Treatment Foster Care Oregon

1. Introduction

Version followed: TFCO-A (adolescents, 12–17/18) as published by TFC Consultants, Inc., Eugene, Oregon (the 2015 TFCO-A Foster Parent Manual, plus the purveyor's programme descriptions on CEBC, the Foundations Guidebook and Blueprints). Where TFCO-C (ages 7–11) and TFCO-P (ages 3–6) differ, this is noted. The TFC Consultants staff manuals (Team Leader, Individual Therapy, Family Therapy, Skills Coach, Behaviour Management, Recruitment and Foster Parent Training manuals, all dated 2015; Implementation Guidebook 2021) are released only to contracted sites. Staff-role content below therefore comes from published descriptions by the developers and the purveyor. [source: TFCO-A Foster Parent Manual 2015; ACF Clearinghouse TFCO-C page; CEBC]

What it is. Treatment Foster Care Oregon (TFCO; called Multidimensional Treatment Foster Care, MTFC, until about 2015) was developed by Patricia Chamberlain and colleagues at the Oregon Social Learning Center (OSLC). It is a programme, not a single therapy. A youth who would otherwise go to group or residential care, custody or hospital is placed alone, or occasionally with one other youth, in a specially trained foster home for about 6–9 months (some sources say 9–12). A small clinical team led by a Team Leader runs the case. The foster home is treated as the main treatment setting. The youth goes to a local mainstream school. The birth family or other aftercare family is taught the same parenting methods in parallel, ready for the youth's return. [source: Blueprints; CEBC; Fisher & Gilliam 2012, p. 196]

How change happens. The model rests on OSLC social learning and coercion theory. Antisocial behaviour is learned and kept going by harsh or inconsistent discipline, little positive reinforcement and poor monitoring, and it is made worse by contact with deviant peers. Change comes from four things, delivered at once across home, school and community: (1) a consistent, reinforcing adult environment; (2) daily structure with clear limits and non-harsh consequences that are always followed through; (3) close supervision of where the youth is and whom they are with; (4) less contact with deviant peers and more prosocial activity, plus a mentoring relationship with at least one adult. The developers' mediation studies name supervision, fair and consistent discipline, a positive relationship with a mentoring adult and less deviant-peer association as the routes to better outcomes. [source: CEBC; Saldana & Buchanan 2010; Fisher & Gilliam 2012, pp. 195–197; Foundations TFCO-A]

What you need before delivering it under the name. TFCO is licensed. You may deliver it under its name only within a site contracted with and trained by TFC Consultants, Inc. (in England, by the National Implementation Service under licence). The typical path [source: CEBC implementation page; Foundations TFCO-A/TFCO-P; ACF Clearinghouse TFCO-C]:

Feasibility and readiness. A free feasibility review, then a readiness phase of about 6 months of video calls (priced at USD 9,010 in January 2023). 3–5 licensed treatment foster homes must be recruited before go-live.
Clinical training in Eugene. Team Leader 5 days, therapists 4 days, Recruiter/Trainer/PDR Caller 3 days.
Foster parent pre-service training. A 2-day course at the agency, given first by TFC Consultants and later by the site's own Recruiter/Trainer. Older descriptions give it as 20 hours.
Weekly fidelity consultation. The Team Leader has a weekly telephone consultation with a TFCO consultant, including feedback on video-recorded foster parent and clinical meetings.
Site visits and data. About five 2-day site visits over 2 years, plus use of the web-based FOCUS PDR data system.
Fidelity assessment. At the end of years 1 and 2 across seven implementation domains, then post-certification checks. The measures include therapy delivery rate, PDR data, behaviour charts and school cards, and meeting videos and attendance.
No train-the-trainer route is offered [source: Blueprints].

Without this, you may borrow principles, but you should not call the service TFCO or MTFC [synthesis].

2. Framework

Versions.

TFCO-A (12–17/18). Youth with chronic delinquency and/or severe emotional and behavioural problems who need out-of-home placement. Referrers include juvenile justice, child welfare and mental health. Uses a three-level point system.
TFCO-C (7–11). Uses behaviour charts and daily routines with tangible rewards that cannot be lost once earned. Weekly individual therapy, about 2 hours of skills coaching and weekly family therapy.
TFCO-P (3–6; formerly MTFC-P, OSLC/Fisher). Uses simple immediate reinforcers such as stickers and star charts. A weekly 2-hour therapeutic playgroup replaces much of the skills coaching. Targets behaviour problems, emotion regulation and developmental delay. The birth or permanent family has a weekly 1-hour skills session.

[source: CEBC; ACF Clearinghouse TFCO-C; Fisher & Gilliam 2012, pp. 196–200; CEBC TFCO-P]

Team and caseload. A team of about 6–8 staff, sized for about 10 placements:

Team Leader, also called Program Supervisor or case manager. A master's-level clinician available 24/7. Holds clinical authority and is the youth's authority figure and disciplinarian. Designs the point and level programme and links with school, court and referrers.
Individual (youth) therapist, master's level.
Family therapist, called Birth Family Coach in UK materials, master's level. Parent Management Training knowledge is desirable.
2–3 Skills Coaches/Trainers, bachelor's level or about 3 years' experience.
Foster Parent Recruiter/Trainer/PDR Caller, often an experienced former foster parent.
Consulting psychiatrist.
TFCO-P adds a Playgroup Leader, Playgroup Assistants and a Foster Parent Consultant.

