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Treatment Foster Care

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As the level of juvenile delinquency rises, most communities have become more concerned with the development of effective strategies that can deal with the problem. The community is always on the receiving end from such activities.    At the same time, the whole society is concerned with the future development path of youths since locking them up in jails means that they will be disrupted from continuing with their studies making their future bleak and prone to crime. Therefore most communities have resulted to positivism approach in which different rehabilitative measures are taken in order to reduced the level of crime and at the same time reduce the vulnerability to crime. The key issue in juvenile delinquency is to protect the community from the acts of crime perpetrated by youths and at the same time offer rehabilitative services that changes the youths. Research has clearly documented that incarceration of juvenile offenders is just an option but it does not offer a complete reprieve to juvenile crime.  However, incarceration is disruptive to the whole community and costly for the government.  It may have a negative long term effect on the youth and in most cases, it leads to increased incarceration in their adulthood.

It has therefore become important to find alternatives to incarceration. The alternative to incarceration has been administrative rehabilitative care to the youths. The most practical been placing youths in group care settings where they interact with other youths with similar history of deliquesce.  This is usually the last step taken in most states before the youths are incarcerated. However, research has also shown negative effect of treatment foster care. There is evidence which supports that increased association with delinquent peers projects a delinquent growth path for most youths.  This leads to development of aggressive behaviors and escalation of delinquent behaviors over a period of time.  Treatment foster care has developed over time to become a leading option for most communities to deal with juvenile delinquency. Although criticized in a number of studies, treatment foster care   has been effective in reducing juvenile delinquency.

In this paper we are going to review the history of treatment foster care to understand how it has developed over time. We will also review the current models that are used. The paper will look at components for training treatment foster parents in order to understand the most effective strategies that can be used to improve the model.

History of Treatment foster care

Currently it is estimated that there are more than 500,000 children who are under foster care in the United States.   Due to the rising case of juvenile delinquency, treatment foster care has become an option for many families.  Since 1960s, treatment foster care has been considered as an option for treatment of children who have juvenile delinquency problems.

The main factor behind the development of treatment foster care is the high rates of juvenile delinquency.  Juvenile violence is one of the major problems facing the American society. Since 1970s, juveniles who are aged 10 to 17 years and constituting 12% of the total population have shown increased committed of various crimes and approximately 25% of all serious crimes every year are committed by juveniles.  There are a number of factors which have been identified as high risk factors for juvenile crimes including low socio-economic factors, lack of parental supervision, erratic discipline, association with delinquent peers, and man others. Most of the treatment foster care program aims at correcting some of these high risk factors to ensure that youths have increased opportunity for a health growth environment. (Turner, 2008)

Treatment Foster Care came into being around 1970s owing to a number of factors that were associated with rising cases of juvenile delinquency.  The program was developed in order to provide a safe, stable, and a nurturing environment for children who require complex physical and mental corrections.

Over the years, juvenile violence has become a problem in most neighborhoods in the country.  For example in 2001, approximately 1.87 million crimes committed by juveniles were reported.   This represented a rate of 5.7 crimes per every individual in this age group.  This rate was the highest for any other age group in the country.  Two thirds of these crimes were less serious which means they were simple assaults resulting to attacks without a weapon (Chamberlain, 1994). However a third of these crimes were serious crimes including aggravated assaults, robbery with violence, rapes, and many other which require a harsh punishment. Research estimates that these figures could be higher since some of the serious crimes which are committed by juveniles against their relatives may go unreported.

More than 80% of children who are placed under foster care shows a history of maltreatment which ranges from physical abuse to sexual abuse.  Research has also shown that majority of parents of abused children  have  history of substance abuse, exposure to violence, high level of poverty, psychiatric disorders, and many other factors which predispose children to increased risk of incarceration. Parental risk factors and maltreatment of children presents an array of adverse child experience (ACE) which place the child an increased risk of physical and mental risks (Royes, 2006).

The rising rate of juvenile crimes and the desire for the society to leave the world to a better generation are among the factors that eventually led to the establishment of the treatment foster care (Turner, 2008). Treatment foster care is designed in line with correcting the juveniles not by punishment but through counseling and other activities that take into consideration correction rather and punitive means.  Therefore over the time, these programs have undergone several changes to align them with the aim of correcting the youths rather than punishing them.

