Treatment Foster Care Oregon for Adolescents

Mental Health In-home Parent Skill-Based Promising

Treatment Foster Care Oregon for Adolescents (TFCO-A), formerly known as Multidimensional Treatment Foster Care – Adolescents, is designed for youth ages 12–17 with severe emotional and behavioral problems. TFCO-A aims to support youth to live in a family setting during treatment, rather than in group or institutional settings, and to support parents and caregivers to provide effective parenting. TFCO-A focuses on five key areas: (1) increasing prosocial behaviors, decreasing negative behaviors, and supporting school engagement; (2) providing close supervision and limiting access to peers who lack effective social skills; (3) providing a consistent and reinforcing environment with a daily structure, clear expectations, and consequences; (4) developing youth’s skills for forming positive relationships; and (5) enhancing parenting skills and decreasing conflict in the family. 

 

TFCO-A places youth in a therapeutic foster family. A treatment team supports each youth. The team includes a program case manager who is the team lead; foster parents; a youth therapist; a family therapist; a skills coach; and a person that calls the foster parents for a daily report. Treatment team members provide daily and weekly monitoring and support to the youth, the foster parents, and the youth’s parents or caregivers. 

 

TFCO-A uses a structured and individualized daily behavior management system. To provide the youth with positive reinforcement, the foster family implements a points-based three-level behavioral system. Youth earn points for normative and prosocial behavior and lose points and privileges for negative behavior. As youth accumulate points and move to the next level, they are afforded more freedom from adult supervision and given additional privileges, such as an allowance. Therapists and skills coaches implement weekly individual therapy and coaching tailored to the youth’s specific developmental needs, which aim to augment and reinforce progress made in the foster home.  

 

The family therapist meets weekly with the parents or caregivers to whom the youth is expected to return after the foster care placement. Family therapy teaches parents and caregivers positive parenting practices, including how to monitor and manage the child's behavior, problem solve, communicate effectively, and de-escalate conflict. The treatement team coordinates at least twice-monthly home visits once the youth passes the first level of the behavioral system. During these visits youth and parents or caregivers practice new skills. Visit length increases as the skills of the parents or caregivers increase. After the youth returns to their parents or caregivers, the family therapist provides aftercare support, in which they maintain contact with the family for at least three months. 


TFCO-A is rated as a promising practice because at least one study achieved a rating of moderate or high on study design and execution and demonstrated a favorable effect on a target outcome. Though at least one study achieved a rating of moderate or high on design and execution and demonstrated a sustained favorable effect of at least 6 months beyond the end of treatment on at least one target outcome, this study was not carried out in a usual care or practice setting. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.


Date Research Evidence Last Reviewed: Jul 2023


Sources

The following sources informed the program or service description, target population, and program or service delivery and implementation information: the program or service manual, the program or service developer’s website, and the studies reviewed.


This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the Review Process page or download the Handbook.

Target Population

TFCO-A is designed for youth ages 12­–17 with severe emotional and behavioral problems.

Dosage

A treatment team delivers TFCO-A to youth and families for 6–12 months with at least 3 months of aftercare support. Therapists meet with youth weekly for individual therapy sessions. Skills coaches meet with youth for approximately 2 hours per week. Family therapists meet with parents or caregivers weekly. The treatment team initiates at least twice-monthly home visits once the youth enters the second level of the behavior system, typically after about a month. Parent daily report callers place daily calls to the foster parents.

Location/Delivery Setting
Recommended Locations/Delivery Settings

The treatment team delivers TFCO-A in-person in the foster home, in the community, and in the home of the parents or caregivers.

Location/Delivery Settings Observed in the Research

  • Home
  • School

Education, Certifications and Training

A treatment team delivers TFCO-A. The TFCO-A team consists of a team lead, who also serves as the program case manager; trained foster parents; a youth therapist; a family therapist; a skills coach; and a parent daily report caller. In addition to the treatment professionals, the team includes a foster parent recruiter and a foster parent trainer who finds and trains foster parents to implement TFCO-A. The parent daily report caller, recruiter, and trainer roles are often combined. 

TFCO-A foster parents must be state-licensed foster parents. To be considered for TFCO-A, foster parents complete a written application and a 1-hour home visit. TFCO-A foster parents also complete 20 hours of pre-service training on the daily behavior management system and how to support the youth. Prior to a placement, foster parents must sign a written agreement to provide TFCO-A services.