Fisher & Gilliam (2012) give a caseload of about 12–15 children per team. [source: CEBC; Saldana & Buchanan 2010; Fisher & Gilliam 2012, p. 198] [uncertain: role titles vary between US and UK materials and between years]

Recommended weekly intensity (TFCO-A) [source: CEBC]:

Foster parents: at least 7 contacts a week. That is five 10-minute PDR calls, one 2-hour foster parent group, and further contact as needed. 24/7 on-call support and respite are also provided.
Youth: a 1-hour individual therapy session and a 2-hour skills session each week. Foundations gives skills coaching as 1–1.5 hours.
Aftercare family: a 1-hour family therapy session each week.
Team: a weekly clinical team meeting with weekly supervision from the Team Leader.

Phases. These are inferred from the published structure. The purveyor's own phase labels are in the restricted Team Leader manual [uncertain].

Pre-placement and readiness (days to weeks).
- Referral and screening.
- The case manager or Team Leader meets the youth, for example in detention, to explain the programme [source: Blueprints].
- The youth is matched to a trained foster home.
- House rules and an individual point programme are drawn up.
- Engagement of the birth or aftercare family begins.
Level 1: placement entry (about 3 weeks).
- 1:1 adult supervision at all times. Only basic privileges.
- Points earned one day buy privileges the next day.
- No home visits.
- Daily PDR calls start on day 1.
- Individual therapy, skills coaching and family therapy start weekly.
- Move to Level 2 once a cumulative 2,100 points are reached. [source: TFCO-A Foster Parent Manual pp. 22–23; Fisher & Gilliam 2012 p. 197]
Level 2: core treatment (typically 12–16 weeks).
- Privileges are bought weekly with the week's points. Allowance begins.
- Some unsupervised time is allowed if approved in advance.
- Home visits begin and grow, with birth parents practising the methods during visits [source: Blueprints].
- Move to Level 3 once the youth has bought 12 weekly "bonds" at 50 points each.
- Demotion: a day below 100 points means a Level 1 day next, after which the youth returns once they earn the Level 1 minimum. [source: Foster Parent Manual p. 30]
Level 3: maintenance and pre-transition (no fixed length).
- Privileges are automatic while the daily minimum (120) is met.
- The youth keeps a budget book, and activities are pre-approved.
- The youth is expected to join prosocial community activities such as sports or clubs.
- Serious violations can mean a drop to Level 1.
- The point is to prepare for return home. [source: Foster Parent Manual p. 37; Fisher & Gilliam 2012 p. 198]
Transition and aftercare.
- The youth returns to the birth, kin, adoptive or other aftercare family, which is already using the same point and supervision system.
- Foundations gives Team Leader support in the move-on home, with individual therapy and skills coaching, for up to 3 months.
- The ACF Clearinghouse (TFCO-C) gives at least 3 months of family-therapist contact.
- Blueprints describes on-call case managers, the point system continuing and parent group sessions for about a year in the original trials.
- Services continue "until the child is stable in the home" (Fisher & Gilliam 2012, p. 198). [uncertain: the length of aftercare differs between sources]

Most youth take 4–6 months to move through the three levels [source: Foster Parent Manual p. 22].

Criteria for moving on [synthesis from the sources above]:

Between levels: the point thresholds and bonds.
Into home visits: the youth has finished Level 1 and the team judges youth and family ready [source: ACF Clearinghouse TFCO-C].
Into discharge: PDR problem counts are stable and low, the school card is acceptable, home visits have gone well, and the aftercare parents can run the system without the team.

3. Guiding principles

[source: CEBC essential components; Fisher & Gilliam 2012 pp. 196–198; Saldana & Buchanan 2010; Foster Parent Manual]

The foster home is the main treatment setting, and foster parents are team members. They are trained, paid professionals who carry out the plan daily, not a placement the clinicians visit.
One treatment youth per home. Keep peer contagion down. Never place two delinquent youths together for convenience.
One clinical authority (the Team Leader). Decisions about consequences, privileges, special incentives and changes to the programme go through the Team Leader. Foster parents and other staff do not improvise extra punishments (Foster Parent Manual p. 49).
Treat symptoms as skill deficits. Ask "what skill is missing and how do we teach and reinforce it?" rather than "what is wrong with this youth?"
Reinforce far more than you correct. Aim for at least 5 positive comments to every corrective one, with 8:1 as the goal (Foster Parent Manual p. 19). Parents who will not reinforce positive behaviour are discouraged from continuing (Fisher & Gilliam p. 197).
Consistent, non-harsh limits that are always followed through. Consequences are small, predictable and calm, built into the point system, and given without lecture or argument. The aim is to break coercive cycles, not to win them.
Close supervision of whereabouts and peers. Adults always know where the youth is, with whom, and doing what. Autonomy is earned step by step.
Steer away from deviant peers and toward prosocial ones. Use activities, school and skills coaching to build normal peer contacts.
Be proactive. Daily data and frequent contact let the team head off escalation before it causes disruption. Foster parents are told to call before things escalate and before changing any approach (Fisher & Gilliam p. 196; Foster Parent Manual p. 49).
Decide from data. PDR trends, school cards and point charts drive weekly changes to the programme. Behaviour programmes are adjusted continually (Fisher & Gilliam p. 198).
Support the adults so they stay effective. High-challenge behaviour pulls carers toward harsh, reactive limits. The team's job is to restore balance with 24/7 support, respite and weekly groups (Saldana & Buchanan 2010).
Plan for the aftercare family from day 1. Reunification or another permanent home is the goal. The aftercare parents learn the same system so gains carry over (Foster Parent Manual p. 51).
Separate, clear roles. Roles are "stratified" with little overlap (Fisher & Gilliam p. 198). The individual therapist is the youth's supporter and advocate, and the Team Leader is the disciplinarian. Keep this split so the therapy relationship is protected.
Normal community life. The youth attends public school and community activities rather than an institution, so skills are learned where they will be used.
Fidelity is monitored. Meetings are video-recorded and reviewed, and PDR and therapy-delivery data are audited (CEBC). Drift from the model is treated as a clinical problem.

