Enhancing Therapeutic Foster Care with components of evidence-based practice: Initial findings from a randomized trial

Background and Purpose: This presentation addresses implementation and preliminary findings from an NIMH-funded randomized trial of Therapeutic Foster Care (TFC) that examined the effectiveness of a training and consultation approach to improving treatment parent practice and outcomes in “usual care” TFC agencies. The approach draws elements both from Patti Chamberlain's evidence-based model as well as practice-based evidence from existing programs. The intervention, Together Facing the Challenge, shows improvement on a range of youth-level outcomes in the enhanced TFC condition. This presentation will provide an overview of the background, intervention, and findings. It will conclude with discussion of ongoing analyses on potential mediators of youth-based outcomes.

Methods: Together Facing the Challenge was implemented with 15 agencies located throughout the state of North Carolina. Agencies in the experimental condition (n=7) received: (1) a two-day training for TFC supervisors; (2) 6-week training for Treatment Parents; (3) monthly consultation for supervisors for one year following the initial training; and (4) booster sessions for Treatment Parents (at 6 and 12 months). Trainings were led by university-based staff but efforts were made to involve TFC supervisors as co-facilitators and to train lead staff as trainers for sustainability of the intervention. Data collection was conducted with treatment parents and youth across time at all sites.

Results: Analysis of youth-level outcomes focused on change across time in psychiatric symptoms, behavior problems, and strengths. Youth in the intervention group showed significantly more positive changes than youth in the control groups. For symptoms (measured by the Strengths and Difficulties Questionnaire), youth in the control group showed no change across time, while youth in the intervention group showed approximately one-third of a standard deviation improvement (p=.02). For behavior problems (measured by the Parent Daily Report), youth in the control group showed a slight increase in problems across time, while youth in the intervention group showed a significant improvement (p=.01). For strengths (measured by the Behavioral and Emotional Rating Scale), the intervention group showed significantly more improvement in the first six months following training (p<.01) but this difference disappeared by the 12 month follow-up. These findings suggest the need for additional work to fully assess the relationship of parent changes in practice and youth outcomes. We will also report the results of our analysis of these mediating relationships in this presentation.

Conclusions and Implications: The work we will present supports the primary hypothesis of the randomized trial that enhancing usual care TFC by training therapeutic parents in evidence based parent management techniques would improve child level outcomes. Overall, the process and results of this effort suggest the substantial potential to improve practice even in sites that are not involved in full dissemination of current evidence-based interventions. It also provides important information about the effort, resources, and commitment required by agencies and staff to improve practice. Such change is not easy, but it is possible and potentially beneficial and rewarding, with apparent gains for agencies, staff, families, and youth.