Core Components

Treatment Foster Care Oregon for Pre-schoolers (TFCO-P) is designed for children aged 3-6 years, within the looked after setting (institutional, residential, group care). These children may have behavioural, emotional, or mental health problems; may have had previous failed placements; and may have received other interventions prior to referral to TFCO-P. Services provided to children within this programme are designed to reduce problem behaviour, promote the development of secure attachments to caregiver, increase permanent placement success and enhance school readiness. It is delivered by TFCO-P teams who have been trained in the TFCO-P model of care. 

The typical start-up size for TFCO sites is eight – ten children, dependent on organisations’ capacity, funding and sustainability. The TFCO-P programme focuses on providing close supervision to the children, limiting disruptive behaviours and encouraging prosocial behaviours. One child in the TFCO-P programme is placed with one foster carer (except sibling groups), for nine to twelve months. An individualised programme to address each child’s specific issues is created by the TFCO-P team leader and clinical team. This programme is then delivered within a positive, nurturing, foster care home setting. Children attend weekly skills coaching sessions where they learn problem solving skills, coping skills, and other skills that have been tailored to meet their specific needs. Children also attend weekly therapeutic playgroup sessions which are designed to promote children’s psychosocial skills and school success. TFCO-P programme provides aftercare to birth parents or other long-term/ permanent caregivers for at least one year. When children return home or move on to more permanent placements, TFCO-P team keep working with them for continued building of their learned skills.

Fidelity

Treatment Foster Care Consultants (TFCC) Inc. promote fidelity in programme delivery by:

• Providing implementation support to new TFCO-P sites
• Training TFCO-P teams on the programme model, and providing treatment model support and clinical consultation to the clinical team
• Evaluating and auditing delivered programmes (e.g. review of clinical team meetings and foster carer team meetings)
• Monitoring adherence to programme model (e.g. fidelity review)
• Fidelity assessments conducted at the end of each year, for the first two years implementation

Modifiable Components

TFCO has been delivered in different countries including Australia, Denmark, Norway, Sweden, Netherland and New Zealand. TFCO has been adapted into a less intensive programme called the KEEP (Keeping foster and kinship carers supported); a support and skills training programme, delivered to kinship/ foster carer groups over sixteen weeks.

Support for Organisation / Practice

Treatment Foster Care Oregon for Pre-schoolers (TFCO-P) was developed by Dr. Patricia Chamberlain at the Oregon Social Learning Centre. TFCO-P is part of a suite of TFCO programmes, which also includes TFCO for middle Childhood (TFCO-C) for children aged 7-11 years, and TFCO for Adolescents (TFCO-A) for children aged 12-17 years. Treatment Foster Care Consultants (TFCC) Inc. in Oregon provide training, consultation, and other implementation support to organisations for all TFCO programmes.

Implementation Support

Prior to programme implementation, a feasibility check is conducted. If feasibility review activities indicate the suitability of TFCO programmes for that organisation, then the readiness phase is activated. In this phase, TFC Consultants work with organisations to address obstacles to successful implementation. This phase includes an initial visit to intending TFCO sites by TFC Consultants and a review of factors necessary for TFCO programme implementation and operation. TFC Consultants build TFCO team understanding of programme implementation requirements and programme model. They also help intending sites create an implementation plan and training timelines for programme staff. The readiness phase can be completed in about six months.

Once complete, the implementation phase is activated. In this phase, stakeholder and site planning meetings are held at the implementing site, and TFCO team member trainings are conducted at both implementing site and TFCO site in Oregon. TFC Consultants provide advice on foster carer recruitment and use of parent daily reports (PDR) systems. They also conduct weekly telephone consultation with team leaders to check treatment plans, problems and progress. TFC Consultants prepare periodic evaluation reports for TFCO sites which include site implementation progress, adherence to TFCO programme model and staff performance. Up to five two-day site visits are made by TFC Consultants to TFCO sites over the first two years of implementation. These visits are planned for every quarter and can include booster trainings, problem-solving, consultation and support. TFC Consultants provide consultation, guidance and support whenever needed by TFCO teams to ensure that TFCO teams understand the TFCO model, and can successfully implement and sustain the programme.