[source tags apply to each bullet as cited]

4. Intervention inventory

The inventory is grouped by the team role that delivers each item. The steps are written in our own words from the published descriptions. The restricted staff manuals hold more detail that was not seen [uncertain]. All example wording is illustrative unless quoted and cited.

Part A. Placement set-up and foster parent work (Team Leader, Recruiter/Trainer, PDR Caller)

A1. Foster parent recruitment and selection

Purpose: Build a pool of treatment homes able to work as part of a team. Readiness requires 3–5 homes before go-live [source: CEBC].
Steps:
1. Recruit through adverts, public postings, word of mouth and current foster parents.
2. Make a screening phone call.
3. Make a home visit to present the programme and assess the home.
4. Select mainly on willingness to join a treatment team with frequent contact. Fisher & Gilliam (2012, p. 196) say no other specific selection criteria are set.
5. Check that state or local foster licensing is in place, and get a signed written agreement before placement. TFCO-C lists a written application, a 1-hour home visit and 20 hours of pre-service training [source: ACF Clearinghouse TFCO-C].
Example language (illustrative): "You'd be the most important person on this youth's team. We'll call you every weekday and meet you every week, and someone is on call around the clock. How does that level of contact sit with you?"
Watch for:
- Applicants who want to parent without input, or who reject point systems or praise as "bribery".
- Homes where other youths could become a peer-contagion risk.
- Not having enough homes, which pushes teams into poor matches [synthesis].

A2. Foster parent pre-service training

Purpose: Teach the model before any youth arrives.
Steps:
1. Deliver the 2-day course (older descriptions: 20 hours over a weekend plus one weekday evening).
2. Cover the programme model, behaviour analysis, daily running of the point programme, encouragement, limit-setting and working with birth families [source: Fisher & Gilliam p. 197; Blueprints; CEBC].
3. Stress concrete reinforcement for prosocial behaviour.
4. Rehearse the daily routines: PDR calls, school card checks, point charts and the evening review.
Example language (illustrative): "Let's practise taking away five points without a lecture. Say the behaviour, say the points, then move on."
Watch for: Trainees who cannot bring themselves to deliver praise or calm consequences in role-play. Fisher & Gilliam (p. 197) say people who refuse to reinforce positive behaviour are discouraged from continuing.

A3. House rules

Purpose: Give the household clear, predictable expectations from day 1.
Steps:
1. Agree about five specific rules with the whole household, covering privacy, food, household routines and physical boundaries such as no roughhousing.
2. Post them where everyone can see them.
3. Review them with the family and revise as needed. [source: Foster Parent Manual pp. 9–11]
Example language (illustrative): "In this house, bedroom doors stay open when anyone else is in the room. Food stays in the kitchen."
Watch for: Long lists of rules, vague rules ("be respectful"), and rules the foster parents themselves do not keep.

A4. Individual point and level programme (design)

Purpose: Turn the youth's daily expectations into earnable points that buy privileges and move the youth up the levels. The Program Supervisor/Team Leader designs it, and the foster parent runs it [source: Saldana & Buchanan 2010].
Steps:
1. List the daily expectations, for example getting up on time, hygiene, going to every class, chores, homework, following instructions and appropriate talk [source: Fisher & Gilliam p. 197].
2. Give each expectation a value. Full points are for adequate performance, partial points for partial completion, and bonus points for exceptional behaviour. A good day earns up to about 150 points.
3. Set point losses so that losing 10–20 points in a day does not wipe out privileges [source: Foster Parent Manual pp. 43–44].
4. Set the level rules:
  - Level 1: daily minimum 100 points; points buy the next day's privileges; 1:1 supervision; no allowance; 2,100 cumulative points to move up.
  - Level 2: daily minimum 100; points buy the next week's privileges (youth typically earn 700–900 a week); allowance starts; unused points are banked by the foster parent; 12 weekly bonds at 50 points each to move up.
  - Level 3: daily minimum 120; privileges are automatic while the minimum is met; larger allowance; the youth keeps a budget book. [source: Foster Parent Manual pp. 22–37]
5. Write a privilege menu suited to the youth and level, for example phone or screen time, outings or later bedtimes [synthesis on specific items].
6. Review the chart weekly with PDR data and adjust it [source: Fisher & Gilliam p. 198].
Example language (illustrative), Team Leader to youth: "Every day you start fresh. Here's what earns points, here's what costs points, and here's what points buy. Your job is to get to 2,100 and move to Level 2."
Watch for:
- Charts so hard that the youth gives up.
- Charts so easy that points mean nothing.
- Earnings below the minimum several days running, which signals a design problem, not only a youth problem [synthesis].
TFCO-C: daily behaviour charts and routines with tangible rewards that cannot be lost once earned [source: ACF Clearinghouse].
TFCO-P: stickers and star charts with immediate reinforcers, kept for the whole placement [source: Fisher & Gilliam p. 198].

