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, 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.
Link to original source (journal subscription may be required for access)Bishop-Fitzpatrick 2015, CINAHL-Teska 2015). TFC models and services vary by agency.
Expected Beneficial Outcomes (Rated)
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Reduced delinquent behavior
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Improved youth behavior
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Reduced incarceration
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Increased foster care placement stability
Other Potential Beneficial Outcomes
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Reduced arrests
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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 (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.
Link to original source (journal subscription may be required for access)Robst 2013). Boys who have participated in TFC have fewer felony charges than peers in group home care (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.
Link to original source (journal subscription may be required for access)Robst 2011). TFC may improve daily life functioning for youth with emotional or behavioral problems (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.
Link to original source (journal subscription may be required for access)Bishop-Fitzpatrick 2015).
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 (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.
Link to original source (journal subscription may be required for access)Murray 2010).
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) (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.
Link to original source (journal subscription may be required for access)Bishop-Fitzpatrick 2015).
Implementation Resources
US DHHS-TFC - US Department of Health and Human Services (US DHHS). Child Welfare Information Gateway. Treatment foster care (TFC).
Citations - Evidence
* Journal subscription may be required for access.
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
- Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
- 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.
- Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
- Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
- Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
- Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results.