Foster carers play a key role in the successful delivery of the TFCO programme, and are highly supported for successful programme delivery. Foster carers have access to 24 hour, 7 days a week support, are have regular respite from their carer duties.

Licence Requirements

A licence is required to deliver this programme

Start-up Costs

Start-up costs for TFCO-P programme include $9,010 for the readiness phase. This covers biweekly conference calls and kick-off site visit. The implementation phase costs $108,225. This includes cost of stakeholder presentation, recruitment calls, TFCO trainings, parent daily reports (PDR) setup and subscription, weekly consultations, monthly and weekly calls with agency leadership, 5 implementation reviews, 5 site visits and 2 fidelity assessments.

Some services can be provided individually. These include $3,285 yearly for PDR access and support; $2,595 monthly for weekly meetings and weekly consultations; $3,900-$5,100 for 2 site visits; $1,525 for implementation review; and $2,545 for fidelity assessments. Training of replacement staff in the first year cost $500 for team leader, $285 for therapist & coach, and $215 for recruiter/trainer/PDR caller.  Training in other situations for the same staff cost $1,345, $980 and $810 respectively.  Application fee for TFCO-P certification costs $3,260. 

Building Staff Competency

Qualifications Required

Team member qualifications depend on their role/ position within the team. Team leaders and Family Therapists typically have Doctorate or Master level degrees, while the rest of the team typically have bachelor’s degrees and/ or knowledge and experience in foster care.

• Team leader (1 FTE): Doctorate or Master level degree in clinical field
• Family Therapist (1.0 FTE): Doctorate or Master level degree in clinical field
• TFCO home consultant/ recruiter/ trainer (1.0 FTE): Knowledge of the TFCO-P model and role of foster parents
• Playgroup leader/ staff (hourly staff): Bachelor’s degree in relevant field
• Skills trainer (20-25 hours/week/10 children programme): Bachelor degree in relevant field
• Parent daily reports (PDR) caller (0.75 FTE): Strong understanding of TFCO-P model
• Mental health consultant (hourly basis): Qualified Psychiatrist
• Foster family: One foster carer per child except sibling groups.

TFCO-P teams are can only deliver the TFCO pre-school programme.

Training Requirements

Training and consultation provided by TFC Consultants are integral to the programme. Trainings are delivered prior to recruitment of children into the programme, and training duration is dependent on the role of the TFCO team members. Team leaders attend 5 days training, Therapists attend 4 days training, and Recruiter/Trainer/PDR caller attend 3 days training. These trainings introduce the TFCO-P model, and explain the operation and implementation of the programme model. Training is supplemented with continued implementation support and feedback. TFCO-P foster carers attend a 2 day foster carer training which can also be attended by foster carer recruiters and team leaders. Foster carers trainings promote understanding of the TFCO-P programme model, and the implementation of this programme within the foster carers’ home. Rolling trainings are available to new foster carers and other new TFCO team members.

Team leaders must continue to receive weekly consultation from TFC Consultants until TFCO teams become certified by Treatment Foster Consultants Incorporated, Oregon. To apply for accreditation, a minimum of 7 children should have successfully completed the programme from the site. Certification process takes a minimum of 12 months from the time of placing the first child. Initial certification is valid for 2 years, while subsequent certifications are valid for 3 years. 

Supervision Requirements

TFC Consultants supervise the activities of the TFCO team to ensure adherence to the TFCO-P model, and fidelity in programme delivery. This supervision is provided in form of weekly phone consultation with TFCO-P team leader, review of weekly recordings of foster carer meetings and clinical team meetings, site visits, regular fidelity reviews, feedback and support to TFCO-P teams.

