Therapeutic Foster Care in a System of Care
(Subcontract PI: Chamberlain)
National Institute of Mental Health

This study builds on the findings from past research on Treatment Foster Care (TFC), one of the only evidence-based residential treatment options for youth with mental health disorders and severe aggression, to test methods for improving outcomes for adolescents in long-term TFC. Previous randomized trials of TFC in model programs show that it can promote a range of positive outcomes (e.g., decreased problems and arrests, increased prosocial behavior, and community tenure). This study takes this research a step further to examine the use, implementation, and outcomes of TFC in real world practice. We found that TFC, as is widely practiced in community agency settings, is often a relatively long-term treatment placement with an average placement length of 22 months. This contrasts sharply to the 6–9 month placements typical in the previously studied TFC programs. Factors that produce outcomes in longer-term placements appear to differ from those in short-term placements, and data suggest that several issues emerge during longer-term placements that require additional treatment foci to maximize the relevance and effectiveness of this approach. A group of agencies in North Carolina are collaborating with CR2P to implement and evaluate a model of treatment for the longer-term placements that are typical in real world settings. This study brings together the strengths of evidence-based TFC treatment with the realities of practice to examine an improved approach to meeting the needs of youth in long-term placements. Such information is crucial for maximizing the utility and effectiveness of TFC for some of the nation’s most difficult-to-treat youth.