Among clinical program staff, the team lead must have at least a bachelor’s degree in social work, behavioral science, or a related field and one year of experience treating children or young adults. A master’s degree is preferred. Youth and family therapists must meet any required state certification or licensing criteria and have relevant clinical experience with youth and families. Skills coaches must meet any required state certification or licensing criteria and be familiar with behavior management principles. Staff in the parent daily report caller or foster parent recruiter roles must have experience with the foster system and at least 1–2 years of office or administrative experience. 

All staff complete an initial clinical training, though duration varies by role. Team leads must complete 5 days of training, therapists complete 4 days of training, and recruiter/trainer/parent daily report callers complete 3 days of training. Initial training is typically in-person, though virtual trainings may be available under limited circumstances. Team leads conduct weekly supervision meetings and provide ongoing training for the treatment team.

Programs must be certified or receive clinical supervision from TFC Consultants, Inc. The certification application process involves a thorough evaluation and a fee. As part of this process, team leads have weekly consultation calls with a TFCO consultant. 

Program or Service Documentation
Book/Manual/Available documentation used for review

The following seven resources are used to implement TFCO-A:

Treatment Foster Care Oregon for Adolescents. (2015). Team lead manual. TFC Consultants, Inc.

Treatment Foster Care Oregon for Adolescents. (2015). The behavior plan. TFC Consultants, Inc.

Treatment Foster Care Oregon for Adolescents. (2015). Family therapy manual. TFC Consultants, Inc.

Treatment Foster Care Oregon for Adolescents. (2015). Individual therapy manual. TFC Consultants, Inc.

Treatment Foster Care Oregon for Adolescents. (2015). Skills coach manual. TFC Consultants, Inc.

Treatment Foster Care Oregon for Adolescents. (2015). Foster parent recruitment manual. TFC Consultants, Inc.

Treatment Foster Care Oregon. (2021). Implementation guidebook. TFC Consultants, Inc.

Available languages

 TFCO-A materials are available in English.

Other supporting materials

TFCO Program Certification

For More Information

Website: https://www.tfcoregon.com/

Phone: (541) 343-2388

Contact form: https://www.tfcoregon.com/contact-us


Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.

Results of Search and Review Number of Studies Identified and Reviewed for Treatment Foster Care Oregon for Adolescents
Identified in Search 14
Eligible for Review 7
Rated High 0
Rated Moderate 2
Rated Low 5
Reviewed Only for Risk of Harm 0
Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings
Child well-being: Substance use 0.38
14
1 (4) 76 Favorable: 2
No Effect: 2
Unfavorable: 0
Child well-being: Delinquent behavior 0.03
1
2 (5) 503 Favorable: 1
No Effect: 4
Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.

Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured
Months after treatment when outcome measured more info
Child well-being: Substance use 0.38
14
1 (4) 76 Favorable: 2
No Effect: 2
Unfavorable: 0
-
Study 13122 - TFC vs. Group Care (Smith, 2010 [Not conducted in a usual care or practice setting])
Tobacco Use 0.24
9
- 75 - 3
Tobacco Use 0.59 *
22
- 70 - 9
Marijuana Use 0.20
8
- 76 - 3
Marijuana Use 0.49 *
18
- 70 - 9
Child well-being: Delinquent behavior 0.03
1
2 (5) 503 Favorable: 1
No Effect: 4
Unfavorable: 0
-
Study 13130 - MTFC-A vs. Usual Care (Total Sample) (Biehal, 2012)
Offending Behavior (TFCO-A Versus Usual Care Combined RCT and QED Sample Results) -0.19
-7
- 214 - 0
Study 13122 - TFC vs. Group Care (Chamberlain, 1998b [Not conducted in a usual care or practice setting])
Lockup in Detention or State Training Schools (Number of Days) 0.55 *
20
- 79 - 3
Elliott Behavior Checklist: General Delinquency 0.36
13
- 79 - 3
Study 13130 - MTFC-A vs. Usual Care (RCT) (Green, 2014)
Offending Behavior (TFCO-A Versus Usual Care RCT Sample Results) -0.13
-5
- 33 - 0
Offending Behavior (TFCO-A Versus Usual Care QED Sample Results) -0.04
-1
- 177 - 0

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.

