Together Facing the Challenge

Target Population

TFTC is designed for therapeutic foster parents who care for children with emotional or behavioral problems. 

Dosage

TFTC is typically offered over the course of seven sessions. Sessions typically last 2-hours and take place every 2 weeks, however session length and frequency can be tailored to fit the needs of agencies and/or foster parents. 

Location/Delivery Setting

Recommended Locations/Delivery Settings

Child welfare agency staff deliver TFTC in public child welfare agencies or community-based agencies. 

Location/Delivery Settings Observed in the Research

• Mental Health Center, Treatment Center, Therapist Office

Education, Certifications and Training

Child welfare agency staff have a master’s degree or a bachelor’s degree with at least 2 years of experience in the field. Staff must participate in a 3-day training workshop focused on how to train foster parents in TFTC. The workshop also covers effective instruction strategies for adult learners, supervision strategies, and fidelity to the TFTC model. 

Agency-wide follow-up consultation sessions with the developer are required monthly for at least 12 months. These sessions are intended to provide implementation support and coaching to agency staff and address fidelity problems. 

After implementing TFTC for at least 1 year, agencies can choose to undergo a formal certification process to be recognized as a TFTC-certified provider. Certification verifies the agency is implementing the program with fidelity and is valid for two years.

Program or Service Documentation

Book/Manual/Available documentation used for review

Murray, M., Farmer, E. M. Z., Burns, B. J., & Dorsey, S. (2017). Together Facing the Challenge: A therapeutic foster care resource toolkit: Train-the-trainer manual (3rd ed.) (K. L. Ballentine & R. Craven, Eds.). Duke University School of Medicine. 

Available languages

Manuals for TFTC are available in English and Spanish.

Other supporting materials

Foster Parent Training Manual Excerpt

For More Information

Website: https://omnifamilyinstitute.com/our-work/tftc/ 

Phone: 629-256-0443

Email: info@omnifamilyinstitute.com

Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.

Results of Search and Review	Number of Studies Identified and Reviewed for Together Facing the Challenge
Identified in Search	8
Eligible for Review	1
Rated High	1
Rated Moderate	0
Rated Low	0
Reviewed Only for Risk of Harm	0

Outcome	Effect Size	95% Confidence Interval	Implied Percentile Effect	N of Studies (Findings)	N of Participants	Summary of Findings
Child well-being: Behavioral and emotional functioning	0.17	[-0.11, 0.46]	6	1 (3)	192	Favorable: 1 No Effect: 2 Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention condition and a negative number favors the comparison condition. A range of comparison conditions, including no intervention, minimal intervention, placebo or attention, treatment as usual, and head-to-head comparison conditions are eligible for review (see Section 4.1.7 of the Handbook Version 2.0). Different types of comparison conditions may affect the magnitude of the effect sizes across studies. For example, an intervention compared to a no treatment comparison condition may produce a larger effect size than the same intervention compared to another intervention because the other intervention may itself be effective. The effect sizes shown may be derived from samples that overlap across studies. See the Individual Study Findings table for information about the specific comparison conditions used in each study and the Studies Reviewed section for information about any overlapping samples. The effect sizes presented here are provided for informational purposes only and are not used in determining a program or service rating.

Outcome	Effect Size	Implied Percentile Effect	Months after treatment when outcome measured	Number of Participants
Child well-being: Behavioral and emotional functioning
Study 11304 - Together Facing the Challenge vs. Treatment As Usual Therapeutic Foster Care (Farmer, 2010)
Parent Daily Report	0.38 *	14	11	192
Behavioral and Emotional Rating Scale: Strength Index	-0.02	0	11	192
Strengths and Difficulties Questionnaire: Total Difficulties	0.16	6	11	192

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention condition and a negative number favors the comparison condition. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Version 2.0, Sections 6.4 and 6.5 and may not align with effect sizes reported in individual publications. The Prevention Services Clearinghouse uses information reported in study documents and, when necessary, information provided by study authors in response to author queries to assign study ratings and calculate effect sizes (see Section 8.4.2 in the Handbook of Standards and Procedures, Version 2.0). The Prevention Services Clearinghouse typically relies on study-reported p-values to form the basis of the assessment of statistical significance for a finding, but will perform its own statistical test of a finding using any available information in study documents or author queries, as needed (see Section 6.3 in the Handbook of Standards and Procedures, Version 2.0). As a result, the effect sizes and statistical significance reported in the table may not align with the estimates as they are reported in study documents.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.

