Social workers in agencies and school settings often deal with high risk, multi problem children such as those in foster care. Increasingly, there is widespread recognition that a coordinated, multifaceted approach is required to address the range of cognitive, social, and mental health problems with which they present. This article recommends utilization of an ecological treatment intervention that is specifically tailored to the needs of the child based on a formulation of the child's experience and developmental deficits. A case example comprising the treatment of an eight-year-old boy in foster care with comorbid diagnoses of alcohol related neurodevelpomental disorder, failure to thrive, and attachment disorder, illustrates this approach. The article concludes with implications for social work practice.