Therapeutic foster care is also known by many other names although these programs have the same objective of rehabilitating the youths.   It many include multidimensional treatment foster care, specialist foster care, family based treatment care, parent-therapist programs, and many others.  These programs provide alternative care to incarceration or hospitalization for children who are disturbed emotionally or adolescent who have shown history of antisocial behavior.  However the program may also be directed to address a number of other deficiencies which affects the youths and the whole community in general. (Price et al., 2008)

Treatment foster care is a family based treatment program.  The participants are placed in a foster home for several months. However the families under which the participant are placed must have members who are trained and well compensated for their work and for providing  structured environment where these activities can be conducted. This program trains and supervises families proving treatment homes for adolescents who have juvenile delinquency.  The goal of the program is to help childe who have serious emotional disturbances and integrate them to live with the community members peacefully.  These programs aim at using comprehensive behavioral health treatment with an objective of changing the behavior pattern of adolescents. (Mrazek and Haggerty, 1994)

Treatment Foster Care (TFC) can be described as a foster family based intervention which provides young people together with their families with individual tailored program with an overall aim of bringing about positive change in life (Turner, 2008).  The initial development of the programs was aimed at providing help to children who had an increased risk of multiple placements or in restrictive placement such as medical care facilities or criminal justice correction facility.

Although different programs have taken different approach to the implementation of eth program, there are basic objectives or activities which take place uniformly in all programs.  The TFC programs include the following objectives:

  1. Reinforce positive behaviors in youths
  2. Supervise youths closely at all times
  3. Monitor peer association at all times to ensure that  they form health association
  4. Specify and enforce clear and consistent rules and limits
  5. Ensure consistent following of rules and follow through with consequences
  6. Encourage the development of academic skills and positive working habits
  7. Encourage the family members to improve their communication skills
  8. Decrease the level of conflicts between family members

To achieve these objectives, a number of approaches are used.  All the approaches however involve activities which will lead to structural change in individual behavior for the participants (Child Trends, 2004).  The programs may also take different approaches depending on their design. For example in some programs, the participants may be separated from their usual peer environment while put in closely supervised schools, homes or families.  The programs may include psychological therapy for the participants and for the members of the child’s biological families which ensure that there is change in the growth environment for the youth after they leave their foster care treatment. (Chamberlain, 1994)

The three principles players in treatment foster care include the foster parents, the child and the biological parents of the child.  There are legal requirements for the child and for the foster parent which vary with the program to program.  (OakLawn, 2009)

For a child to be considered for placement, one must meet the following criteria;

  • Has to be between birth and 18 years
  • Must exhibit need for special which cannot be met in¬† regular biological home or foster institution
  • Must have physical handicaps, emotional and behavioral problems

In many programs, a Therapeutic foster parent must meet the following criteria;

  • Aged 21 to 65 years
  • Can be single or married
  • Must have an adequate space for the child
  • Must be in good physical health

Development of Treatment foster care

Historically, various children have shown difference in coping with emotional and psychological changes especially during their teenage years.  Most of them have required out to home services in order to correct the emotional and behavioral problems which they receive to a number treatment facilities.  This separation has been cited necessary in order to remove the youths from their current growth environment and introduce them to a supervised environment from where they can successfully change their behaviors (Turner, 2008).  However in the earlier approaches, children were just removed from their families and placed in various correction facilities. In these facilities, these children are left to deal with a myriad of problems which they left in their own home. Regardless of the treatment they received in out of community placement, these children went back to the same growth environment as before and there was not remarkable change in their life (Child Trends, 2004).

This necessitates creation of an appropriate model which would oversee the full correction of these children. There was need to develop an  approach that would oversee the  full change in these youths and change their environment back at home to ensure that  even when  they returned to their homes, they would still not face a harsh life and return back to their old way of life (Chamberlain and Friman, 1997).