Studies Rated Moderate

Study 13130

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. British Journal of Psychiatry, 204(3), 214-221. https://doi.org/10.1192/bjp.bp.113.131466

Dixon, J., Biehal, N., Green, J., Sinclair, I., Kay, C., & Parry, E. (2014). Trials and tribulations: Challenges and prospects for randomised controlled trials of social work with children. British Journal of Social Work, 44(6), 1563-1581. https://doi.org/10.1093/bjsw/bct035

Sinclair, I., Parry, E., Biehal, N., Fresen, J., Kay, C., Scott, S., & Green, J. (2016). Multidimensional Treatment Foster Care in England: Differential effects by level of initial antisocial behaviour. European Child & Adolescent Psychiatry, 25(8), 843-852. https://doi.org/10.1007/s00787-015-0799-9

Biehal, N., Dixon, J., Parry, E., Sinclair, I., Green, J., Roberts, C., Kay, C., Rothwell, J., Kapadia, D., & Roby, A. (2012). The Care Placements Evaluation (CaPE) Evaluation of Multidimensional Treatment Foster Care for Adolescents (MTFC-A). Research Report DFE-RR194. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/249856/DFE-RR194.pdf

This study was conducted in a usual care or practice setting (Handbook Section 6.2.2).

Study 13122

Chamberlain, P., & Moore, K. J. (1998a). A clinical model of parenting juvenile offenders: A comparison of group versus family care. Clinical Child Psychology and Psychiatry, 3(3), 375-386. https://doi.org/10.1177/1359104598033004

Chamberlain, P., & Reid, J. B. (1998b). 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

Chamberlain, P., Ray, J., & Moore, K.J. (1996). Characteristics of residential care for adolescent offenders: A comparison of assumptions and practices in two models. Journal of Child and Family Studies, 5(3), 285-297. https://doi.org/10.1007/BF02234664

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

Fisher, P. A., & Chamberlain, P. (2000). Multidimensional Treatment Foster Care: A program for intensive parenting, family support, and skill building. Journal of Emotional and Behavioral Disorders, 8(3), 155-164. https://doi.org/10.1177/106342660000800303

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

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

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. https://doi.org/10.1080/1067828X.2010.511986

Rhoades, K. A., Leve, L. D., Eddy, J. M., & Chamberlain, P. (2016). Predicting the transition from juvenile delinquency to adult criminality: Gender-specific influences in two high risk samples. Criminal Behaviour and Mental Health, 26(5), 336-351. https://doi.org/10.1002/cbm.1957

This study was not conducted in a usual care or practice setting (Handbook Section 6.2.2).


Studies Rated Low

Study 13118

Biehal, N., Ellison, S., & Sinclair, I. (2011). Intensive fostering: An independent evaluation of MTFC in an English setting. Children and Youth Services Review, 33(10), 2043-2049. https://doi.org/10.1016/j.childyouth.2011.05.033

Biehal, N., Ellison, S., & Sinclair, I. (2012). Intensive fostering: An independent evaluation of MTFC in an English setting. Adoption & Fostering, 36(1), 13-26. https://doi.org/10.1177/030857591203600104

This study received a low rating because baseline equivalence of the intervention and comparison groups was necessary and not demonstrated.
Study 13148

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

This study received a low rating because the standards for addressing missing data were not met.
Study 13132

Hansson, K., & Olsson, M. (2012). Effects of multidimensional treatment foster care (MTFC): Results from a RCT study in Sweden. Children & Youth Services Review, 34(9), 1929-1936. https://doi.org/10.1016/j.childyouth.2012.06.008

Bergstrom, M., & Hojman, L. (2016). 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, 19(2), 219-235. https://doi.org/10.1080/13691457.2015.1030361

This study received a low rating because the standards for addressing missing data were not met.
Study 13147

Westermark, P., Hannsson, K., & Vinnerljung, B. (2008). Does MTFC reduce placement breakdown in foster care? International Journal of Child & Family Welfare, 11(4), 155-171. https://ugp.rug.nl/IJCFW/article/view/37795/35384

This study received a low rating because it did not meet design confound standards.
Study 13120

Chamberlain, P. (1990). Comparative evaluation of specialized foster care for seriously delinquent youths: A first step. Community Alternatives: International Journal of Family Care, 2(2), 21-36. https://psycnet.apa.org/record/1991-13536-001

This study received a low rating because it did not meet design confound standards.


