Program

Treatment Foster Care Oregon (TFCO) [Previously Multidimensional Treatment Foster Care]

Dec 13, 2016

OVERVIEW

Treatment Foster Care Oregon (TFCO, formerly Multidimensional Treatment Foster Care of MTFC) is designed to serve as an alternative to residential treatment, and to prevent later incarceration, among a high-risk population of adolescents and youth. Adolescents and youth exhibiting severe criminal, antisocial, or delinquent behavior are considered to be at an increased risk for future criminal offenses. The goal of TFCO is to provide them with the skills, resources, supervision, and structure necessary to reduce delinquency and promote more prosocial behaviors. The program relies on the involvement of trained foster families, therapists, and case managers. The goal of TFCO is to return youth to their biological or adoptive families, who are involved throughout the process. TFCO has been shown to reduce rates of incarceration, arrest, and drug use among its participants. The program was also found to increase positive social behavior and reduce several types of criminal behaviors.

DESCRIPTION OF PROGRAM

Target population: Adolescents and youth with severe criminal, antisocial, or delinquent behaviors.

Treatment Foster Care Oregon (TFCO) was designed by the Oregon Social Learning Center (OSLC) to provide alternative residential placements for youth with serious criminal, antisocial, or delinquent behavior. Each adolescent or youth who participates in TFCO receives an individualized program that emphasizes behavioral skills training, discipline and reinforcement, and positive relationships.

Case managers serve as the primary contact for the participant and his or her family. The case managers are responsible for coordinating nearly all aspects of TFCO implementation. They are trained in social learning theory, and typically have a minimum of a bachelor’s degree in fields related to adolescent development and psychology. All case managers participate in a three-day training program prior to implementation of the TFCO program.

The first component of TFCO involves training of foster families, who receive 20 hours of training before placements are made, and monthly stipends to cover their expenses during the participant’s stay. The basis of TFCO is the individualized plan created by the case manager and foster family. The plan emphasizes behavioral management techniques and a foster home environment that promotes development of prosocial behaviors. The home environment is meant to provide youth with structure, limits, and rules, and to develop the strengths and assets of the adolescent or youth. The plan relies on training, which includes interpersonal skills and prosocial behaviors, discipline techniques, role modeling, establishing rules and consequences for the youth, eliminating exposure to negative peer influences, and providing the adolescent with positive and productive relationships. One component of the foster family plan is a three-level point system to monitor and reward the youth’s behavior and provide him or her with daily feedback. As the adolescent progresses through the three levels during the course of the placement, standards and expectations for behavior become increasingly more demanding, and are associated, in turn, with more privileges and a reduction in supervision. The adolescent is not permitted any unsupervised free time during the course of the placement. During placement, staff members call foster families daily to assess progress and difficulties that may arise; their reports are continually reviewed by case managers, who meet weekly with the foster families. During these meetings, case managers review weekly progress and the individualized plan designed for the adolescent or youth. Frequent supervision and assessment allow for continual modification of the treatment plan, so that it meets the individual needs of the TFCO participant.

While the youth is placed with a foster family, his or her biological or adoptive family receives family therapy. This component familiarizes the family with TFCO theory and methodology, as well as the progress in the program. The youth’s biological or adoptive family attends weekly treatment sessions, during which they learn specifically about the TFCO home environment and the youth’s individualized program, in addition to more general topics such as supervision, discipline, and reinforcement techniques. Following the family completion of treatment, the youth participates in supervised home visits with the biological or adoptive family. These home visits are intended to provide an opportunity to practice TFCO methods in a controlled environment. Visits take place throughout the program, beginning with one to two hours duration; gradually, visits develop into overnight stays. The family therapist and case manager, both of whom are in frequent contact with families during this time, review home visits. The family therapy and visitation components are central to the TFCO program, since the main goal of the program is to eventually return the youth to their biological or adoptive family.

In addition to participating in the daily behavioral management plan at his or her foster home, the youth also participates in individual, skills-based therapy on a weekly basis. The primary purpose of these sessions is to support and the youth’s positive progress throughout the placement. Other mental health services are provided as needed. The youth continues to attend school while in his or her foster placement. Homework, attendance, peer interaction, and behaviors are closely monitored to ensure that progress made during TFCO is maintained.

Once the youth returns home, biological or adoptive parents receive aftercare support in the form of weekly group meetings run by case managers and TFCO foster families. During this time, parents meet with other families to learn additional skills, discuss problems, and review home practice techniques. Case managers continue to provide the adoptive or biological families with supervision and consultations as needed. Parents also receive phone calls to assess daily or weekly progress. Aftercare services are offered as long as necessary, and typically run for a year after the youth returns home.

On average, treatment for each youth costs between $200 and $225 per day, which includes both program and implementation costs. Implementation costs for the first year are about $59,550, which includes program materials, readiness process, first-year implementation services, and travel costs to attend training. Costs in the second year are generally about $29,775, and costs to maintain fidelity in subsequent years are about $5,000 to $8,000.

EVALUATION(S) OF PROGRAM

Bergström, M. & Höjman, 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.  

