Treatment Foster Care

Treatment or Therapeutic Foster Care (TFC) provides a foster family-based intervention that is structured, nurturing, individualized, and therapeutic to youth with mental, social, emotional, and behavioral challenges. TFC offers a less restrictive environment than residential care or juvenile justice settings. Core components of TFC include specialized training and routine support for foster parents, treatment services and supervision for youth by foster parents, and agency caseworkers who serve as consultants and service coordinators (SAMHSA-TFC 2013, CINAHL-Teska 2015). TFC models and services vary by agency.

Expected Beneficial Outcomes (Rated)

  • Reduced delinquent behavior

  • Improved youth behavior

  • Reduced incarceration

  • Increased foster care placement stability

Other Potential Beneficial Outcomes

  • Reduced arrests

  • Improved social emotional skills

Evidence of Effectiveness

There is some evidence that Treatment Foster Care (TFC) reduces problem behaviors, general delinquency, and days incarcerated for participating youth while increasing placement permanency (Campbell-MacDonald 2008). However, additional evidence is needed to confirm effects.

TFC can also reduce the likelihood of arrest among youth with emotional or behavioral problems compared to peers in group home care (). Boys who have participated in TFC have fewer felony charges than peers in group home care (). TFC may improve daily life functioning for youth with emotional or behavioral problems ().

Enhanced TFC, which includes intense behavioral modification training for foster parents and staff, can improve outcomes more than traditional TFC (Farmer 2010a). Researchers also recommend enhancing TFC with routine check-ins to address problems before they worsen, and training staff regularly and foster parents over several weeks so that trainees can practice their skills ().

Impact on Disparities

No impact on disparities likely

Implementation Examples

Treatment or Therapeutic Foster Care is practiced in at least 2000 locations through various models including Treatment Foster Care Oregon (TFCO), Specialized Therapeutic Foster Care (STFC), Pressley Ridge Treatment Foster Care (PR-TFC), and Together Facing the Challenge (TFTC) ().

Implementation Resources

US DHHS-TFC - US Department of Health and Human Services (US DHHS). Child Welfare Information Gateway. Treatment foster care (TFC).

Citations - Evidence

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Murray 2010* - Murray MM, Southerland D, Farmer EM, Ballentine K. Enhancing and adapting treatment foster care: Lessons learned in trying to change practice. Journal of Child and Family Studies. 2010;19(4):393–403.

Campbell-MacDonald 2008 - MacDonald GM, Turner W. Treatment foster care for improving outcomes in children and young people. Campbell Systematic Reviews. 2008:9.

Robst 2011* - Robst J, Armstrong M, Dollard N. Comparing outcomes for youth served in treatment foster care and treatment group care. Journal of Child and Family Studies. 2011;20(5):696–705.

Farmer 2010a - Farmer EMZ, Burns BJ, Wagner HR, Murray M, Southerland DG. Enhancing “usual practice” treatment foster care: Findings from a randomized trial on improving youths’ outcomes. Psychiatric Services. 2010;61(6):555–61.

Bishop-Fitzpatrick 2015* - Bishop-Fitzpatrick L, Jung N, Nam I, Trunzo AC, Rauktis ME. Outcomes of an agency-developed treatment foster care model for adolescents. Journal of Emotional and Behavioral Disorders. 2015;23(3):156–166.

Robst 2013* - Robst J, Armstrong M, Dollard N, Rohrer L. Arrests among youth after out-of-home mental health treatment: Comparisons across community and residential treatment settings. Criminal Behaviour and Mental Health. 2013;23(3):162–176.

Citations - Implementation Examples

* Journal subscription may be required for access.

TFCO - TFC Consultants, Inc. Treatment Foster Care Oregon (TFCO).

Bishop-Fitzpatrick 2015* - Bishop-Fitzpatrick L, Jung N, Nam I, Trunzo AC, Rauktis ME. Outcomes of an agency-developed treatment foster care model for adolescents. Journal of Emotional and Behavioral Disorders. 2015;23(3):156–166.

STFC - Daniel: Improving the odds for kids. Specialized Therapeutic Foster Care (STFC).

PR-TFC - Pressley Ridge. Pressley Ridge Treatment Foster Care (PR-TFC).

TFTC - Duke University School of Medicine, Services effectiveness research program. Together Facing the Challenge (TFTC).

Date Last Updated

Sep 2, 2016