO-A)] and group care (GC). Participants were randomly assigned to the MTFC condition or to a GC control condition. Measures utilized include delinquency as-of follow-up was assessed using a combination of number of criminal referrals, number of days in locked settings, and the Elliott General Delinquency Scale. Results indicate 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. Limitations include the small sample size, and the fact that the majority of participating girls were Caucasian.

Length of controlled postintervention follow-up: 2 years.

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. https://doi.org/10.1177/1049731506293971

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, 2% Other or Biracial, and 1% Asian American
  • Gender — 100% Female
  • Status — Participants were girls who were referred from juvenile court judges.

Location/Institution: Oregon

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy of Multidimensional Treatment Foster Care - Adolescents (MTFC-A) [now called Treatment Foster Care Oregon - Adolescents (TFCO-A)] on school attendance and homework completion in juvenile justice girls who were referred to out-of-home care. Participants were randomly assigned to MTFC-A or out-of-home care services as usual. Measures utilized include the Parent Daily Report Checklist (PDR). Results indicate that MTFC-A was more effective than group care in increasing girls' school attendance and homework completion while in treatment and at 12 months post-baseline. Limitations include the small number of minority youth, and the lack of male subjects in the sample.

Length of controlled postintervention follow-up: Unclear – data was collected 12 months after the baseline data collection, and the mean length of treatment was 174 days (Std Dev = 144).

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. https://doi.org/10.1111/j.1467-6427.2010.00515.x

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

Population:

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

Location/Institution: Socialhogskolan, Lund University and Familjeforum AB

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine 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). Participants were randomly assigned to treatment in MTFC 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 lack of generalizability to other ethnic groups.

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

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 Abuse, 22(5), 435–449. https://doi.org/10.1080/1067828X.2013.788887

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: Study 1: 166; Study 2: 105

Population:

  • Age — Study 1: 12–17 years; Study 2: 12–16 years
  • Race/Ethnicity — Study 1: 72% Caucasian, 16% Mixed ethnic heritage or another race, 9% Hispanic, 1% African American, 1% Asian, and 1% Native American,; Study 2: 9% more than one race, 8% White British, and 3% Black Caribbean
  • Gender — Study 1: 100% Female; Study 2: 100% Female
  • Status — Participants were youth who had participated in MTFC in the United States and England.

Location/Institution: United States (Oregon), and England

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was 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 to an offer of MTFC-A or to TAU. 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 that both MTFC-A and TAU 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 controlled postintervention follow-up: Not Specified

Green, J. M., 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. The British Journal of Psychiatry, 204(3), 214–221. https://doi.org/10.1192/bjp.bp.113.131466

Type of Study: Other quasi-experimental
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 basic study design, measures, results, and notable limitations)
The purpose of the study was 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 to an offer of MTFC-A or to TAU. 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 that both MTFC-A and TAU 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 controlled postintervention follow-up: None.

Additional 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

John Aarons
Agency/Affiliation: TFC Consultants, Inc.
Website: www.tfcoregon.com
Email:
Phone: (541) 343-2388 x1

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