Evaluated population: A total of 46 male youth, ages 12 and 17, were evaluated. To be included, a youth had to meet the diagnostic criteria for a conduct disorder according to DSM-IV-TR, and be at risk for immediate out-of-home placement.

Approach: Participants were randomly assigned to the MTFC condition (N=19) or to treatment as usual (TAU, N=27). Most of the youth in the TAU group (N=21) received more than one intervention during the first year after assessment. Out-of-home care was the most-used option (N = 26). Fifteen received in-home care. One youth was sent home, stayed home the whole first year, and later received in-home care. Another two youth were sent home first, but received out-of-home care during parts of the first year. Youth were evaluated at baseline, and at 12 and 24 months post-baseline. Measures were based on self-report and the social case-record.

Data from rating scales and interviews were outcome measures. The scales measured each youth’s psychosocial symptom load according to four different respondents. The structured interviews measured the youth’s problem areas from two different respondents. Outcome variables which were measured using the social case record included number of placements, placements in a locked setting, homelessness, and experiencing a negative exit from treatment. Two additional outcomes measured using the social case records were subsequent criminality and substance abuse.

Randomization according to background variables such as age, gender, age at treatment start, court-ordered treatment and previous interventions resulted in equivalent groups at study outset. However, the MTFC group had significantly more families with an immigrant background.

Results: Significantly fewer youth in the MTFC group were placed in locked settings the first year after being included in the study. There was no significant difference thereafter (years two and three), or across all three years. However, youth who were assigned to MFTC spent fewer days in locked settings. During the three-year test period, the MFTC youth experienced, on average, about one month in a locked setting, whereas the TAU group experienced an average of three months. Youth assigned to MFTC also committed fewer violent crimes, according to the social case-records. During the three-year follow-up period, 41 percent in the TAU group were reported to have engaged in violent crime, compared to none in the MFTC group.

No impacts were found for number of placements, and no significant difference was found between the two groups regarding homelessness. Finally, regarding negative exit from treatment, there was no significant difference between the groups, although in the first year youth in the MTFC group were marginally less likely to have a negative treatment exit than those in the TAU group.

Chamberlain, P., & Reid, J. B. (1998). Comparison of two community alternatives to incarceration for chronic juvenile offenders. In D. S. Elliott (Ed.), Blueprints for violence prevention (Vol. 8). Boulder, CO: Venture Publishing and C & M Press.

Evaluated population: Seventy-nine male youth offenders in Oregon, ages 12-17, were evaluated. Youth in the sample averaged 13 prior arrests and 4.6 prior felonies.

Approach: Youth had been mandated by juvenile courts to receive out-of-home care and were randomly assigned to either TFCO (N=37) or Group Care (N=42) placements. Group Care (GC) placements took place at 1 of 11 programs throughout the state. Although GC programs varied, they all emphasized a positive-peer-culture approach and included both individual and group therapy. There were between 6 and 15 youth at each placement site, and youth attended in-house schools.

Youth were evaluated at baseline, three months into treatment, and then every six months, for two years following treatment. Measures were based on self-report, caregiver-report, and official arrest data, and included delinquent and criminal activity, supervision, discipline, positive relationships with adult caregivers, and association with deviant peers.

Results: At three months, TFCO youth were rated significantly better than their GC counterparts on measures of behavior under supervision, discipline, relationships with adults, and association with deviant peers. TFCO youth also reported fewer daily problem behaviors than GC youth, but this was not consistent with caretaker-reports, which rated the groups similarly. At one year post-treatment, TFCO youth had significantly fewer arrests and were incarcerated significantly less often than GC youth. TFCO participants were also more likely to report no further arrests, post-treatment. Finally, youth receiving TFCO treatment reported less criminal and delinquent behavior.

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.

Evaluated Population: A total of 166 female youth who were referred to the study because of chronic delinquency were evaluated. The youth ranged in age from 13 to 17 years (mean: 15.3 years).The youth in the study had at least one criminal referral in the past year, were not currently pregnant, and were placed in out-of-home care within one year following referral. The sample was 74 percent Caucasian, 7 percent Hispanic, 4 percent Native-American, 2 percent African-American, 1 percent Asian, and 13 percent reported mixed ethnic heritage.

Approach: Participants were randomly assigned to either the experimental TFCO condition (N=81) or a comparison condition of Group Care services (GC) (N=85). Participants were assessed for delinquency (through measures of criminal referrals), sexual activity, and pregnancy history, at baseline through 24 months.

Results: The TFCO treatment group was found to have lower pregnancy rates over the 24-month period, compared with the GC treatment group.

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, 339-347.

Evaluated Population: A total of 153 youth (72 males and 81 females), ages 12 to 17, (mean for males=14.4, and mean for females=15.3) were evaluated. The sample was 74 percent Caucasian for females, and 83 percent Caucasian for males, with the majority of the remaining participants African-American, Hispanic, or American Indian. Participants averaged from 11.9 to 13.5 prior criminal referrals, depending on sex and ethnicity.

Approach: Participants were randomly assigned to the TFCO treatment condition (N=73) or a comparison condition of Group Care (GC) (N=80). Data were collected at baseline and at 3, 6, 12, 18, and 24 months after placement, and assessed self-reported and caregiver-rated association with delinquent peers.

