Research
Sustaining Fidelity for 50 Years: Boys Town and the Teaching-Family Model
The use of evidence-based programs to improve the quality of residential care is not common, and, to the extent they are used, there is little evidence that those programs are used with fidelity. Fidelity is defined as the extent to which the essential components of an innovation are used in practice. Fidelity was used as the standard to assess progress of organization change and quality of youth services as the Teaching-Family Model was established at Father Flanagan’s Boys’ Home, Boys Town, Nebraska. The organization change process was initiated in 1975, fundamental changes were completed in 1979, and the new organization functions, roles, and structures were fully in place in 1984. The sustainability of the change is assessed after 50 years. The Implementation Quotient was used to track the progress of organization change from 1975 to 1984 and sustainability in 2025. Data from hundreds of Teaching-Family Model Fidelity Assessments (collected as part of the Teaching-Parent Certification process) documented the improvements in quality of care within years and across years from 1979 to 1984 and again in 2022–2024.
Effectiveness of the Teaching-Family Model
The Boys Town Family Home Program® has the same origins as the Teaching-Family Model (Phillips, Phillips, Fixsen, & Wolf, 1974), with adaptations over the years resulting from ongoing evaluation, research, and continuous quality improvement (Thompson & Daly, 2015). Over 500 articles have been published on Boys Town programs, including more than 80 papers about Boys Town’s adaptations of the Teaching-Family Model. More information can be found in Boys Town’s Research Bibliography.
Does Model Matter?
Within the relatively sparse literature on group homes, there is some evidence that some models of treatment may be associated with more positive outcomes for youth. This article, by Farmer, E. M. Z., Seifert, H., Wagner, H. R., Burns, B. J., and Murray, M., explores this possibility by examining differences across time for youth served in group homes utilizing the Teaching Family Model (TFM) and geographically proximate homes using more eclectic approaches. Journal of Emotional Behavioral Disorders, 2017 June, 119-128. Epub 2016 March.
This article (2017) proposes and examines a parsimonious framework for assessing quality in therapeutic residential care. Elizabeth M. Z. Farmer, PhD, Maureen L. Murray, MSW, LSCW, Kess Ballentine, MEd, Mary Elizabeth Rauktix, PhD, and Barbara J Burns, PhD utilize a synthesized conceptual framework that includes four potentially critical domains of quality: setting, staffing, safety, and treatment. Data from a recently completed quasi-experimental study of group homes were used to examine prevalence of various key indicators within each of these domains and to explore relationships between these indicators and youth-level outcomes. Beyond this most basic level, utilization of an evidence-informed model (in this case, the teaching family model) was associated with better outcomes. Journal of Emotional and Behavioral Disorders, Volume: 25 issue: 1, page(s): 28-36, March 1, 2017. Epub 2017, January 12.
Applying Lessons from the Teaching Family Model: Positive Behavioral Interventions and Supports (PBIS)
Positive Behavioral Interventions and Supports (PBIS) is one example of an approach that has benefitted directly from the Teaching-Family Model story. PBIS is a framework for establishing both school-wide behavior support and the individualized supports needed to make schools more effective, efficient, and equitable learning environments for all students (Horner, Sugai, & Anderson, 2010). Through the iterative process of implementation, evaluation, adaptation, and replication, PBIS has expanded to over 25,000 schools across the United States (Sugai, 2017). In this commentary, we describe how the vision provided bythe founders of the Teaching-Family Model have benefitted those of us trying to improve the social culture of schools.
Would We Know It If We Saw It? Assessing Quality of Care in Group Homes for Youth.
Data from a recently completed quasi-experimental study of group homes were used to examine prevalence of various key indicators within each of these domains and to explore relationships between these indicators and youth-level outcomes. Findings suggest that, among this sample of licensed homes in a southeastern state, licensure may be an initial indicator of baseline quality. Beyond this most basic level, utilization of an evidence-informed model (in this case, the teaching family model) was associated with better outcomes.
Teaching-Family Model In-Home Services
Families First has existing published research studies which together may meet the requirements for “well-supported” under the definition of FFPSA’s evidence-based criteria:
A randomized controlled study of Families First by Robert Lewis, PhD, in 1995 which shows several sustained effects at six months. Lewis, R. E. (2005). The effectiveness of Families First services: An experimental study. Children and Youth Services Review, 27, 499–509.