Therapeutic foster care became an innovative answer to this nagging problem. The problem of juvenile delinquency need to be dealt with in a similar environment that the youths have been used to and  which they will be exposed to even after they leave the correction homes.  TFC therefore provided a suitable environment which would provide an effective change atmosphere for these youths (Turner, 2008).  Under the approach, the delinquent youth are placed in the same environment as before which is in their community. They are corrected in the same community as their original families.

This proximity to their original homes, schools, social network, family and friends helps the children to grow in an environment where they realize their mistake that they have done before and establish mechanism for change.  This also helps the youths to deal with the problems that they have faced before which are related to the above entities which have a lot of influence in their life.  These entities are important in providing the overall support in the development path of the youth and therefore these entities will be of great importance.

The model has also been reinforced by ensuring that only families which are well trained are given the duty to take care for these children. This means that the family which fosters the child must be well trained to acquire various skills which are important for the overall change in behavior and psychological patterns of the child.  These families are usually given advanced training to acquire skills which are required to take care for the emotionally disturbed children. (Child Trends, 2004)  The program is also designed in a way that it integrates various professionals for effective correction of the child.

For example, for mentally challenged children, clinicians usually work closely with therapeutic foster parents to ensure the overall correction of the child. These families will also work closely with psychosocial rehabilitation providers to utilize the treatment protocol that is used for mentally disturbed patients and to integrate them back to their social life (Price et al., 2008).  This means that throughout the whole treatment, a child will have to undergo a number of treatments including psychiatric services, short term inpatient hospitalization, and many other medical processes which are aimed at correcting all the growth deficiencies in the youths. When the child is returned back to her original home, the same kind of care is not entirely cut off but there is continuously support from the foster care parents. The main reason why the child is placed in the immediate community is to ensure a close follow up even after the child is taken back to her original family. This ensures success of the correction process. (OakLawn, 2009)

Therefore we can argue that TFC is a program that is developed in order to meet the needs of both involuntarily and voluntarily placed child.   However the principles for these systems may different in reference to the role that is played by the family of the child.  There is a great difference between voluntarily and involuntarily programs.  Involuntarily placement is made with an aim of protecting the child from maltreatment the at the hands of their caretakers or child maltreatment of their caretakers.   On the other hand, voluntary placement is made from the will of the parents. This means that it is made by parents whose child is mentally disturbed or has behavioral, emotional or any other type of disturbances and the family is not in a position to meet these needs (Turner, 2008).  However, in all the programs, the parents are very well involved in the planning and the overall treatment of the child. The children and the family needs to undergo various counseling session from mental health professional, social workers, and the foster parents.

There are two main foci interventions which are mainly the child and the permanent care giver.  The first intervention is environmentally based interventions. Under this intervention, the main focus is on the child or the youth. This is mainly delivered by a well qualified therapeutic foster parents and it is designed to offer structured living environment for the child. (Royes, 2006)

The other intervention is intensive treatment interventions which is a child focused intervention but which is mainly provided by a trained mental health professionals.  This intervention is specifically trained designed to treat the mental disability of the child in order to improve their functioning and to enhance their overall development.  These two kinds of intervention have an eventual aim of settling the youths to their original homes where they are settled and corrected.  The intensive treatment interventions include a wide range of activities including individual therapy, group therapy, day treatment, medication, crisis intervention, therapeutic behavioral services, drug abuse, and many other services. (Mrazek and Haggerty, 1994)

The other kind of intervention is parallel, pre-discharge community based interventions. This kind of interventions is focused on the care givers and it is designed to help the original family of the children, the school, the community and the general ecology encompassing the life of the child.  This is in way meant to provide smooth transition of the child from the foster family to the original family and community. (Chamberlain, 1994)

This is usually provide as a extended rehabilitative services  to the youth and the permanent care giver in order to strengthen the stability and the  success of the connection between home, school and the community to which the  child is a part of. There is also follow-up or post discharge intervention. Famously referred to as wraparound care services, children are usually given follow up care after they leave the foster family.  As we have highlighted above, the child family is given enough training on how to handle their children after they leave the foster care family. Therefore wraparound services are important in integrating the corrected child back to their biological father.  (Price et al., 2008)