Results: The TFCO treatment group had lower levels of associating with delinquent peers, when compared to the GC treatment group at 12 months. Association with delinquent peers was found to decrease over time for both groups.

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, 1181-1185.

Evaluated Population: A total of 103 females referred to the study because of chronic delinquency were evaluated. The youth ranged in age from 13 to 17 years (mean =15.3). The participants had at least one criminal referral in the past year, were not currently pregnant, and were placed in out-of-home care within one year following referral. The sample was 74 percent Caucasian, 2 percent African-American, 9 percent Hispanic, 12 percent Native American, 1 percent Asian, and 2 percent mixed ethnicity.

Approach: Participants were randomly assigned to either the experimental TFCO condition (N=37) or a comparison condition of Group Care services (GC) (N=44). Measures of delinquency were days in locked settings, criminal referrals, caregiver-reported delinquency, and self-reported delinquency, at baseline and 12 months later.

Results: The TFCO group spent significantly fewer follow-up days in locked settings, compared with the GC group. TFCO participants had fewer follow-up criminal referrals than GC youth; however, this difference did not reach significance. No significant differences on other delinquency measures were found.

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.

Evaluated Population: Seventy-nine chronic delinquents in an urban area of the Pacific
Northwest were evaluated. The participants ranged from 12 to 17 years old (mean=14.9). The sample was 85 percent Caucasian, 6 percent African-American, 6 percent Hispanic, and 3 percent American Indian.

Approach: The youth were randomly assigned to either the TFCO treatment condition (N=37) or a comparison condition of Group Care services (GC) (N=42). The participants were assessed at baseline, and at 6, 12, 18, and 24months of treatment, using official referrals for violent offenses and measures of self-reported violence.

Results: The TFCO group reported significantly fewer incidents of violence, compared to the GC group. The TFCO group also had significantly fewer criminal referrals for violence in the two years after intervention than participants in the GC condition.

Chamberlain, P., & Reid, J.B. (1991). Using a specialized foster care community treatment model for children and adolescents leaving the state mental hospital. In D. S. Elliott (Ed.), Blueprints for violence prevention (Vol. 8). Boulder, CO: Venture
Publishing and C & M Press.

Evaluated population: Twenty emotionally disturbed children, adolescents, and youth,
ages 9 to 18, who were leaving a state mental hospital in Oregon were evaluated. Subjects had experienced high rates of hospitalization in the year prior to the evaluation, related to conduct disorder, schizophrenia, and personality disorders. Eight were male and twelve were female.

Approach: Subjects were randomly assigned to receive TFCO (N=10) or “treatment as usual” in the community (N=10). “Treatment as usual” typically consisted of institutional placements. Assessments were based on adult and child reports, and included problem behaviors, psychiatric symptoms, and re-hospitalization rates. Participants were assessed after being referred to the study group and again at three and seven months post-treatment.

Results: TFCO participants received significantly better scores on adult-reported daily problem behaviors, compared with participants in the treatment-as usual condition.

No differences were found between groups on re-hospitalization rates or youth-reported psychiatric symptoms.

One limitation of the study was the time difference between referrals and actual placements; the mean time between referral and placement for TFCO subjects was 81 days, in comparison to 182 days for control youth. Due to the difficult nature of “treatment as usual” placements, some control subjects were still in the hospital during follow-up assessments.

SOURCES FOR MORE INFORMATION

References

Bergström, M. & Höjman, 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.

Chamberlain, P., & Mihalic, S. F. (1998). Multidimensional treatment foster care. In D. S. Elliott(Ed.), Blueprints for violence prevention (Vol. 8). Boulder, CO: Venture Publishing and C & M Press.

Chamberlain, P., & Reid, J. B. (1998). Comparison of two community alternatives to incarceration for chronic juvenile offenders. In D. S. Elliott (Ed.), Blueprints for violence prevention (Vol. 8). Boulder, CO: Venture Publishing and C & M Press.

Chamberlain, P., & Reid, J. B. (1991). Using a specialized foster care community treatment model for children and adolescents leaving the state mental hospital. In D. S. Elliott (Ed.), Blueprints for violence prevention (Vol. 8). Boulder, CO: Venture Publishing and C & M Press.

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, 12,2-8.

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, 339-347.

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, 1181-1185.

Website:

http://www.tfcoregon.com/

Contact Information

Gerard J. Bouwman

541-343-2388

Gerardb@mtfc.com

KEYWORDS:
High-Risk, Youth (16+), Juvenile Offenders, Delinquency, Other Behavioral Problems, Skills Training, Counseling/Therapy, Family Therapy, Adolescents (12-17), Home Visitation, Education, Life Skills Training, Children (3-11), Male Only, Female Only, Caucasian or White, Urban, Clinic-Based, Provider-Based, Cost Information is Available, Other Relationships, Aggression, Conduct/Disruptive Disorders, Other Mental Health, Males and Females, Sexual Activity, Teen Pregnancy.

Program information last updated 12/12/2016.

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