What are the advantages of the development and implementation of Treatment/Therapeutic Foster Care?

Therapeutic foster care is considered the least restrictive form of out-of-home placements for children with severe emotional disorders. Care is delivered in private homes with specially trained foster parents. The programs are often funded jointly by child welfare and mental health agencies; however, some are funded solely by child welfare. Homes are strengthened and sustained through a number of outside supports available to treatment families and their children. These programs have lower costs than more restrictive programs because they do not rely on facilities and salaried staff. Parents of the foster children may also be included in the treatment and interventions that take place.

Therapeutic foster care serves a wide range of children with special needs and is often a transition from or alternative to more restrictive institutionalization, such as hospitals, residential treatment facilities, and juvenile detention. The range of children served by therapeutic foster care includes children with serious emotional disturbances (DSM IV diagnosis), children adjudged to be delinquent, substance-abusing children, mentally challenged children, physically disabled children, and children with severe medical problems.

While therapeutic foster care programs vary considerably, they share some common characteristics. Foster parents are given extensive required pre-service and in-service training to work with children with special needs. Homes are usually restricted to one or two children at a time. Foster parents are regarded as professionals and are paid higher stipends than foster parents in traditional foster care. Staff has very low caseloads so that the care coordinator and social worker are maximally availability to families and children, and additional resources and traditional mental health services are provided as needed. In addition, a psychiatrist and/or a psychologist assist with ongoing assessment and treatment.

There have been four efficacy studies of therapeutic foster care, each with randomized controlled designs. All four studies of treatment effectiveness showed that youths in therapeutic foster care made significant improvements in adjustment, self esteem, sense of identity, and aggressive behavior. In addition, gains were maintained for some time after leaving the therapeutic foster home. (Bogart, 1998; Hawkins et al., 1989; Chamberlain and Reid, 1991) Mental Health: A Report of the Surgeon General (1999) indicated that based on studies, "it is clear that therapeutic foster care produces better outcomes at lower costs than more restrictive types of placement. Furthermore, with the fairly recent development of standards for therapeutic foster care, as well as a standards review instrument (Foster Family-Based Treatment Association, 1995), services can be monitored for quality and fidelity to the therapeutic approach, making it easier to ascertain if the approach taken produces favorable outcomes.