Replicating the Teaching-Family Model: In-Home Family Services Across Different Types of Service Settings
Teaching-Family Model (TFM) across different service settings, including child welfare, juvenile justice, diversion, and other prevention programs. Using administrative data (i.e. fidelity, service delivery and family outcomes) for Boys Town In-Home Family Services (BT-IHFS) from 2021 to 2023, results indicate consistent implementation across service settings, with minor adaptations in dosage for juvenile justice cases. Significant improvements from intake to case closure were observed in family functioning and parenting skills across all contracts, with large effect sizes in several domains. When comparing family outcomes at case closure using an analysis of covariance approach, families in “other prevention programs” reported higher family-functioning outcomes compared to the three other contract types. The study highlights the ability to implement BT-IHFS in diverse contexts and obtain consistent positive outcomes for families, emphasizing the importance of routine data collection for continuous improvement. Limitations include missing data and challenges in measuring parenting across different child age groups. Overall, the research provides strong evidence for the In-Home TFM’s adaptability and effectiveness, offering valuable insights for policymakers, practitioners, and researchers working to support families from child welfare, juvenile justice, diversion, and prevention program settings. Originally developed for a group care residential population, the Teaching-Family Model has been successfully adapted for family-based In-Home Services.
How the Teaching Family Model is transforming residential care in Victoria
TFM is evidence-based, with more than 40 years of research evidence. In 2019, accredited TFM agencies supported 51,747 people across 4 countries[1].
TFM practitioners provide children and young people with trauma-informed care in a family-style setting helping them to:
learn how to form healthy family relationships
improve their social skills
identify the main triggers that cause them stress
better manage their emotions.
All this means they’re better equipped to return safely to their families or to ongoing stable placements when they can’t live safely back home. It also means they have the chance to reach their full potential.
How we’re rolling out the model
Following our successful TFM pilot in 2017, we have:
transitioned 5 Therapeutic Residential Care homes to TFM, supporting up to 20 children and young people at any one time
provided 141 staff with intensive training in the model, including 106 TFM practitioners and 7 TFM consultants
embedded training modules designed and delivered by Berry Street’s Take Two clinicians for TFM practitioners, focusing on therapeutic principles and trauma-informed care.
“TFM staff have amazing skills and knowledge as to what their young people need to thrive and are always there to support and guide them” – professional working closely with TFM staff
We ultimately plan to transition all Therapeutic Residential Care units to TFM.
Fifty Years of the Teaching-Family Model at Boys Town: Keys to Sustainability
This review article is part of a special issue of Residential Treatment for Children and Youth celebrating the 50th anniversary of the Teaching-Family Model (TFM) at Father Flanagan’s Boys’ Home, Boys Town, Nebraska. The manuscript provides a historical account from experts of the TFM who initially created the organizational changes at Boys Town for the TFM to be used as intended and sustain for 50 years. Resources that were essential for the organizational changes included the technology of the TFM (i.e. administration, training, consultation, and evaluation systems), consumer orientation, feedback, and teaching skills. Additionally, the article describes five factors that have contributed to sustainability such as 1) using data effectively, 2) culture of success, 3) model expertise, 4) quality standards, and 5) research focus. The review concludes with implications for future practice and research.
The Teaching-Family Model: A Program Description and Its Effects on the Aggressive Behaviors and Quality of Life of Two Adults With Intellectual Disabilities
This article is a description of a program that may be effective for reducing the aggressive behaviors of adults with intellectual disabilities. Data are presented in the form of a naturally occurring multiple baseline across two participants. Results suggest that an intervention anchored in teaching-family model (TFM) procedures was effective to reduce the mean value of (a) physical aggression toward people or property and (b) verbal aggression. Quality-of-life data taken before and after participation in TFM indicated that quality of life improved for both participants. Social validity data indicated that parents, teachers, and employers were all highly satisfied with the program procedures and outcomes.
Comparing Outcomes for Youth in Treatment Foster Care and Family-style Group Care
As this brief overview suggests, Teaching-Family group care is quite different from the eclectic group care programs previously used in comparison studies with treatment foster care. Although the work of Chamberlain and colleagues has shown that a TFC model can outperform typical group care programs, this is the first study to compare a well-established and promising group care intervention with a treatment foster care model. In this study, both the group care and TFC programs have adopted the Teaching-Family approach. By holding the treatment model constant, differences in performance across the interventions can be more cleanly attributed to differences in the modality of the intervention (i.e. group or family care)..
Effective Organizational Change and Positive Social Impact via the Teaching-Family Model
Organizational Behavior Management (OBM) has widely demonstrated its utility for improving performance in organizations. Yet, OBM researchers and practitioners have called for developing more comprehensive and systemic approaches for creating long-term improvements and improving marketability. A successful program in ABA, called the Teaching-Family Model, may provide useful ideas for OBM. Lessons from the development of the Teaching-Family Model suggest that OBM may benefit from further research on the components of OBM programs to clarify those that are essential, identifying strategies to engage and coach leaders and sustain the program, and creating a supportive system to establish and maintain high fidelity use of the programs as they are scaled and disseminated. Ideas for next steps and future research are discussed.
The Teaching-Family Model is an elegant example of how effective practices can be implemented at a scale of significant social impact.
In recounting their journey through the development, replication, and diffusion of the Teaching-Family Model, Fixsen and Blase describe how effective and sustained change was achieved at scale. Their story affirms that the design of effective and supportive environments is possible and replicable, and we gain lessons on how to establish systems to improve quality of life in community, home, employment,...