Treatment Foster Care

Evidence Rating  
Evidence rating: Some Evidence

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Health Factors  
Date last updated

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 coordinators12, 3. TFC models and services vary by agency.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Reduced delinquent behavior

  • Improved youth behavior

  • Reduced incarceration

  • Increased foster care placement stability

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Reduced arrests

  • Improved social emotional skills

What does the research say about effectiveness?

There is some evidence that Treatment Foster Care (TFC) reduces problem behaviors, general delinquency, and days incarcerated for participating youth while increasing placement permanency4. 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 care5. Boys who have participated in TFC have fewer felony charges than peers in group home care6. TFC may improve daily life functioning for youth with emotional or behavioral problems2.

Enhanced TFC, which includes intense behavioral modification training for foster parents and staff, can improve outcomes more than traditional TFC7. 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 skills8.

How could this strategy impact health disparities? This strategy is rated 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 Oregon9, Specialized Therapeutic Foster Care10, Pressley Ridge Treatment Foster Care11, and Together Facing the Challenge122.

Implementation Resources

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


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1 SAMHSA-TFC 2013 - Substance Abuse and Mental Health Services Administration (SAMHSA). What does the research tell us about services for children in therapeutic/treatment foster care (TFC) with behavioral health issues?: Report of the SAMHSA, CMS and ACYF Technical Expert Panel, September 27–28, 2012. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration; 2013.

2 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.

3 CINAHL-Teska 2015 - Teska J. A quick lesson about therapeutic foster care: Child welfare. Glendale, CA: CINAHL Information Systems; 2015.

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

5 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.

6 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.

7 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.

8 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.

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

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

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

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