Treatment Foster Care for improving outcomes in children and young people

  • Review
  • Intervention

Authors


Abstract

Background

Treatment foster care (TFC) is a foster family-based intervention that aims to provide young people (and, where appropriate, their families) with a tailored programme designed to effect positive changes in their lives. TFC was designed specifically to cater for the needs of children whose difficulties or circumstances place them at risk of multiple placements and/or more restrictive placements such as hospital or secure residential or youth justice settings.

Objectives

To assess the impact of TFC on psychosocial and behavioural outcomes, delinquency, placement stability, and discharge status for children and adolescents who require out-of-home placement.

Search methods

We searched the Cochrane Controlled Trials Register (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to January 2007), CINAHL (1982 to December 2006), PsycINFO (1872 to January 2007), ASSIA (1987 to January 2007), LILACS (1982 to January 2007), ERIC (1966 to January 2007), Sociological Abstracts (1963 to January 2007), and the National Research Register 2006 (Issue 4).

Selection criteria

Included studies were randomised controlled trials investigating the effectiveness of TFC with children and young people up to the age of 18 who, for reasons of severe medical, social, psychological and behavioural problems, were placed in out of home care in restrictive settings (e.g. secure residential care, psychiatric hospital) or at risk of placement in such settings.

Data collection and analysis

Titles and abstracts identified in the search were independently assessed for eligibility by the two authors (GM and WT) who also extracted and entered into REVMAN. Date were synthesised on the few occasions where this was possible. Results are presented in tabular, graphical (forest plots) and textual form.

Main results

Five studies including 390 participants were included in this review. Data suggest that treatment foster care may be a useful intervention for children and young people with complex emotional, psychological and behavioural need, who are at risk of placements in non-family settings that restrict their liberty and opportunities for social inclusion.

Authors' conclusions

Although the inclusion criteria for this systematic review set a study design threshold higher than that of previous reviews, the results mirror those of earlier reviews but also highlights the tendency of the perceived effectiveness of popular interventions to outstrip their evidence base. Whilst the results of individual studies generally indicate that TFC is a promising intervention for children and youth experiencing mental health problems, behavioural problems or problems of delinquency, the evidence base is less robust than that usually reported.

摘要

背景

為增進孩童及年輕人之預後的治療性領養照護

治療性領養照設 (Treatment foster care, TFC) 是以領養家庭為主的介入方式,目標是要提供年輕人 (更適切地說是他們的家庭) 一個適合的計畫,可以對他們生活有正向的改變。TFC的設計特別是為了滿足孩童的需要,那些孩童的困難或環境會讓他們比較容易經歷多處安置,而且/或是被安置在較侷限的地方,例如醫院、安全居所或是少年法院安置。

目標

評估TFC在心理社會及行為結果、少年犯罪、安置穩定度等方面的影響,以及對那些需要離家安置的孩子與青少年來說,離家後的狀態。

搜尋策略

我們搜尋了the Cochrane Controlled Trials Register (CENTRAL) (2006年Issue 4), MEDLINE (1966年至2007年1月), CINAHL (1982年至2006年12月), PsycINFO (1872年至2007年1月), ASSIA (1987年至2007年1月), LILACS (1982年至2007年1月), ERIC (1966年至2007年1月), Sociological Abstracts (1963年至2007年1月) 以及the National Research Register (2006年Issue 4) 等資料庫。

選擇標準

包括的研究是隨機控制試驗,在研究TFC對孩子及十八歲以下的年輕人的效果,這些孩子有著各種嚴重的醫學、社會、心理及行為問題,包括被安置在離開家庭的受限的環境中 (也就是安全的居住照護、精神科醫院) 或是有著有可能有被安置在這些環境中的風險。

資料收集與分析

搜尋的標題及摘要是獨立地被兩位作者 (GM and WT) 評估認為是合格的,兩位作者將之摘錄並進入REVMAN。並整理日期。結果用表格、圖表 (樹狀圖) 及文字的方式表現出來。

主要結論

這篇回顧文獻總共5個研究,共包括了390位受試者。資料顯示治療性的領養照護對於某些孩童及年輕人是有用的介入方式,那些孩子是有著複雜的情緒、心理及行為需要及有處於被安置於非家庭的環境的風險中,而在和社會接觸的自由與機會上受到侷限。

