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.

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.

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

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.

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