Studies Not Eligible for Review

Study 13121

Chamberlain, P., & Reid, J. B. (1991). Using a specialized foster care community 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)19:3%3C266::AID-JCOP2290190310%3E3.0.CO;2-5

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 13131

Gustle, L.-H., Hansson, K., Sundell, K., Lundh, L.-G., & Löfholm, C. A. (2007). Blueprints in Sweden. Symptom load in Swedish adolescents in studies of Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC). Nordic Journal of Psychiatry, 61(6), 443-451. https://doi.org/10.1080/08039480701773196 

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 13135

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 Consulting and Clinical Psychology, 77(3), 588-593. https://doi.org/10.1037/a0015289 

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. https://doi.org/10.1037/a0027336 

Harold, G. T., Kerr, D. C. R., Van Ryzin, M., Degarmo, D. S., Rhoades, K. A., & Leve, L. D. (2013). Depressive symptom trajectories among girls in the juvenile justice system: 24-month outcomes of an RCT of Multidimensional Treatment Foster Care. Prevention Science, 14(5), 437-446. https://doi.org/10.1007/s11121-012-0317-y 

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. https://doi.org/10.1080/1067828X.2013.788886 

Kerr, D. C. R., DeGarmo, D. S., Leve, L. D., & Chamberlain, P. (2014). Juvenile justice girls’ depressive symptoms and suicidal ideation 9 years after Multidimensional Treatment Foster Care. Journal of Consulting and Clinical Psychology, 82(4), 684-693. https://doi.org/10.1037/a0036521

Poulton, R., Van Ryzin, M. J., & Harold, G. T. (2014). Foster care intervention leads to reduction in psychotic symptoms. Brown University Child & Adolescent Psychopharmacology Update, 16(11), 4-5. https://onlinelibrary.wiley.com/toc/15567567/2014/16/11

Poulton, R., Van Ryzin, M. J., Harold, G. T., Chamberlain, P., Fowler, D., Cannon, M., Arseneault, L., & Leve, L. D. (2014). Effects of multidimensional treatment foster care on psychotic symptoms in girls. Journal of the American Academy of Child & Adolescent Psychiatry, 53(12), 1279-1287. https://doi.org/10.1016/j.jaac.2014.08.014 

Leve, L. D., Chamberlain, P., & Kim, H. K. (2015). Risks, outcomes, and evidence-based interventions for girls in the US juvenile justice system. Clinical Child & Family Psychology Review, 18(3), 252-279. https://doi.org/10.1007/s10567-015-0186-6

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://pubmed.ncbi.nlm.nih.gov/33281198/

Rhoades, K. A., Leve, L. D., Harold, G. T., 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. https://doi.org/10.1111/jora.12077 

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), 1181-1184. https://doi.org/10.1037/0022-006X.73.6.1181 

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

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

Rhoades, K. A., Leve, L. D., Eddy, J. M., & Chamberlain, P. (2016). Predicting the transition from juvenile delinquency to adult criminality: Gender-specific influences in two high-risk samples. Criminal Behaviour and Mental Health, 26(5), 336-351. https://doi.org/10.1002/cbm.1957 

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 13136

Leathers, S. J., Falconnier, L., & Spielfogel, J. E. (2010). Predicting family reunification, adoption, and subsidized guardianship among adolescents in foster care. American Journal of Orthopsychiatry, 80(3), 422-431. https://doi.org/10.1111/j.1939-0025.2010.01045.x 

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 13140

McMillen, J. C., Narendorf, S. C., Robinson, D., Havlicek, J., Fedoravicius, N., Bertram, J., & McNelly, D. (2015). Development and piloting of a treatment foster care program for older youth with psychiatric problems. Child and Adolescent Psychiatry and Mental Health, 9(23), Article 23. https://doi.org/10.1186/s13034-015-0057-4

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 13141

Miklowitz, D. J. (2014). Delinquency, depression, and psychosis among adolescents in foster care: What holds three heads together? Journal of the American Academy of Child & Adolescent Psychiatry, 53(12), 1251-1253. https://doi.org/10.1016/j.jaac.2014.09.006 

Miklowitz, D. J. (2015). 'Delinquency, depression, and psychosis among adolescents in foster care: What holds three heads together': Erratum. Journal of the American Academy of Child & Adolescent Psychiatry, 54(2), 155-155. https://doi.org/10.1016/j.jaac.2015.01.001 

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 13144

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 

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).