A short-term specialised foster care program that provides structured, individualised services for children and young people with complex behaviours.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Targeted and specialist
- Continuing care
Australian Study
Risk of Bias
Cost
Target Age Group
About
Treatment Foster Care Oregon (TFCO) is a specialised foster care program developed as an alternative to institutional, residential and group care placements for children and young people with severe emotional and behavioural disorders. There are 3 versions of the model, tailored to the unique developmental needs of children at specific age groups:
- TFCO for Pre-schoolers (TFCO-P) serves children aged 3 to 6
- TFCO for middle Childhood (TFCO-C) serves children aged 7 to 11
- TFCO for Adolescents (TFCO-A) serves youth aged 12 to 17.
Note: The evidence in this review describes findings from studies that examined TFCO-A. The evidence below did not include a systematic search for Multidimensional Treatment Foster Care (MTFC), the former name for TFCO.
Aims
- Increase family reunification
- Improve intergenerational child protection system contact
- Improve daily school attendance and engagement
- Reduce adolescent pregnancies
- Develop children’s positive attachment to adults.
Impact
Evidence suggests that TFCO was effective in reducing the number of maltreatment reports and contact with the child welfare system up to 10 years post-baseline. The evidence for reducing youth pregnancies and the number of children in legal custody was mixed.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Child protection system contact (intergenerational) | Yes | Not found | Not found |
| Child | Reproductive outcomes | Yes | Yes | Yes |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
TFCO has an evidence rating of Supported+.
This means that TFCO has evidence from one randomised controlled trial (RCT) or quasi-experiment (QE) demonstrating positive, long-term impact on at least one child and family outcome.
This assessment is based on 2 research outputs from one primary study. TFCO has not received a Well-supported rating as it has not yet replicated its results in another rigorous RCT or QE with a different population or setting.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 2 |
| Quasi-experiment | Not identified or included |
The evidence has some concerns with risk of bias.
One of the RCTs (Linscott, 2018) was assessed to have high risk of bias. This should be taken into consideration when interpreting the results.
The study was conducted in the United States and does not include Aboriginal children and families.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The trial was conducted in the state of Oregon, United States.
Sample
- Participants were females aged 13 to 17, with a criminal referral in the past 12 months.
- They were placed in out-of-home care as adolescents and over 85% had a history of childhood maltreatment.
- Participants identified as Caucasian (68%), mixed ethnic heritage (17%), Hispanic (11%), African American (2%), Native American (1%) and Asian (1%).
Implementation
Delivery model, mode and setting
- TFCO is delivered in-person, to the parent and child separately or together, or in a group format with other parents, children and/or families.
Target cohort
- Children and young people in residential care or at risk of entering residential care because of very serious emotional and/or behavioural difficulties
- Children aged 3 to 17.
Program delivery
- TFCO consultants visit sites to bring all of the stakeholders to a common understanding about the model and implementation procedures.
- The model is presented to administrators, program staff, any foster parents who may have already been identified for participation and representatives from relevant outside entities, such as the local juvenile justice community, mental health community or foster care certification agencies.
- An implementation plan and timelines are developed for training program staff, including recruiting, training and certifying foster parents and placements in the foster homes.
- The homes receive initial and ongoing training, daily monitoring, weekly group support and in-the-moment coaching.
- The biological family or long-term placement carer attend a one-hour family therapy session weekly, which focuses on coaching them through key techniques to regain confidence and effectiveness with their youth. TFCO support is available 24/7, to allow for quick and effective responses to situations and behaviours.
- For TFCO carers, there are typically a minimum of 7 contacts per week. This includes 5 lots of 10-minute contacts, one 2-hour group contact and additional contacts based on the amount of support or consultation required.
- Additional in-person training, problem-solving and consultation can be provided when needed. Up to 6 days of on-site consultation is available.
- Children and young people in TFCO receive weekly support to navigate the program and practice problem-solving and coping skills along with other skills individualised for their particular needs.
- The team meets weekly to review progress and daily behavioural information and adjust the child or youth’s individualised treatment plan and daily telephone contact.
