Turner, W., and G. Macdonald (2011). "Treatment foster care for improving outcomes in children and young people: A systematic review." Research on Social Work Practice 21(5): 501-527.
This study examines the impact of treatment foster care (TFC) outcomes for children and adolescents living in out-of-home care in restrictive settings, or are at risk of such placement due to severe psychological, behavioural, social and/or medical problems. This study reviewed existing data from five studies to assess the usefulness of TFC as an intervention for psychosocial and behavioural outcomes, delinquency, placement stability, and discharge status for children/adolescents in the aforementioned placement setting.
The studies reviewed contained data collected from randomized controlled trials, with the majority of studies having randomized individual children. One study randomized foster caregivers rather than children; however the foster caregivers provided data about these children living with them at the time. Due to the variety of outcomes measured in the five studies, data on specific outcomes were only available from at most two studies, which limit the overall understanding of the effectiveness of TFC. For example, one study administered the Parent Daily Report Checklist over the phone at multiple time periods to measure the occurrence of problem behavioural symptoms in the child. This measure was not used by researchers in any of the other studies. However, the key finding from each study suggests that TFC may be a suitable intervention for children and adolescents with complex psychological, emotional, and behavioural needs, particularly those with conduct disorders and delinquency, who are at risk of placement settings that may restrict their opportunities for social inclusion.
This study examined TFC programs that provided different levels of service through multicomponent TFC, an intervention with multiple elements that support foster parents through training and daily supervision, individualize treatment plans for children and adolescents, and make case managers available 24 hours a day to both foster caregivers and biological parents (as appropriate). These programs also served varied populations. The studies assessed the effectiveness of multicomponent TFC with male and female youth at risk of arrest or incarceration and young people discharged from psychiatric hospitals, as well as less intensive TFC with abused/neglected children. Given the variance in TFC program structure and implementation, findings cannot be assumed applicable to all programs or populations.
All five studies reviewed originate from the United States, with the majority of participants identifying as Caucasian. The results, therefore, lack diversity in terms of participant ethnicity, and geographical and cultural contexts. Studies are currently underway in England, the United States, and Sweden, which may provide insight into the applicability of TFC in different cultural contexts. Due to the limited number of studies in the area of TFC, there is a need for further research to increase the evidence base. In the meantime, the authors recommend additional consideration of the effectiveness of TFC with children who are at risk of social exclusion due to medical conditions, learning or physical impairments. Finally, there has been little attention in the evidence base to the cost of programs and therefore, cost-benefit analyses for future programs and past data are recommended.