作者結論

雖然在這個系統性回顧中所包括的準則將研究設計的門檻設得比之前回顧文獻來得高,結果和之前的回顧相似,但是也突顯了公眾介入治療所帶來的效果比起証據所顯示的來得大之傾向。雖然個別之研究的結果顯示TFC對於經驗到心智健康問題、行為問題或犯罪問題的孩子及年輕人來說是有種有效的治療介入方式,但是支持此結果的証據仍顯不足。

翻譯人

本摘要由成功大學附設醫院謝佩君翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

治療性領養照護 (TFC) 是以領養家庭為主的一種介入方式,目標在提供年輕人 (在某些時候也包括他們的家庭) 一種個人化指導的課程,這課程的設計是要幫助帶給他們生活正向的改變。TFC被設計來幫助孩子們,而這些孩子們有著困難或某些情境會讓他們處於多項安置的風險,以及/或是被安置在限制的環境中,例如醫院或安全居住環境或是少年司法機構中。這個回顧研究可以評估治療性領養照護對於孩子和年輕人在環境中的影響,包括了心理社會和行為的結果、違法行為、居所的穩定以及出院的狀況。五個研究符合納入準則。所有的研究都在美國執行。有四個研究著重於年輕的違法或是有著各樣行為問題的孩子。第五個研究檢視了TFC在州立精神科醫院對年輕人的有效性。結果發現TFC或許是個有用的介入模式,來幫助這些通常難以安置的孩童及年輕人維持在家庭環境當中。結果也發現了一些臨床上有意義的降少比率:包括反社會行為、孩童及年輕人離開安置地方的天數、犯罪案件轉介的數量以及處於被限制環境的時間。有一些証據顯示在治療性照護下的年輕人在長期看來花較多的時間在治療上以及在家庭中。檢視教育和職業的結果,顯示在各方面的進步,包括就學、完成家事以及投入職場工作。然而,研究的普同性是受到限制的。被包括的研究總數很小,同時參與者的性質是混雜的。這個証據或許會有一些主觀的偏見,是來自於在研究團隊中的計畫發展者是負責所有被包含在內的研究。以這個回顧研究為根基來說,關於所花費的和所得到的益處來說,沒有什麼是相對昂貴的服務。更進一步,不可能去直說TFC跟其他相對的介入比較來看是比較有效的。未來的研究需要以著獨立的研究團隊重覆這項研究,才能來測試這個研究結果的普同性。研究需要在不同的地點被執行,以著不同群的年輕人、不同年齡和更多種類的族群、一個較清楚被定義的問概況 (例如心理疾患、違法行為) ,以及比兩年更長的追蹤時間。

Plain language summary

Research suggests that Treatment Foster Care can help youth with behaviour problems. More research needed

Treatment foster care (TFC) is a foster family-based intervention that aims to provide young people (and, where appropriate, their families) with an individually tailored programme designed to help bring about positive changes in their lives. TFC was designed to help children whose difficulties or circumstances place them at risk of multiple placements and/or more restrictive placements such as hospital or secure residential or youth justice settings. This review set out to assess the impact of Treatment Foster Care on a range of outcomes for children and young people in such circumstances, including psychosocial and behavioural outcomes, delinquency, placement stability, and discharge status. Five studies were identified that met the inclusion criteria. All were conducted in the USA. Four focussed on young delinquents or children with a range of behaviour problems. The fifth examined the effectiveness of TFC for young people in a state mental hospital. Findings indicate that TFC care may be a useful intervention to help place these usually hard to place children and young people in family settings. Results indicate some clinically meaningful decreases in: antisocial behaviour, the number of days children and young people running away from placement; the number of criminal referrals and the time spent in locked settings. There is some evidence that young people in Treatment Foster Care spent more time in treatment over the long-term and more time at home. Examination of educational and employment outcomes showed improvements in school attendance, homework completion and finding work.

However, the generalisability of findings is limited. The total number of included studies was small and the profile of participants quite mixed. The evidence may be subject to bias given the involvement of programme developers in the research teams responsible for all included studies. On the basis of this review, nothing can be said about the costs and benefits of what is a relatively costly service. Furthermore, it is not possible to make statements about TFC effectiveness vis-a-vis other composite interventions.

Future research should seek to test the generalisability of findings from these studies by replicating the studies using independent research teams. Studies need to be conducted in different locations, with different groups of young people, of different ages and more diverse ethnicity, and with a range of clearly specified problem profiles (e.g. psychological disorders; delinquency), and with follow-up periods longer than two years.

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