Improving Implementation and Dissemination in Treatment Foster Care

 

Background and Purpose

This presentation builds upon 2 decades of work on improving and disseminating effective Treatment Foster Care (TFC). Together Facing the Challenge (TFTC) was developed and evaluated through a series of NIMH-funded studies to improve practice and outcomes for youth in TFC via enhanced training and consultation to TFC agency staff. The current presentation will focus on the trajectory of this work, gains and challenges of developing, evaluating, and disseminating TFTC, and ongoing work to improve dissemination and sustainability of the model.  Results from an initial randomized trial of TFTC indicated that youth outcomes improved significantly in agencies utilizing TFTC compared to those utilizing “usual care” models. However, these findings were based on university-led training and consultation to agencies and treatment foster parents. Ongoing work is exploring the extent to which findings from the initial model can (a) be replicated with agency-led training for treatment parents, and (b) whether increased consultation with agency-based supervisors improves implementation and sustainability of effects.  

Methods

Study Design: The current randomized trial employs a “train-the-trainer” model emphasizing enhanced coaching/consultation. In all participating agencies, agency staff members were trained to provide on-site training to treatment parents. Half of the sites were randomized to receive “enhanced” consultation, while the other half received the same level of consultation as in the original randomized trial. 

Sampling and Participants: All current staff and families in participating agencies were invited to participate (n=154 treatment parents; 68 TFC staff).    

Data Collection Procedures and Measures: Data were collected at baseline, post-training (for intervention agencies), 6 months, and 12 months from treatment parents and TFC supervisors. Measures include: pre- and post-training knowledge questionnaires, relationships with supervisors, Evidence-Based Practice Attitude Scale (EBPAS), Strengths and Difficulties Questionnaire (SDQ), Alabama Parenting Questionnaire (APQ), Trusting Relationships Questionnaire (TRQ), and Parent Daily Report  (PDR). Supervisors provided data on treatment parent’s implementation of interventions as well as youth progress (e.g., SDQ).

Analysis: Analyses include a variety of descriptive, bivariate, and multivariate approaches. These include cross-sectional comparisons between intervention and control groups at a point in time as well as longitudinal analyses of change across time (between groups and within groups).

Results

Overall, treatment parents reported considerable contact with their supervisors and were overwhelmingly positive about their relationship with their supervisor.  Both treatment parents and staff showed relatively high levels of acceptance for evidence-based practices (Staff showed slightly higher positive attitudes than treatment parents, but both were higher than have been seen in broader samples of child-serving providers). Overall, EBPAS scores were significantly higher for parents who were younger (compared to older) and for staff who were female (compared to male). However, parental involvement was significantly higher for younger treatment parents and among those with higher levels of education.  Ongoing analyses are examining patterns and predictors of change across time.

Conclusions and Implications

Current data suggest that increased training and consultation improve practice and outcomes. Ongoing analyses will offer insight into benefits on practice, outcomes, and intervention sustainability of further enhancing training and consultation.