A5. Running the point system daily and the demotion rule (foster parent, coached by the Team Leader)

Purpose: Give consistent feedback many times a day.
Steps:
1. Award points as soon as possible after each expectation is met.
2. Take points calmly, in a neutral tone, with no lecturing or arguing.
3. Save teaching and problem-solving for calm moments, never during high emotion [source: Foster Parent Manual pp. 46–47].
4. On Level 2 or 3, a day below the minimum means the next day is a Level 1 day. The youth goes back up the following day if they earn the Level 1 minimum, and that Level 1 day's points do not count toward the weekly total [source: Foster Parent Manual p. 30].
5. Serious violations on Level 3 can mean demotion to Level 1 (a Team Leader decision) [source: Foster Parent Manual p. 37].
Example language (illustrative): "That's minus ten for swearing at your sister." (Then turn away or change the subject.) Later: "You only lost ten today, which is great. You earned a lot back with the dishes."
Watch for:
- Foster parents piling on extra losses in anger.
- Arguing about points.
- Points used as a threat ("if you don't…"). Coach these in the weekly group [synthesis].

A6. Encouragement and incentives

Purpose: Keep reinforcement dense and reward the behaviour you want to grow.
Steps:
1. Hold to a positive-to-corrective ratio of at least 5:1, aiming for 8:1.
2. Use four habits: watch for the behaviour, notice and reinforce it, model it yourself, and show interest in the youth.
3. Make praise specific, prompt and sincere, and do not wait for perfection.
4. Add incentives: activities (choosing a TV programme, having a friend over), parent time (walks, outings) and food choices (choosing dinner or dessert). [source: Foster Parent Manual pp. 19–21]
5. Special incentives for major progress are decided by the Team Leader [source: Foster Parent Manual p. 49].
Example language (illustrative): "You asked for help with that maths sheet instead of slamming the book. That's exactly it. Want to pick dessert tonight?"
Watch for: Praise that is general ("good job") or sarcastic, or praise that falls away once behaviour improves. In the foster parent group, ask carers to estimate their own ratio [synthesis].

A7. Clear requests and "minding"

Purpose: Make instructions easy to follow and easy to reinforce.
Steps:
1. Give one clear request.
2. Expect the youth to start within about 10–15 seconds.
3. Reinforce compliance.
4. Treat non-compliance through the point system rather than with repeated nagging.
5. Keep in mind that typical youths comply about 70% of the time, so expectations stay realistic. [source: Foster Parent Manual pp. 17–18]
Example language (illustrative): "Please put your shoes in the hall now." (Pause.) "Thanks, that's points for following instructions."
Watch for: Requests phrased as questions, strings of several requests at once, and repeating a request many times before following through.

A8. Daily evening review

Purpose: Close each day with feedback, keeping the relationship positive.
Steps:
1. One or both foster parents sit with the youth and go over the day's points and the school card.
2. Use a "sandwich": start with what went well, then the correction, then end on a positive.
3. Finish with the next day's privileges and plan. [source: Foster Parent Manual p. 47]
Example language (illustrative): "You got all your class initials today, brilliant. You lost points for the phone at dinner, so let's sort that tomorrow. And thanks for helping with the dog."
Watch for: The review turning into a lecture, or being skipped on bad days, which are exactly when it is needed.

A9. Additional consequences: work chores and privilege removal

Purpose: Respond to more serious rule-breaking beyond ordinary point loss, in a way that is still non-harsh.
Steps:
1. Only the Team Leader sets extra consequences. Foster parents may be asked for chore ideas and progress reports [source: Foster Parent Manual p. 49].
2. Pick short, specific work chores or a time-limited loss of a privilege.
3. Say when the consequence is over. For aftercare families of older youth, the recommended consequence is chores combined with privilege removal. For younger children it is time-out [source: Fisher & Gilliam p. 198].
4. The girls' programme adds random urine screens 1–3 times a week and room searches, with points or bonuses for clean tests and privilege loss, reduced privileges or chores for positive ones [source: Saldana & Buchanan 2010]. Risk flag: get clear consent from the youth and legal guardian and authority from the placing agency. Use searches proportionately, document them and protect the youth's dignity [synthesis].
Example language (illustrative), Team Leader: "Because you left school without permission, you'll do one hour of yard work on Saturday. When it's done, it's done, and we start fresh."
Watch for:
- Consequences that build up into long losses, which can feel harsh and lead to hopelessness and running away [synthesis].
- Foster parents inventing their own punishments.