The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.

For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.

Characteristics of the Participants in the Studies with Moderate or High Ratings
Study Location	Study Year	Demographic Characteristics	Populations of Interest*	Household Socioeconomic Status
Study 11304 - Together Facing the Challenge vs. Treatment As Usual Therapeutic Foster Care
Characteristics of the Children and Youth
North Carolina, USA	2003	Average age: 13 years; Age range: 2-21 years 57% Black 34% White 10% Other 45% Female	100% Youth in treatment foster care	--
Characteristics of the Adults, Parents, or Caregivers
North Carolina, USA	2003	Average Parent Age: 48.5 years 74% Black 22% White 4% Other 90% Female	--	--

“--” indicates information not reported in the study.

* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings.

Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.

Studies Rated High

Study 11304

Farmer, E. M., Burns, B. J., Wagner, H. R., Murray, M., & Southerland, D. G. (2010). Enhancing "usual practice" treatment foster care: Findings from a randomized trial on improving youths' outcomes. Psychiatric Services, 61(6), 555-561. https://doi.org/10.1176/ps.2010.61.6.555

Murray, M. M., Southerland, D., Farmer, E. M., & Ballentine, K. (2010). Enhancing and adapting treatment foster care: Lessons learned in trying to change practice. Journal of Child and Family Studies, 19(4), 393-403. http://dx.doi.org/10.1007/s10826-009-9310-x

This study was conducted in a usual care or practice setting (Handbook Version 2.0, Section 7.2.2)

Studies Not Eligible for Review

Study 11306

Murray, M., Culver, T., Farmer, E., Jackson, L. A., & Rixon, B. (2014). From theory to practice: One agency’s experience with implementing an evidence-based model. Journal of Child and Family Studies, 23(5), 844-853. https://doi.org/10.1007/s10826-013-9738-x

This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)

Study 11307

Murray, M. E., Khoury, D. Y., Farmer, E. M., & Burns, B. J. (2018). Is more better? Examining whether enhanced consultation/coaching improves implementation. American Journal of Orthopsychiatry, 88(3), 376. https://doi.org/10.1037/ort0000296

This study is ineligible for review because it does not use an eligible comparison condition (Handbook Version 2.0, Section 4.1.7)

Study 11308

Nevada Division of Child & Family Services. (2019) Specialized foster care in Nevada: State fiscal year 2018. https://dcfs.nv.gov/uploadedFiles/dcfsnvgov/content/Tips/Reports/Evaluation_Report_Specialized_Foster_Care_SFY18_Final.pdf

This study is ineligible for review because it does not use an eligible comparison condition (Handbook Version 2.0, Section 4.1.7)

Study 11309

Southerland, D. G., Farmer, E. M., Murray, M. E., Stambaugh, L. F., & Rosenberg, R. D. (2018). Measuring fidelity of empirically‐supported treatment foster care: Preliminary psychometrics of the together facing the challenge—fidelity of implementation test (TFTC‐FIT). Child & Family Social Work, 23(2), 273-280. https://doi.org/10.1111/cfs.12415

This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)

Study 15250

Nevada Division of Child & Family Services. (2022). Specialized Foster Care in Nevada: State Fiscal Year 2021. https://www.leg.state.nv.us/Division/Research/Documents/RTTL_NRS424.043_2021.pdf

This study is ineligible for review because it does not use an eligible comparison condition (Handbook Version 2.0, Section 4.1.7)

Study 15249

Nevada Division of Child & Family Services. (2021). Specialized Foster Care in Nevada: State Fiscal Year 2020.

This study is ineligible for review because it does not use an eligible comparison condition (Handbook Version 2.0, Section 4.1.7)

Study 15248

Eisenberg, R. A., McCurdy, B. L., Rutherford, L. E., Stricker, L., & Dever, B. V. (2023). Evaluating the effectiveness of a training program for treatment foster parents in an urban community. Journal of Emotional and Behavioral Disorders, 31(4), 285-297. https://doi.org/10.1177/10634266221126472

This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)