The Treatment Foster Care Oregon (TFCO) program was developed as an alternative to institutional, residential, and group care placement for adjudicated teenagers with histories of chronic and severe criminal behavior. The two main goals of TFCO are to create opportunities for youth to successfully live in a family setting and to simultaneously help parents (or other long-term family resource) provide effective parenting. The rationale for TFCO is that adolescent adjustment can be enhanced by the extent to which parents are able to effectively supervise their teenager, follow through with consequences when necessary, and promote positive involvement in school and other normative activities.
Community foster families are recruited, trained, and closely supervised to provide TFCO-placed adolescents with treatment and intensive supervision at home, in school, and in the community; clear and consistent limits with follow-through on consequences; positive reinforcement for appropriate behavior; a relationship with a mentoring adult; separation from delinquent peers along with access to prosocial peers; and an environment that supports daily school attendance and homework completion.
TFCO utilizes a behavior modification program based on a three-level point system by which the youth are provided with structured daily feedback. As youth accumulate points, they are given more freedom from adult supervision. Youth are provided weekly meetings with an individual therapist who provides support and assists in teaching skills needed to relate successfully to adults and peers. Family therapy sessions help parents prepare for the youth’s return home and help them become more effective at supervising, encouraging, supporting, and following through with consequences. Case managers closely supervise and support the youths and their foster families through daily phone calls.
Throughout the six- to nine-month placement in foster homes, there is an emphasis on teaching interpersonal skills and on participation in positive social activities including sports, hobbies, and other forms of recreation. Aftercare services remain in place for as long as the parents want, but typically last about one year.
The initial evaluation certified by Blueprints involved three articles (Chamberlain, 1997; Chamberlain et al., 1996; and Eddy et al., 2004) in which 79 boys, who were mandated into out-of-home care by the juvenile court, were randomly assigned to treatment (n = 37) or control (n = 42) between 1991 and 1995. The boys were from 12 to 17 years old, had an average of thirteen previous arrests and 4.6 prior felonies, and half had committed at least one crime against a person. After one year, TFCO boys, relative to controls, were incarcerated 60% fewer days, had fewer arrests, reported less self-reported drug use, and were less likely to run away from their program. TFCO boys also experienced less tobacco and marijuana use, and other drug use at 18 months. After two years, TFCO boys had fewer violent offense referrals and self-reported violent offenses than controls.
A second Blueprints-certified study (Leve et al., 2005 and Chamberlain et al., 2007) involved girls who were mandated to community-based, out-of-home care because of problems with chronic delinquency. Girls were 13-17 years of age at baseline, and were only recruited if they had at least one criminal referral in the prior 12 months, were not currently pregnant, and were placed in out-of-home care within 12 months following referral. Girls were randomly assigned to TFCO (n=37) or group care (n=44). TFCO girls, relative to controls, experienced fewer days in locked settings, fewer criminal referrals, lower caregiver-reported delinquency, and more time on homework at 12 months post-baseline. The reductions on days spent in locked settings and criminal referrals remained at 24-months post-baseline, along with reductions in self-reported delinquency.
The third Blueprints-certified evaluation (Kerr et al., 2009) included two consecutively run randomized controlled trials involving the girls from the second study plus an additional 85 girls selected based upon the same eligibility criteria. In total, the trials included 166 girls with 81 randomized to treatment and 85 to control. Results indicated that the odds of girls in group care (control) becoming pregnant were 2.44 times that of girls in TFCO. Reporting on the same sample, Rhoades et al. (2014) found that girls randomly assigned to TFCO when they were 13-17 years old reported significant decreases in drug use over a 2-year period in young adulthood (7-9 years after the study began), while those assigned to group care did not report significant decreases in drug use during this time.
TFCO has been adapted to meet the needs of other populations, including adolescents with severe emotional and behavioral problems referred by mental health and child welfare systems, youth with developmental disabilities who also have a history of sexual acting out, and preschoolers. Evaluations conducted with these populations have not been thoroughly tested.
TFCO is a cost-effective alternative to group or residential treatment, incarceration, and hospitalization for adolescents who have problems with chronic antisocial behavior, emotional disturbance, and delinquency. The Washington State Institute for Public Policy estimates a return of $1.85 for every dollar invested.
References:
Chamberlain, P. (1997, April). The effectiveness of group versus family treatment settings for adolescent juvenile offenders. Paper presented at the Society for Research on Child Development Symposium, Washington, D.C.
Chamberlain, P., Ray, J., & Moore, K. (1996). Characteristics of residential care for adolescent offenders: A comparison of assumptions and practices in two models. Journal of Child and Family Studies, 5, 285-297.
Eddy, J., Whaley, R., & 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.
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.
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.
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 Counseling and Clinical Psychology, 77(3), 588-593.