A10. Supervision of whereabouts and peer contact

Purpose: Prevent deviant-peer association and give earned independence.
Steps:
1. Level 1: an adult supervises 1:1 at all times.
2. Levels 2 and 3: unsupervised time only when the activity, place, people and return time have been approved in advance [source: Foster Parent Manual pp. 23, 30, 37].
3. Check up afterwards [synthesis on the method].
4. Steer the youth toward prosocial activities such as sports and clubs, and away from known deviant peers [source: CEBC; Fisher & Gilliam p. 197].
Example language (illustrative): "You can go to the skate park with Sam from 4 to 6. I'll text at 5, and you're back by 6:15."
Watch for: Lying about whereabouts, and contact with former peers through phones or social media. Agree online monitoring rules with the Team Leader [synthesis].

A11. Parent Daily Report (PDR) call

Purpose: Monitor behaviour and carer stress every day, catch problems early and give data for decisions.
Steps:
1. The PDR Caller phones the foster parent every weekday from the first day of placement. CEBC specifies Monday–Friday, and Foundations says "daily".
2. Read the PDR checklist and ask whether each behaviour happened in the last 24 hours. The Foster Parent Manual describes yes/no answers. The OSLC presentation describes a 0/1/2 scale: did not occur, occurred but not stressful, occurred and stressful.
3. Keep the call to 5–10 minutes.
4. Enter the data in FOCUS PDR.
5. Flag high totals or high stress to the Team Leader for follow-up the same day. [source: Foster Parent Manual p. 13; Saldana & Buchanan 2010; Fisher & Gilliam p. 197; CEBC] [uncertain: the scoring format differs by version]
Example language (illustrative), caller: "Hi, it's Ana with the daily check-in. Since yesterday this time, any arguing? Any lying? Was either of those stressful for you?"
Watch for:
- Rising totals. In OSLC data, each problem behaviour per day above six raised the risk of placement disruption by about 25% [source: Saldana & Buchanan 2010].
- Patterns by time of day or setting, such as arguing before dinner.
- A carer who sounds worn out. Raise all of these at the weekly meeting.

A12. Weekly foster parent support and supervision group

Purpose: Supervise and support the foster parents, solve problems and keep the model consistent.
Steps:
1. Meet about 2 hours a week, with child care and food provided.
2. The Team Leader leads, co-led by the Foster Parent Consultant or Recruiter.
3. Go through each youth's PDR data for the week and point chart.
4. Each carer shares a success and a challenge.
5. The group solves problems together, and the Team Leader decides any changes to the programme.
6. Record the meeting on video for fidelity review. [source: Fisher & Gilliam pp. 197–198; CEBC]
Example language (illustrative): "Let's look at Jordan's PDR. Arguing is down from four days to one. What did you change? Can the others use that?"
Watch for:
- Groups that turn into complaint sessions without a plan.
- Missed attendance (which is a fidelity measure).
- A carer whose ratio has tipped negative. Follow up with a home visit or call [synthesis].

A13. 24/7 on-call crisis support and respite

Purpose: Stop placements breaking down and stop carers reacting harshly under stress.
Steps:
1. Have a Team Leader or team member reachable at all times [source: CEBC; Fisher & Gilliam p. 197].
2. Ask foster parents to call before a situation escalates, before changing any approach, and when the household changes (guests, emergencies, travel) [source: Foster Parent Manual p. 49].
3. Arrange regular respite [source: Foundations].
Example language (illustrative), on-call: "You did the right thing calling. Don't take more points right now. Give him space, keep him in sight, and I'll come by in 30 minutes."
Watch for: Carers who avoid calling because they fear being judged. Praise them for calling [synthesis].

Part B. Youth, school, family and team work

B1. Pre-placement orientation with the youth

Purpose: Explain the programme and its rules before the move, so the structure feels predictable rather than punitive.
Steps:
1. The case manager or Team Leader meets the youth before placement, for example in detention, and goes through the model [source: Blueprints].
2. Explain the levels, how points work and what is earned at each level [synthesis on content].
3. Explain what supervision looks like on Level 1.
4. Introduce who is on the team.
5. Present return home or to another permanent family as the shared goal.
Example language (illustrative): "For the first few weeks an adult will be with you all the time. That's how everyone starts, not a punishment. Most people move up in about three weeks, and then you get more freedom and home visits."
Watch for: The youth hearing the programme as a sentence. Link each part to the youth's own goals [synthesis].

B2. School card

Purpose: Get daily information from school and connect school behaviour to home points.
Steps:
1. The youth carries a card to every class.
2. Each teacher records attendance or tardiness, assignments and whether they were handed in, overdue homework (on the back), and behaviour as good or poor, then initials it.
3. The foster parent collects the card every day and turns the ratings into points.
4. If the youth "forgets" the card, the school is contacted, with the Team Leader and foster parent agreeing who does it. [source: Foster Parent Manual pp. 16, 27–28; Blueprints; Fisher & Gilliam p. 197]
Example language (illustrative), to a teacher: "It takes ten seconds: initial the box, tick good or poor behaviour, and note any missing homework. He earns points at home for every initial."
Watch for:
- Forged initials or lost cards. Verify with the teacher by phone or email [synthesis].
- Teachers who stop filling it in. Keep them engaged with brief thanks and feedback [synthesis].