Duration and intensity
- TFCO has a placement duration of 6 to 9 months. The child or young person’s treatment consists of a one hour weekly individual therapy session and 2-hour weekly individual skills training session.
Guides and manuals
- There is an implementation manual to deliver TFCO. Ongoing weekly telephone consultations are conducted with program supervisors regarding treatment plans, progress, issues and problems for each placement.
- TFCO adheres to a set of guidelines and fidelity checks. Periodic reports on implementation progress, staff performance, model adherence and other relevant issues are required. As part of the quarterly review, videotapes of the site’s weekly foster parent and clinical meetings are coded for adherence to TFCO principles and procedures.
- FOCUS Parent Daily Report procedures are initiated for monitoring and support.
Additional information
- The Treatment Foster Care Oregon website has more information about the program.
Staffing
- The TFCO team includes:
- TFCO Leader: responsible for the team, all decisions and planning
- Carer Supporter: recruits, assesses, trains and supports TFCO foster carers
- Family Supporter: works with the family to help plan for the child’s return home
- Child Supporter: works with the child to develop their social and individual skills
- Skills Coach: conducts regular sessions with the child to link to community activities
- School Specialist: provides specialist support to the child and their school.
- To operate a program with the typical start-up size of approximately 10 beds, the following staff is needed:
- A program supervisor
- A individual therapist for TFCO-A or hourly playgroup staff for TFCO-P
- A family therapist
- Skills trainer(s) at 20 to 25 hours a week
- A foster parent recruiter, trainer and PDR caller at 0.75FTE
- One foster family for each placement (except sibling groups in TFCO-P)
- Psychiatry services on an hourly fee basis.
- The minimum requirement for a program supervisor is a master’s degree in a clinical field in addition to considerable relevant experience in supervisory skills. The program supervisor must be available to the foster parents and treatment team members 24/7.
- Family and individual therapists should have a masters’ degree in a clinical field.
- Skills trainers should have bachelor's degree in a relevant field and knowledge of foster parenting.
- TFCO carers are required to be over 21 years of age and must follow the exact instructions in the program over a short-term period of 6 to 9 months under close supervision. TFCO carers need to be available for their foster child when needed at any time of the day/night. TFCO carers are supported 24/7 by a team of 6 professionals, daily calls, financial reimbursement and a respite carer as needed.
Training
- Agency staff are required to attend a 4-day training session and Program Supervisors are required to attend a 5-day training session at the model site in Oregon. These training sessions are scheduled 3 times per year.
- TFCO-P and TFCO-C training sessions are scheduled as needed.
- Foster parents are trained at the site during a 2-day training.
- Ongoing weekly telephone consultation are conducted with program supervisors regarding treatment plans, progress, issues and problems for each placement.
- Periodic reports are prepared for program director or administrators on implementation progress, staff performance, model adherence and other relevant issues.
- Additional in-person training, problem solving and consultation can be provided when needed.
To our knowledge, TFCO is available in Victoria, New South Wales, Queensland and South Australia.
In Victoria, TFCO-C is delivered by OzChild to children aged 7 to 12 years old, and TFCO-A is delivered by Anglicare Victoria to young people aged 12 to 17 years old. Both programs are delivered in conjunction with VACCA and are supported by the Victorian Government.
Cost
A complete TFCO placement costs approximately $240,000 per child, including carer reimbursement rates. This is based on OzChild’s 2020 Annual Report, which is available on their website.
References
Studies identified and included in the review
- Leve, L.D., et al. (2015). Intergenerational transmission of maltreatment: A multilevel examination. Development & Psychopathology 27(4): 1429-1442.
- Linscott, J.G. (2018). The intergenerational continuity of child maltreatment: An examination of adolescent, young adult, and reproductive risk factors among high-risk women. Dissertation Abstracts International: Section B: The Sciences and Engineering 79(4): No Pagination Specified.
Studies identified but not counted towards the evidence rating due to study quality
No studies that were identified were excluded due to study quality.