Current models

There are several models which depend on the state that is implementing the TFC program and the broad aims of the program.  The two dominant models are Multidimensional Treatment Foster Care (MFTC) and Residential group foster care treatment.  Multidimensional Treatment Foster Care is cost effective and designed to meet the broad needs of the disturbed children.  Under this model, families in the community are recruited, trained and supervised in the process of providing treatment foster care for the child.  Intensive supervision and close working relationship with medical agents is ensured in order to have a positive reinforcement for appropriate behavior change. The programs also aim at separating the children from the delinquent peers to discontinue peer influence. The service of adult mentoring are also offered under the program to ensure that the biological parents are well prepared to handle their children when they go back home. (Chamberlain and Friman, 1997)

 One of the most important aspects of this model is that unlike other programs which targets children under the age of 18 years, MTFC targets teenagers who have a history of criminal behavior which puts them at a higher risk of incarceration. It also targets teenager who exhibits severe mental problems who are at an increased risk of hospitalization from their mental condition.  The program also emphasizes on behavior management methods in order to provide the youths with a therapeutic environment which can ensure efficient change of behaviors. Ongoing training of the treatment foster parent is emphasized in order to equip them with knowledge to deal with challenges arising from their clients (Turner, 2008).

Residential group treatment therapy also follows the same approaches to multidimensional therapeutic care. However, it differs from MTFC in that the youths are put under a group foster care.  This means the child is put in a group with the same kind of conditions. Residential group treatment foster care is however criticized on the ground that   children may be exposed to the same kind of peer influence that they had before and therefore they many not experience change  in their behavior. It is also difficult to integrate the child back to their original family since the foster family does not have enough time with the child biological family (OakLawn, 2009).

In some states, there are group homes which are structured in the same way as residential group treatment. Residential group treatment is mostly offered in Therapeutic group homes. These homes tend to admit several youths with the same problems.  Like residential group treatment therapeutic homes have been criticized for failing by exposing children to similar aggressive environment as before.  In most cases, some youths deteriorate in their behaviors after leaving the therapeutic group homes.  (Richardson et al., 1998)

There are two service designs or type of therapeutic group homes.  There is teaching family models like the one which was developed in Kansas University and later transferred to Boys Town in Omaha and there is also the Charley model which was developed in Menninger clinic. In both models, staffs are used as the key change agents for the disturbed youths. This means that the staffs are supposed to provide a family atmosphere for the children. Under the model, the selection and training of staff is emphasized on. There is clear evidence that most of these programs prefer employing couples who living for 24 hours in these homes.

However, there is a difference between the two models.  The teaching family model calls for structural change in behavior while Charley model emphasize on individual psychotherapy and the interaction of the group members.  However, both models have shown a high rate of efficient in changing youth behaviors.

 There have been several studies which have looked into the differences and similarities between therapeutic group homes and therapeutic foster care. Studies have found out that therapeutic group home placement was twice costly compared to therapeutic foster care.  In another study, it was found out that children who were placed in therapeutic foster care had fewer incidences of   criminal referrals and coped well with parents after their foster care as compared to other groups.  These findings suggest that therapeutic foster care is a more effective intervention compared to therapeutic group homes. (Adopting.org, 2009)

Components for training treatment foster parents

Therapeutic foster care is one of the most intensive, individualized mental health programs which is provided to any child in a family. This program makes use of special trained and supervised foster parents who provides guidance for the overall change in behavior and conduct of the child.  These programs place a child singly or in pairs in conjunction with a foster parent who is trained to match with the needs of the child. There are key components of the programs but mainly a team work approach is the most important component of the program.  However the most important component in the programs is empowerment of the foster parents who acts as a central organ that facilitates change in children with disturbed emotions.

Foster parents must be well trained in order to handle the various challenges that they face in their encounter with children with various needs.  Foster parents act as the central change agent and therefore they must be well acquainted with the whole process to ensure that there is complete change of children who are placed under their care.

Before the child enters into the house of a therapeutic foster care, the therapeutic foster parent must undergo intensive training in order to gain the necessary skills that will assist them to deal the various needs of the child.  The core training should be centered on the need to learn behavior management strategies (Turner, 2008). The intensive training of treatment foster parent centers on the management of the psychological and behavioral factors which affects the current behavior of the child.  The parent has to be well acquainted with various behavior management strategies which will ensure effective behavior change for the child.