B3. School consultation

Purpose: Make school a consistent part of the treatment environment.
Steps:
1. Staff consult teachers directly.
2. Attend school planning meetings.
3. Help put a positive behaviour support plan in place [source: Fisher & Gilliam p. 197].
4. Design interventions for school staff or work-placement staff to deliver, or deliver them to the child in school (TFCO-P) [source: Foundations TFCO-A, TFCO-P].
5. The Program Supervisor talks with teachers and coaches [source: Saldana & Buchanan 2010].
Example language (illustrative): "Can we agree one target for maths, such as starting work within two minutes, and reward it at home through the card?"
Watch for: Exclusions and suspensions, which take away structure and raise peer contact. Agree ahead of time on alternatives to exclusion and a plan for supervision during the day [synthesis].

B4. Individual therapy (youth therapist)

Purpose: Weekly 1-hour sessions. The therapist gives the youth support and advocacy, helps them adjust to placement, and teaches skills for getting on with adults and peers [source: Foster Parent Manual pp. 5–6; Blueprints; CEBC].
Steps:
1. Build a supportive alliance. The therapist is the youth's advocate in the team and is kept separate from discipline (the Team Leader is the disciplinarian) [source: Saldana & Buchanan 2010].
2. Set personal goals with the youth and review them weekly.
3. Carry out functional assessments of problem behaviours, for example triggers for substance use.
4. Teach and rehearse skills in role-play: problem-solving, refusal skills for peer pressure and drugs, and coping.
5. In the girls' adaptation, add: identifying social aggression and role-playing alternatives, emotion regulation and coping strategies, and motivational interviewing [source: Saldana & Buchanan 2010].
6. Pass skill targets to the skills coach and foster parent, so the skill is reinforced at home and in the community [synthesis on the hand-off mechanism].
- [uncertain: the session-by-session content of the Individual Therapy manual (2015) was not available]
Example language (illustrative): "Let's work out what happens just before you use. Where are you, who's there, and what are you feeling? Then we'll practise three ways to say no that you'd actually use."
Watch for:
- The youth using the therapist to bargain about points. Send those requests to the Team Leader, and tell the youth you will pass on their view.
- Disclosures of harm. Follow safeguarding procedures [synthesis].
- Progress shows as the youth using a rehearsed skill, reported on the PDR or the school card.

B5. Skills coaching

Purpose: About 1–2 hours a week in the community. The coach is a prosocial adult mentor who teaches problem-solving and social skills, and gets the youth into positive activities such as sports, hobbies and recreation, where the skills will be used [source: CEBC; Foundations; Blueprints; Fisher & Gilliam p. 198].
Steps:
1. Pick a real setting, such as a shop, a job enquiry, a sports club or the library.
2. Pre-teach one target skill, such as introducing yourself, asking for help or accepting no.
3. Model it, then let the youth practise in the setting.
4. Give immediate, specific feedback, including on positive talk.
5. Role-play coping and social skills [source: Saldana & Buchanan 2010].
6. Report back to the team.
7. Continue for up to 3 months after discharge [source: Foundations].
Example language (illustrative): "When we go in, you ask the coach about the try-out times. I'll stand back. Afterwards I'll tell you two things you did well and one to try next time."
Watch for:
- Sessions drifting into simple outings with no skill target.
- Contact with deviant peers in community settings.
- Progress shows as the youth joining activities independently, which is a Level 3 expectation [source: Fisher & Gilliam p. 198].

B6. Family therapy with the birth or aftercare family (Family Therapist / Birth Family Coach)

Purpose: Weekly 1-hour parent management training with the family the youth will go to, so they can provide the same supervision, encouragement, limits and follow-through. It also reduces family conflict [source: CEBC; Blueprints; Saldana & Buchanan 2010; Fisher & Gilliam p. 198].
Steps:
1. Engage the family early.
2. Present the placement as a partnership aimed at reunification [source: Foster Parent Manual p. 51].
3. Teach the OSLC parenting skills in turn [synthesis on order]:
  - Encouragement and incentives.
  - Clear requests.
  - Tracking behaviour.
  - Monitoring and supervision of whereabouts and peers.
  - Non-harsh limit-setting, with time-out for young children and chores plus privilege removal for adolescents [source: Fisher & Gilliam p. 198].
  - Problem-solving and communication.
  - De-escalation [source: ACF Clearinghouse TFCO-C].
4. Teach the family the youth's own point and level system so it can carry on at home.
5. Practise with role-play in session, set home practice, and review home-visit data [synthesis on format].
6. In the girls' programme, coach parents on reducing contact with negative peers and on supporting coping skills [source: Saldana & Buchanan 2010].
- [uncertain: the session sequence in the Family Therapy manual was not available]
Example language (illustrative): "This weekend, every time she does what you ask the first time, say so and tick the chart. If she argues, take the points calmly and walk away. We'll look at how it went on Monday."
Watch for: Parents who feel blamed, cancel sessions or reject reinforcement. It is working when parents run home visits using the system and PDR-style reports from visits stay low.

