Enhancing "usual practice" treatment foster care: findings from a randomized trial on improving youths' outcomes.

OBJECTIVES This article reports the initial findings from a randomized trial to enhance treatment foster care (TFC) in "usual care" agencies. The intervention, Together Facing the Challenge, was built on a combination of practice-based elements from a prior descriptive study of TFC and selected elements from Chamberlain's evidence-based model (multidimensional treatment foster care) to fill conspicuous gaps in usual practice. The study was designed to examine whether additional training and consultation to staff and treatment foster parents improved outcomes for youths. METHODS The study was conducted with 247 youths in TFC and their treatment parents from 14 TFC agencies in a southeastern state in 2003-2008. Half of the agencies were randomly assigned to the intervention condition and received study-provided training and consultation. Agencies in the control group continued to provide training and treatment as usual. Data for the analyses presented here were from interviews with treatment parents at baseline, six months, and 12 months. RESULTS Compared with youths in the control group, youths in the intervention group showed improvement on the three focal domains--symptoms, behaviors, and strengths. Effects were significant for all outcomes at six months. Effects for behaviors remained significant by 12 months. CONCLUSIONS This study employed a hybrid model to improve practice. It built on current practices in existing agencies and infused additional training and consultation to overcome observed deficits. Such an approach has tremendous potential for moving beyond a singular focus on disseminating evidence-based interventions to a broader view of improving practice in a wide range of agencies.