Theory of Change

TFCO-P programme is grounded in social learning theory. This theory stresses the significance of observation and modelling of positive attitudes, emotional responses and conducts of others. Hence the children in this programme learn by the things they see around them, and the things that are reinforced in their lives by the TFCO-P team. The TFCO-P team work in a co-ordinated manner to teach children important skills to promote social skills, emotional competence and academic success. 

Values

The TFCO-P programme is targeted at children aged 3-6 years in looked after settings. One child is placed with one foster carer (except sibling groups), for nine to twelve months. At its core, this programme helps children develop the skills they need to enhance their social relationships, emotional competence, and promote school success. Enhancing these skills in children have translated to more successful permanent placements and reduced problem behaviours.

• Does your organisation want to implement a programme targeted at young children (3-6 years) in the looked after setting?

Priorities

• Is your organisation looking to implement a programme that places children with specially trained foster carers?
• Is implementing an individualised programme that promotes placement success and reduces problem behaviours a priority for your organisation?
• Is your organisation looking to deliver a programme that runs over 9–12months?

Existing Initiatives

• Do you have existing initiatives that focus on children aged 3-6 years in looked after settings?
• Do the existing initiatives address the same outcomes as the TFCO-P programme? Are the existing initiatives effective?
• Are there critical aspects with the TFCO-P programme that existing initiatives do not address?

Workforce

The TFCO-P programme requires essential members within each team for successful delivery of the programme. They include 0.1 FTE team leader; 1.0 FTE foster carer recruiter/ trainer; a foster carer for each child placement (except sibling groups); 1.0 FTE family therapist; skills coach/ trainer at 20-25 hours/week/10 children programme; hourly paid playgroup staff; 0.75fte Parent daily reports caller; and two respite carers. Arrangement with a mental health consultant is also required to enable timely consultation and advice when needed.

• Do you have practitioners with the appropriate qualification, experience, interest and time to form TFCO-P teams and deliver the programme?
• Is your organization committed to supporting the training of practitioners for fidelity of programme delivery?
• How many children will be included in the programme in the first year?

Technology Support

Supervision of TFCO-P teams involves weekly telephone consultations, review of recorded weekly foster carer meetings and review of recorded weekly clinical team meetings.

• Does your organisation have the technology to consult with TFC Consultants, and record videos for review?

Administrative Support

TFCO-P is designed for looked after children. Successful programme delivery requires continued communication between team members. This is in form of parent daily reports, weekly foster carer meetings, and weekly clinical team meetings. Recorded weekly foster carer and clinical team meetings are reviewed by TFC Consultants.     

• How will you recruit children into this programme?
• Do you have venues for the weekly foster carer meetings, clinical team meetings, therapeutic playgroup, and skills coaching sessions?
• Do you have policies and procedures in place regarding the video recording and storing of these recordings?

Financial Support

Start-up costs for TFCO-P programme includes $9,010 for the readiness phase and $108,225 for the implementation phase.

• Can your organisation financially support the implementation of this programme?
• How many children does your organisation intend caring for? Does your organisation have the capacity and funding to implement and sustain the programme with this number of children?

Comparable Population

The TFCO-P programme is targeted at children aged 3-6 years in looked after settings, who may exhibit behavioural problems, and may have had prior breakdowns in their placements.

• Is this comparable to the population your organisation would like to serve?
• Has your organisation identified children who may benefit from the TFCO-P programme?

Desired Outcome

The TFCO-P aims to promote children’s development of secure attachment with caregivers and increase successful permanent placements. A randomized controlled trial has shown that programme implementation is associated with significant improvements across several outcomes including reduced avoidance behaviours, reduced caregiver stress, increased secure behaviours and increased successful permanent placements.

• Are the above outcomes priorities for your organisation?
• Are there other outcomes that your organisation would like to achieve, which are outside the premise of the TFCO-P programme?
• Does your organisation have other systems in place that effectively and efficiency address the above outcomes?