B7. Graduated home visits

Purpose: Let parents practise in real conditions and test readiness for return.
Steps:
1. Allow no home visits on Level 1 [source: Foster Parent Manual p. 23].
2. Start visits from Level 2 [source: Blueprints], or once the team judges youth and family ready (TFCO-C) [source: ACF Clearinghouse].
3. Begin short and supervised, then lengthen to overnights [synthesis].
4. Before each visit, agree the plan, rules and point tracking with the parents [synthesis].
5. Debrief with the family therapist and foster parent afterwards [synthesis].
Example language (illustrative): "For Saturday: home 10 to 4, Mum keeps the card, and you're in sight unless she agrees otherwise. Back here we'll go through it together."
Watch for: Rule-breaking or contact with old peers during visits, or tension when the youth comes back. Shorten visits and coach again rather than stopping them [synthesis].

B8. Psychiatric consultation

Purpose: Medication assessment and management for youth who need it, coordinated with the team so that management stays consistent [source: CEBC; Fisher & Gilliam p. 199].
Steps:
1. Refer to the consulting psychiatrist.
2. Share PDR and school-card data as measures of the youth's response.
3. Agree how the youth's medication will be supervised in the foster home and at school [synthesis].
Example language (illustrative): "We'll send the psychiatrist four weeks of daily report data so any medication change can be judged on real behaviour."
Watch for: Medication changes made outside the team, and medication used in place of the behavioural programme [synthesis].

B9. Weekly clinical team meeting and supervision

Purpose: Coordinate a single plan.
Steps:
1. The Team Leader chairs a weekly meeting.
2. Review each case's PDR trends, points, school card, therapy targets, skills coaching and family progress.
3. Adjust the point programme and plans.
4. Video-record the meeting for fidelity review [source: Foundations; CEBC].
5. The Team Leader gives each staff member weekly 1-hour skills-based supervision and has their own weekly fidelity consultation with the purveyor [source: Foundations].
Example language (illustrative): "PDR shows lying up on Mondays. Skills coach, can you rehearse honest reporting with him? Family therapist, let's check whether Sunday visits are the trigger."
Watch for: Staff giving the youth mixed messages, and roles blurring.

B10. Transition and aftercare

Purpose: Hold on to gains after discharge.
Steps:
1. Move the point and supervision system into the aftercare home.
2. Continue family therapy, with the Team Leader or family therapist supporting the move-on family, for at least 3 months [source: Foundations; ACF Clearinghouse].
3. Continue individual therapy and skills coaching for up to 3 months [source: Foundations].
4. In the original model, keep case managers on call and parent groups running for about a year [source: Blueprints].
5. Continue until the youth is stable in the home [source: Fisher & Gilliam p. 198].
Example language (illustrative): "The chart comes home with you. Dad will run it the way you've practised, and we'll keep calling and meeting for at least the next three months."
Watch for: The aftercare family dropping the system once things settle, and a return to old peers. Phase things out deliberately rather than stopping suddenly [synthesis].

B11. Therapeutic playgroup (TFCO-P only)

Purpose: A weekly playgroup of about 1.5–2 hours that builds school-readiness, social skills and self-regulation in children aged 3–6 [source: Foundations TFCO-P; CEBC TFCO-P].
Steps:
1. The Playgroup Leader prepares and runs the curriculum, with Playgroup Assistants [source: CEBC TFCO-P].
2. Target behaviour problems, emotion regulation and developmental delays [source: Fisher & Gilliam p. 200].
3. Use concrete, immediate reinforcement.
- [uncertain: curriculum content not published in the sources]
Example language (illustrative): "You waited for your turn with the blocks. That's a sticker!"
Watch for: Children overwhelmed by group size. Keep groups small and routines predictable [synthesis].

B12. Adolescent girls' adaptations

Purpose: Address risks the developers identified for girls in MTFC: social aggression, emotion regulation, sexual risk and substance use [source: Saldana & Buchanan 2010].
Steps:
1. The individual therapist works on social aggression, emotion regulation, goal-setting and motivational interviewing (see B4).
2. Teach decision-making, recognising coercion, and refusal skills around sexual risk. The developers used video vignettes and an activity called "Virtual Date".
3. Use substance-use monitoring as in A9.
4. The skills coach reinforces coping, positive talk and assertiveness.
5. The family therapist coaches supervision and support for coping.
- Some of these components come from the related middle-school prevention programme for girls in foster care, not the placement model itself [uncertain].
Example language (illustrative): "Let's replay that group chat. What could you send that keeps your friendship without joining in on her?"
Watch for: Relational aggression shown in school or online rather than at home. Ask about it directly [synthesis].

5. Handling problems

The published sources say little about handling problems beyond four things: proactive daily contact, 24/7 crisis support, Team Leader authority and continual adjustment of the programme [source: Fisher & Gilliam pp. 196–198; Foster Parent Manual p. 49]. The detailed protocols are in the restricted staff manuals. Anything below marked [synthesis] is our own guidance, consistent with the model's principles.

Youth stuck on Level 1 or repeatedly demoted.

Check the chart before blaming the youth. Are the minimums reachable? Are losses in proportion? Is the youth getting bonus points for small wins? The point economy is built so the youth can lose 10–20 points in a day without serious loss of privileges [source: Foster Parent Manual pp. 43–44].
Break hard expectations into smaller steps and add more bonus chances.
Ask the foster parent to raise praise toward the 8:1 goal.
Use the individual therapist to find out what the youth wants and link it to earned privileges. [synthesis]

Youth arguing, bargaining, or "not caring" about points (resistance).

