Treatment Foster Care: Family-Based Care for Children with Severe Needs

Therapeutic Foster Care (TFC, also called Treatment Foster Care) is an intensive treatment-focused form of foster care provided in a family setting by trained caregivers. Under contract to ASPE, RTI and Chapin Hall have produced research products about states’ use of TFC. Given new federal restrictions on congregate care provided under the federal IV-E Foster Care Program enacted in the Family First Prevention Services Act of 2018, many states are looking to TFC as a family based alternative that can meet the needs of children with significant emotional and behavioral problems.

The following reports are available from this study:

  1. Challenges and Opportunities in Treatment Foster Care. This short research summary highlights key findings from an ASPE study seeking to understand how states currently use treatment foster care to serve youth with serious emotional and behavioral disorders in the least restrictive possible setting. It presents highlights from all study components.

  2. State Practices in Treatment/Therapeutic Foster Care. Treatment foster care (TFC; sometimes known as therapeutic foster care) is a family-based placement option for children with serious emotional, behavioral, or medical needs who can be served in the community with intensive support. This report describes how TFC is implemented and supported by states. It provides an overview of the key program elements of TFC defined by states and how states differentiate TFC from traditional foster care. The report also provides a description of how states provide adjunct services, such as case management and behavioral health services, to children in TFC. Finally, the report includes information on the different funding strategies employed by states to support TFC services. Interviews with state officials and key stakeholders revealed that there is significant variation among state TFC programs. Although rigorously evaluated models have demonstrated positive outcomes in mental health, behavioral health, and delinquency, most state TFC programs do not use the evidence based models in their entirety but instead select and adapt elements of them, defining required components within agency regulations and contract specifications. The report’s appendix provides detailed profiles of 6 states’ TFC programs, in Connecticut, Illinois, New York, North Carolina, North Dakota, and Tennessee.

  3. Patterns of Treatment/Therapeutic Foster Care and Congregate Care Placements in Three States. This report examines the characteristics and care trajectories of children in Illinois, New York, and Tennessee who receive TFC services compared with those receiving congregate care, traditional, non-kinship foster care, and kinship foster care. Additionally, this study seeks to understand whether TFC serves a similar population as congregate care and thus could help states meet the new requirements of the federal government to reduce congregate care placements, as outlined in the Family First Prevention Services Act.

  4. Research Brief: Patterns of TFC and Congregate Care Placements in Three States. This is a shorter paper highlighting primary findings of the longer report described in #3 above.