Author
TURNER William; MACDONALD Geraldine;
Title
Treatment foster care for improving outcomes in children and young people: a systematic review.
Journal citation/publication details
Research on Social Work Practice, 21(5), September 2011, pp.501-527.
Summary
The evidence for this systematic review on the effectiveness of treatment foster care programmes came from five intervention studies set in the USA, each carried out by the programme developers. The limited evidence indicates that treatment foster care may be an alternative to restrictive placements, especially for young people with conduct disorders and delinquency, but further research is required.
Context
Treatment foster care is a family-based intervention that is individually tailored to the needs of children whose difficulties put them at risk of multiple placements and more restrictive placements. Early studies suggest that treatment foster care can: offer an alternative to restrictive placements such as correctional institutions, result in positive changes in self esteem, and reduce the likelihood of progression to institutionalisation. They can also be less costly than the alternatives. The aim of this systematic review was to ‘assess the impact of TFC (treatment foster care) on psychological and behavioural outcomes, delinquency, placement stability, and discharge status for children and adolescents who require out-of-home placement’.
Methods
What sources were searched?
The following electronic databases, all from the USA, were searched from the date of inception to December 2006 or January 2007: Medline, CINAHL, PsycINFO, LILACS, ERIC, Sociological Abstracts, and the Cochrane Central Register of Controlled Trials. Issue 4 of the National Research Register was also searched. The bibliographies of related reviews and the reference lists of the relevant papers identified were hand searched, and experts in the field were contacted for additional information. An internet search was conducted on the names of key authors.
What search terms/strategies were used?
There is no information on the search terms used or of specific search strategies employed. Language restrictions were not applied.
What criteria were used to decide on which studies to include?
Randomised and quasi-randomised controlled trials of treatment foster care programmes in young people aged up to 18 years were eligible for inclusion. Treatment foster care, also known as ‘wraparound’ or ‘multidimensional’ foster care, was defined according to nine key criteria described by Snodgrass, 1989, which are presented in the text. Outcomes could include child outcomes, foster caregiver outcomes, agency outcomes, or costs. Child outcome measures could include: behavioural measures such as aggression, truancy, delinquency, substance abuse, or prescribed medication use; psychological functioning; educational outcomes; interpersonal functioning; mental health status, or; physical health status.
Who decided on their relevance and quality?
Study selection was carried out by the two authors working independently. Disagreements were resolved through discussion. Methodological quality was assessed based on seven factors likely to introduce bias, and is reported for each study in Table 1.
How many studies were included and where were they from?
A total of 632 articles were identified from the searches; 31 studies underwent further analysis. Five studies, reported in ten papers, were eventually included in the review. All of the studies were set in the USA.
How were the study findings combined?
Data was extracted onto standardised forms by the two authors, with no disagreements. Study authors were contacted for further information or clarification, as required. Effect sizes were calculated and reported as standardised mean differences. Random effects meta-analyses were carried out where possible. Outcomes are presented separately for each of the four main groupings mentioned above.
Findings of the review
There were two studies of less intensive programmes with abused and/or neglected children, one multicomponent programme with delinquent boys, and another with girls, and a multicomponent programme with children discharged from psychiatric hospitals. The quality of the evidence, overall, was judged to be fair, but reporting was generally poor. Evidence on intervention effects on the range of outcomes reported were mixed and often limited to data from only one or two studies.
Two studies provided sufficient data for meta-analysis on five outcomes. Combined data on the effect of treatment foster care on the number of days in locked settings suggest a moderate beneficial effect at 12-month follow-up and a large effect after 24 months. There were also moderate beneficial effects on the number of criminal referral rates after 12 months and again at 24 months. The results on self-reported delinquency indicated a small beneficial effect that was not significant.
Authors' conclusions
‘Although the numbers of studies are relatively few, diverse, and small scale, the evidence suggests that TFC (treatment foster care) is a promising social intervention for children and young people at risk of placement in settings that restrict their liberty and who are at risk of adverse outcomes. This holds for a range of children and youth with behavioural and emotional disorders, but particularly those with conduct disorders.’
Implications for policy or practice
Although implications for practice are discussed, such as the need to address emotional and psychiatric conditions for girls, and targeted selection, training and support for foster caregivers, they are based on inconclusive evidence.