Calm point loss without debate is the model's own answer [source: Foster Parent Manual pp. 46–47].
Refer complaints about the programme to the Team Leader at a set time, so that foster parents never negotiate in the moment.
Find out which privileges actually matter to the youth and revise the privilege menu.
Keep the individual therapist out of disputes about points so the alliance holds. [synthesis]

Escalation or aggression in the home.

The carer stops consequences during high emotion [source: Foster Parent Manual p. 47], keeps everyone safe, and calls on-call [source: CEBC].
Afterwards: give a Team Leader-set consequence (for example a chore), do a brief functional review in individual therapy, and update the plan. [synthesis]
If there is serious violence, use the agency's emergency procedures and emergency services. Report to the referring agency or court as the placement contract requires. [synthesis]

Running away / absconding. No protocol appears in the sources [uncertain]. Our suggested approach [synthesis]:

Agree a missing-person procedure with the placing agency and police before placement.
The foster parent reports to on-call at once.
On return: a safety and welfare check, a calm re-entry, and a Team Leader-set consequence. Usually this means restarting Level 1 supervision.
Explore the reasons in individual therapy: peers, family, fear, or hopelessness about the levels.
Running away was one of the trial outcomes the model reduced [source: Foundations TFCO-A], so repeated running away calls for a team review of the youth's fit and plan.

Foster parent strain, harshness or drift (placement-disruption risk).

Watch PDR totals. In OSLC data, each problem behaviour a day above six raised the risk of disruption by about 25% [source: Saldana & Buchanan 2010].
Respond the same day with extra calls, a home visit and respite [source: Foundations].
In the group, coach carers back toward reinforcement and away from piling on consequences.
The model expects high-challenge behaviour to pull adults toward harsh limits. Name that pull without blame [source: Saldana & Buchanan 2010].
If a carer repeatedly refuses to reinforce, reconsider the match [source: Fisher & Gilliam p. 197, by extension].

Non-adherence by foster parents (skipped PDR calls, missed groups, extra punishments).

Treat it as a fidelity issue. Attendance and PDR completion are measured [source: CEBC].
The Team Leader reviews it 1:1, solves practical barriers such as child care (which the group provides), and goes back over roles. [synthesis]

Birth family disengaged, hostile or unsafe.

Engage them as partners, since reunification is the stated goal [source: Foster Parent Manual p. 51].
Offer flexible times and home-based sessions [synthesis].
If reunification is not possible, the programme moves to supporting positive family relationships and finding another aftercare resource such as kin, adoptive parents or long-term foster care [source: Foster Parent Manual p. 51; CEBC TFCO-P]. Fisher & Gilliam (p. 198) note that some children stay with the foster family long-term.
Never send a youth home to a family where there are unresolved safeguarding concerns [synthesis].

Ruptures with the youth.

Keep the split between the therapist (advocate) and the Team Leader (disciplinarian) [source: Saldana & Buchanan 2010].
After a rupture with a foster parent, use the evening review "sandwich" and a deliberate rise in positive contact [source: Foster Parent Manual p. 47].
In individual therapy, acknowledge the youth's view and carry their requests to the team. [synthesis]

Trauma symptoms, depression or self-harm.

TFCO frames symptoms as skill deficits and is not a trauma-specific treatment [synthesis].
Screen at intake. Where needed, add a trauma-focused treatment such as TF-CBT, delivered by the individual therapist or alongside, coordinated through the team [synthesis].
For self-harm or suicide risk: follow standard risk assessment and safety planning, and do lethal-means counselling with the foster home (safe storage or removal of medicines and other means). Involve the consulting psychiatrist. Do not apply point losses to the self-harm behaviour itself [synthesis].

Substance use.

Use functional assessment and refusal-skills training (B4).
The girls' programme used random urine screens and room searches tied to points [source: Saldana & Buchanan 2010]. Only do this with proper legal authority and consent, documented and proportionate [synthesis].
Refer to specialist substance-use treatment where use is severe [synthesis].

School exclusion or refusal.

Use the school card plus direct consultation [source: Fisher & Gilliam p. 197].
Negotiate alternatives to exclusion in advance, and keep 1:1 supervision during any exclusion day [synthesis].

Sexualised behaviour, or allegations against carers.

Adapted versions have served youth with a history of sexual acting out, but Blueprints notes these adaptations are "not been as thoroughly tested".
Strengthen supervision and privacy rules (A3).
Follow the agency's safeguarding procedures for any allegation, which includes a carer being investigated [synthesis].

Cultural and contextual fit.

Adapt privileges, incentives, school arrangements and family-therapy examples to the family's culture and context, while keeping the core components intact.
Check with the purveyor before changing any structural element, because changes can affect certification. [synthesis]

Model-specific risk: the system becoming punitive.

Point and level systems can drift into control without reinforcement.
Audit charts for the ratio of points earned to points lost, check that demotions are always followed by quick re-earning, and watch for consequences that add up over time. The developers' own position is non-harsh, consistent limits inside a warm, reinforcing environment [source: CEBC; Fisher & Gilliam p. 197]. [synthesis on the auditing method]

Sources

Sources: