Treatment Foster Care Oregon (Multidimensional Treatment Foster Care) (TFCO/MTFC) for adolescents with antisocial behaviour, emotional disturbance and delinquency
At a glance
Country of origin
- USA
Level(s) of intervention
- Targeted intervention
Treatment Foster Care Oregon (TFCO), formerly Multidimensional Treatment Foster Care, is an alternative to group or residential treatment, incarceration or hospitalisation for adolescents who have problems with chronic antisocial behaviour, emotional disturbance and delinquency. Community 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 behaviour; a relationship with a mentoring adult; and separation from delinquent peers. TFCO utilises a behaviour modification programme based on a three-level points system through which young people are provided with structured daily feedback.
As they accumulate points, they are given more freedom from adult supervision. Individual and family therapy is provided, and case managers closely supervise and support young people and their foster families through daily phone calls and weekly foster parent group meetings. There is an emphasis on teaching interpersonal skills and on participation in positive social activities including sports, hobbies and other forms of recreation. Placements in foster parent homes typically last for about six months. Aftercare services remain in place for as long as the parents want, but typically about one year.
Keywords
No dataLinks to this programme in other registries
Implementation Experiences
Read the experiences of people who have implemented this programme.Contact details
The Michael Rutter Centre for Children and Young People
South London and Maudsley NHS Trust
Email: jolanta.hernik[a]kcl.ac.uk
Website: www.tfcoregon.com
Overview of results from the European studies
Studies overview
The programme has been evaluated in one randomised controlled trial in Sweden, and three quasi-experimental studies, one in Sweden nad two in the UK.
In Sweden, 46 young people aged 12 and 17 years old, meeting the diagnostic criteria for conduct disorder according to the DSM-UV-TR and at risk for immediate out-of-home placement were randomly allocated to MTFC or usual services. At post-test, significantly fewer youth in the MTFC group were placed in locked settings. Two years after the intervention ended, there was no effect on being placed in locked settings or substance abuse. Youth receiving MTFC were significantly less likely to engage in violent crime during the study period. There was no effect on parent or self-reported behaviour.
In the Swedish quasi-experimental study, 35 youth with a mean age of 15.4 years, diagnosed of a conduct disorder according to the DSM-IV and at risk of immediate out-of-home placement participated. Based on data collected immediately post intervention and 12 months later, the intervention had significant positive effects on parent and self-reported externalising behaviour and parent reported internalising behaviour, but not on self-reported internalising behaviour and psychiatric symptoms.
In the UK, 47 serious and persistent offenders facing an imminent custodial sentence participated. 23 received the intervention and 24 were either sentenced to custody or in four cases sentenced to an intensive supervision and surveillance programme. At posttest, the youth receiving the intervention were significantly less likely to be reconvicted. Only 22% of youth receiving MTFC compared to 50% of the comparison group had re-entered custody.
In another UK study, participants were youth aged 11 to 16 yeas and in a placement which was unstable, at risk of breakdown or not meeting their assessed needs or at risk of custody or secure care and were showing complex or severe emotional difficulties and/or challenging behaviour. 34 youth were randomised to MTFC or control, and a further 92 young people receiving MTFC and 93 receiving control services were included. There was no significant difference between groups. After adjusting for initial risk, the study found that young people who had been more disruptive at baseline were significantly less so at follow-up if they had received MTFC.
Countries where evaluated
- Sweden,
- United Kingdom
Characteristics
Protective factor(s) addressed
- Community: opportunities and rewards for prosocial involvement in the community (including religiosity)
- Family: attachment to and support from parents
- Family: opportunities/rewards for prosocial involvement with parents
- Family: parent social support
- Individual and peers: clear morals and standards of behaviour
- Individual and peers: interaction with prosocial peers
- Individual and peers: opportunities and rewards for prosocial peers involvement
- Individual and peers: Problem solving skills
- Individual and peers: skills for social interaction
- School and work: rewards and disincentives in school
Risk factor(s) addressed
- Family: family management problems
- Individual and peers: anti-social behaviour
- Individual and peers: favourable attitudes towards anti-social behaviour
- Individual and peers: interaction with antisocial peers
Outcomes targeted
- Academic performance
- Alcohol use
- Use of illicit drugs
- Crime
- Risky sex, STIs, teen pregnancy
- Violence
Description of programme
The Treatment Foster Care Oregon (TFCO) programme was developed as an alternative to institutional, residential or group care placement for teenagers with histories of chronic and severe criminal behaviour. In most communities, such juveniles are placed in out-of-home care settings before closed custody incarceration. Typically, these settings include some type of group home or cottage on a larger institutional campus, where young people live with others who have similar problems and histories of offending. On a continuum of care, TFCO is a relatively non-restrictive community-based placement that can be used instead of residential or group care or for young people transitioning back into the community from such settings. TFCO is less expensive than placement in group, residential or institutional care settings.
The fundamental philosophy behind the programme is reinforcement and encouragement of young people. Before placement, the case manager meets with an adolescent in detention to review the programme model and programme components. TFCO adolescents go through a behaviour modification programme that is based on a three-level points system through which they are provided with structured daily feedback. The young people have the opportunity to earn points throughout the day for expected activities outlined in the treatment, including going to class on school days. They lose points for any type of rule infraction, including in terms of attitude. The system emphasises positive achievements, and point loss is handled matter-of-factly. Once a young person earns a total of 2 100 points (this usually takes three weeks), they are able to ascend to a higher level. At each level, the young person is able to benefit from a more extended list of privileges, including home visits. At level three, they are even able to be involved in community activities without direct adult supervision.
There is an emphasis on teaching interpersonal skills and on participation in positive social activities including sports, hobbies and other forms of recreation. Once the programme begins and an adolescent has been placed with a TFCO family, daily telephone contact is made and behaviours are assessed through the Parent Daily Report. These calls are brief and are designed to monitor the occurrence of problems during the past 24 hours. Points earned and lost are also tracked, along with any incidents that may be affecting treatment. The young person is also assigned to an individual therapist, who provides support and assists in teaching skills needed to relate successfully to adults and peers. Meetings with the individual therapist occur on a weekly basis. Family therapy sessions help parents to prepare for the young person’s return home and help them become to more effective at supervising, encouraging, supporting and following through with consequences. Parents are then able to practise these skills during home visits once the child has reached level two of the programme. They work through a modification of the points system being used in the TFCO home, which more closely aligns with the TFCO system as time goes on, and home visits become longer and more frequent.
Another component of the programme is school monitoring. The young person has a school card, which they carry to class, and teachers sign off on attendance, behaviour and homework completion. The cards are collected daily by the TFCO parents, and the teacher ratings transfer into points in the daily programme. Once the programme has been completed (typically after six to nine months) and the young person has returned home, the family continue to receive aftercare support. Case managers remain on call to the family, and the points system remains in place. Parents can participate in group sessions with other families, where they can continue to learn specific parenting skills, as well as receiving feedback and support from other parents. Aftercare services remain in place for as long as the parents want, but typically about one year.
