Treatment Foster Care Oregon Prevention

About the programme

What happens during the delivery?

How is it delivered?

• TFCO-P is a team-based approach, working with the child, foster carer, birth family, school, and move-on placement. It usually lasts for 6-12 months.
• TFCO aims to increase a child’s social, emotional and relational skills and therefore reduce the need for more challenging and antisocial behaviours. The main way this is achieved is via:
  • Providing close supervision.
  • Offering multiple opportunities for feedback and reinforcement.
  • Providing a responsive, warm and predictable environment.
  • Providing daily structure with fair and consistent limits for inappropriate behaviour.
  • Children having a supportive relationship with at least one mentoring adult.
  • Children having less contact with peers with similar problems.
• The main components of TFCO-P are:
  • Component 1: TFCO Foster Carers deliver the TFCO model directly to the children in their everyday interactions, under the guidance of the TFCO Team Leader. They have two days of TFCO training prior to the first placement. While they have a child in their care, they attend weekly foster carer meetings, and complete a daily Parent Daily Report that monitors children's behaviours and carer stress. The Foster Carers have access to 24/7 support and are provided with regular respite.
  • Component 2: All children follow a behavioural incentive programme within the foster placement, developed and overseen by the Team Leader. All children receive weekly Skills Coaching sessions for 1- 1.5 hours, for the duration of their placement, and for up to three months post-TFCO. Some children attend a weekly Therapeutic Playgroup for 1.5 hours, which focuses on skills for school-readiness.
  • Component 3: The Birth Family Coach works weekly with the birth family and/or extended family for one hour. They make use of a TFCO parenting programme to help shape up strengths and skills and improve the quality of contact, and to increase the chances of children being returned home. This work can continue once a child returns home or will be offered to the follow-on placement.
  • Component 4: The TFCO team work closely with schools to develop interventions for teachers to deliver. Alternatively, an intervention will be delivered directly to the child from the TFCO team, within the school.

What happens during the intervention?

• At the centre of the TFCO programme is the foster carer and their child. TFCO carers are highly trained and well supported to minimise stress and maximise their capacity to offer a nurturing and consistent home environment.
• The Team Leader co-ordinates and guides the TFCO programme for each child, within the foster home, at school, with the biological family and in the move-on family’s home for three months following TFCO. Timely information sharing with the Team Leader is key to the effective delivery of TFCO and there are a number of mechanisms within the TFCO model that facilitate this:
  • weekly clinical team meeting
  • weekly foster carer meeting
  • 24/7 on-call to help carers navigate stresses and difficulties
  • daily completion of a Parent Daily Report with foster carers, which tracks carer stress and child behaviours
  • team Leader providing TFCO supervision to all clinical staff.
• Children’s skill development is targeted in a number of ways throughout the TFCO programme:
  • Modelling, coaching and practise of specific skills in the community or in social situations with a Skills Coach.
  • Modelling and reinforcement of targeted skills within the foster home and the biological family home.
  • Weekly attendance at the Therapeutic Playgroup where TFCO children come together with Skills Coaches to learn and practise school-based skills, in a structured environment.
  • Children already in school may have support from Skills Coaches who work closely with staff to help them implement TFCO interventions that target specific skill development.
• Throughout the duration of the TFCO programme the Birth Family Coach works with the birth and extended family members in regular contact with the TFCO child to help shape up their strengths and skills. Ultimately, the goal is to stabilise and improve relationships so that a move-on home is more realistic; however, when this is not a possibility the skills are targeted to improve the quality of contact.

What are the implementation requirements?

Who can deliver it?

• This programme is delivered by a clinical team. The team consists of a Team Leader (recommended NFQ 7/8), TFCO-A Foster Carers (recommended NFQ 4), Foster Carer Recruiter/Consultant (recommended NFQ 6), Birth Family Coach (recommended NFQ 4), Skills Coach (recommended NFQ 5), Individual Therapist (recommended NFQ 6), Administrator (recommended NFQ 6), and the Programme Manager (recommended NFQ 7/8).
  

What are the training requirements?

• Practitioners have 3-4 days of programme training depending on their role. Booster training of practitioners is recommended.
• The TFCO-P clinical team and Foster Carers are required to be trained by the National Implementation Service when they initially set-up. Following this, new Foster Carers can be trained by the Team Leader.

How are the practitioners supervised?

• It is a requirement that Team Leaders are supervised by one external supervisor (recommended NFQ 7/8) at the National Implementation Service, through weekly one-hour consultations via the telephone. 
  
• The National Implementation Service provides consultation to the Team Leader on all aspects of the TFCO-P model, to ensure fidelity to the model. This is not clinical supervision and the NIS does not hold clinical responsibility for TFCO-P children. 
  
• TFCO-P skills-based supervision is provided by the Team Leader (recommended NFQ 7/8) to the rest of the clinical team. This is done via weekly face-to-face meetings. 
  
• TFCO-P team members would still be expected to meet the supervision requirements of the agency they are employed by, that is appropriate for the team member’s professional qualification (e.g. Social Worker or Mental Health Practitioner). This includes, clinical, skills and case management.
  

What are the systems for maintaining fidelity?

• Training manual
• Other printed material
• Other online material
• Fidelity monitoring.

Is there a licensing requirement?

There is a licence required to run this programme.

How does it work? (Theory of Change)

How does it work?

• Children’s behavioural difficulties and deficits in their social and emotional skills are rooted in repeated coercive or maladaptive parent-child interaction, which can cause immediate and long-term consequences in a child’s capacity to have successful social relationships and to manage the demands of nursery or school.
• TFCO is a team-based intervention that works across all aspects of a child’s life to provide a consistent approach that maximises opportunities for a child to learn new skills and reduces the likelihood of disruptive and antisocial behaviour.
• Over the duration of the programme both the children and their families will learn new skills that help them experience more stable and affirming relationships and the children will also experience more success with their peer relationships and at school.
• In the longer term, children are more likely to experience placement stability.

Intended outcomes

Contact details

Colin Waterman
Director (and Systemic Family Psychotherapist) 
National Implementation Service
colin.waterman@mft.nhs.uk

www.tfcoregon.com
www.evidencebasedinterventions.org.uk
www.mtfc.org.uk

About the evidence

TFCO-P’s most rigorous evidence comes from one RCT which was conducted in the United States. This is a level 2+ study, which identified statistically significant positive impact on a number of child outcomes. 

A programme receives the same rating as its most robust study, and so the programme receives a level 2+ rating overall.