Treatment Foster Care Oregon

Evidence Rating:

Suggestive Tier

Highlights

Program:

A foster care program for severely delinquent youth.
Evaluation Methods:

Two randomized controlled trials (RCTs) conducted in Oregon, one with a sample of 166 girls and the other with a sample of 85 boys.
Key Findings:

For girls, the program nearly halved the incidence of pregnancy over the two-year period after random assignment (51% of the control group became pregnant versus 28% of the treatment group, statistically significant p<0.01). The studies also found evidence of a reduction in delinquency for both boys and girls that we believe is suggestive but not yet strong due to study limitations.
Other:

(i) Because pregnancy was not the program’s primary targeted outcome, the effect on pregnancy rates, while substantial, warrants confirmation in an additional study to rule out the possibility it occurred by chance due to the study’s measurement of multiple outcomes.

(ii) Both RCTs were conducted in Oregon. A replication RCT conducted in another jurisdiction would be desirable to hopefully confirm the above findings and establish that they generalize to other settings.

Treatment Foster Care Oregon (TFCO), formerly Multidimensional Treatment Foster Care, provides severely delinquent youths with foster care in community families trained in behavior management, and emphasizes preventing contact with delinquent peers. Typical community treatment for such youth, by contrast, often involves placement in a group residential care facility with other troubled youth.

As an example of the program’s behavior management techniques, foster parents track and regulate the youths’ behaviors using a point system, with youths receiving points for positive behaviors and losing points for negative behaviors. As youths accumulate points, they are afforded more freedom from adult supervision.

The program also provides the youths and their families with individual and family therapy, and program case managers closely supervise and support the youths and their foster families through daily phone calls and weekly foster parent group meetings. Biological (or adoptive) families to whom the youth is returning after the TFCO placement receive family therapy and support. The average length of stay in the program is 6-7 months. The average cost is about $4,200 per month (2017 dollars), which is 30 to 50 percent lower than the cost of treatment in a group residential care facility in Oregon (where the studies of the program were conducted).

Click here for TFCO’s website.

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Top Tier

Programs shown in well-conducted RCTs, carried out in typical community settings, to produce sizable, sustained effects on important outcomes. Top Tier evidence includes a requirement for replication – specifically, the demonstration of such effects in two or more RCTs conducted in different implementation sites, or, alternatively, in one large multi-site RCT. Such evidence provides confidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original studies.

Near Top Tier

Programs shown to meet almost all elements of the Top Tier standard, and which only need one additional step to qualify. This category primarily includes programs that meet all elements of the Top Tier standard in a single study site, but need a replication RCT to confirm the initial findings and establish that they generalize to other sites. This is best viewed as tentative evidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original study.

Suggestive Tier

Programs that have been evaluated in one or more well-conducted RCTs (or studies that closely approximate random assignment) and found to produce sizable positive effects, but whose evidence is limited by only short-term follow-up, effects that fall short of statistical significance, or other factors. Such evidence suggests the program may be an especially strong candidate for further research, but does not yet provide confidence that the program would produce important effects if implemented in new settings.

References

Study 1 – Delinquent girls:

Leslie D. Leve, Maria Schweer-Collins, and Elizabeth Bates. “Criminal Offense Charges in Women: A 10-Year Follow-Up of an RCT of Treatment Foster Care Oregon.” Journal of Consulting and Clinical Psychology, vol. 90, no. 12, 2022, pp. 901-910.

Rhoades, Kimberly A., Leslie D. Leve, Gordon T. Harold, Hyoun K. Kim, and Patricia Chamberlain. “Drug use trajectories after a randomized controlled trial of MTFC: Associations with partner drug use.” Journal of Research on Adolescence, vol. 24, no. 1, 2014, pp. 40-54.

Leve, Leslie D., David C. R. Kerr, and Gordon T. Harold. “Young adult outcomes associated with teen pregnancy among high-risk girls in a randomized-controlled trial of Multidimensional Treatment Foster Care.” Journal of Child & Adolescent Substance Abuse, vol. 22, no. 5, July 2013, pp. 421-434.

Van Ryzin, Mark J. and Leslie D. Leve. “Affiliation with delinquent peers as a mediator of the effects of Multidimensional Treatment Foster Care for delinquent girls.” Journal of Consulting and Clinical Psychology, vol. 80, no. 4, 2012, pp. 588-596.

Kerr, David C. R., Leslie D. Leve, and Patricia Chamberlain. “Pregnancy Rates Among Juvenile Justice Girls in Two Randomized Controlled Trials of Multidimensional Treatment Foster Care.” Journal of Consulting and Clinical Psychology, vol. 77, no.3, June 2009, pp. 588-593.

Chamberlain, Patricia, Leslie D. Leve, and David S. DeGarmo. “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, vol. 75, no. 1, 2007, pp. 187-193.

Leve, Leslie D. and Patricia Chamberlain. “A Randomized Evaluation of Multidimensional Treatment Foster Care: Effects on School Attendance and Homework Completion in Juvenile Justice Girls.” Research on Social Work Practice, vol. 17, 2007, pp. 657-663.

Leve, Leslie D., Patricia Chamberlain, and John B. Reid. “Intervention Outcomes for Girls Referred From Juvenile Justice: Effects on Delinquency.” Journal of Consulting and Clinical Psychology, vol. 73, no. 6, 2005, pp. 1181-1185.

Study 2 – Delinquent boys:

Smith, Dana K., Patricia Chamberlain, and J. Mark Eddy. “Preliminary support for Multidimensional Treatment Foster Care in reducing substance use in delinquent boys.” Journal of Child & Adolescent Substance Abuse, vol. 19, no. 4, 2010, pp. 343-358.

Eddy, J Mark, Rachel Bridges Whaley, and Patricia Chamberlain. “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, vol. 12, no. 1, spring 2004, pp. 2-8.

Fisher, Philip A., and Patricia Chamberlain. “Multidimensional Treatment Foster Care: A Program for Intensive Parenting, Family Support, and Skill Building.” Journal of Emotional and Behavioral Disorders, vol. 8, no. 3, fall 2000, pp. 155-164.

Chamberlain, Patricia and Kevin Moore. “Models of Community Treatment for Serious Juvenile Offenders” in Social Programs That Work, edited by Jonathan Crane (Russell Sage Foundation, 1998), pp. 258-276.

Chamberlain, Patricia and John B. Reid. “Comparison of Two Community Alternatives to Incarceration for Chronic Juvenile Offenders.” Journal of Consulting and Clinical Psychology, vol. 66, no. 4, 1998, pp. 624-633.

Highlights

Program:

Evaluation Methods:

Key Findings:

Other:

References

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