Apart from undergoing intensive training on these strategies, the foster parent must also gain skills on education the biological parents of the child on how to handle the child during and after undergoing therapeutic care. The treatment foster care parent acts as the link between the child and the biological parent and apart from facilitating change in behavior for the child, the foster care parent needs to prepare the biological parents to build a lasting positive relationship between the parents and the child. Training of the biological parents is important as it ensures that there is effective training in various activities which are offered in the treatment foster care such that when these children go back to their biological home, they will have a continuation of the experience they had in the treatment foster care (Chamberlain, 1994).

The key areas of training that every treatment foster parent must be well acquainted with include the ability to diagnose the specific problem that the individual child is suffering from  and the appropriate measures that must be undertaken in order to  ensure successive change of the  their behaviors. This means therapeutic foster parents must be well trained in various areas by the clinical social workers who are well experienced in delivering of services. This means that they must undergo training by a wide range of professionals to equip them with specific skills in nursing, psychology, occupation, social work, and many others.

The most important component in training of Therapeutic foster care parents is to equip them with necessary skills in using behavior management approach to change the overall behavior patterns of disturbed adolescents.  This is important to ensure that therapeutic foster parents act as agents of change for the disturbed adolescents. This will also equip them with the necessary skills to deal with the challenge of preparing the biological family of the foster parent to be ready to accept their child back once they are through with the their foster care. (Royes, 2006)


Treatment or Therapeutic Foster Care is one of the most recent approaches that were developed in response to the increasing rate of juvenile delinquency. These programs emerged in 1970s due to the increased rate of juvenile crimes and the evidence that incarceration of juvenile offenders increased their risk of repeat crime and it did not effectively change their behaviors.  Therapeutic foster care emerged as an individualized program that is centered on the needs of the youths who may be emotionally or psychologically disturbed. Under the program, a child undergoes behavior management in a family set up in the same community. However, the therapeutic foster family must be well trained to handle a wide range of needs for the disturbed youth. The foster family also works with other specialists like psychiatrists, social workers and others in order to have an effective behavior change for the youth. TFC provides an alternative model of juvenile rehabilitation to the restriction methods.  However, for the program to be effective there must be close working between the therapeutic foster care parent, the child and the biological family of the child. TFC is therefore an effective model in the correction of disturbed youths.


Adopting.org, (2009). Therapeutic Foster Care and Group Homes. Retrieved 20th January 2009 from http://www.adopting.org/adoptions/therapeutic-foster-care-therapeutic-group-homes.html

Chamberlain, P. & Friman, P.C. (1997). Residential programs for antisocial children and adolescents. Hand-book of Antisocial Behavior

Chamberlain, P. (1994). Family Connections: Treatment foster care for adolescents with delinquency. Castalia Publishing

Mrazek, P.J. & Haggerty, R.J. (1994). Reducing risks for mental disorders: frontiers for prevention intervention research. Washington, DC: National Academy Press.

OakLawn, (2009). Therapeutic Foster Care. Retrieved 20th January 2009 from http://www.oaklawn.org/services/children-adolescents/foster-care

Richardson, B., Foster, V., & McAdams, C. R. (1998). Parenting attitudes and moral development of treatment foster parents: Implication for training and supervision. Child and Youth Care Forum, Vol. 27(6)

Royes, S., Johnson, E., Marrifor, J., Belcher, M. & Harolyn, E. (2006). Understanding placement stability in treatment foster care. Howard University

Turner, M. G. (2008). Research suggests that Treatment Foster Care can help youth with behavior problems. Retrieved 20th January 2009 from http://www.cochrane.org/reviews/en/ab005649.html

Child Trends, (2004). Multidimensional  treatment foster care. Retrieved 20th January 2009 from http://www.childtrends.org/lifecourse/programs/MultidimensionalTreatmentFosterCare.htm

Price, J., Chamberlin, P., Landsverk, J., Reid, J., Leslie, L., & Laurent, H. (2008).  Effect of a foster paerent trainiign intervention  on placement changes of children in Foster Care. Child Maltreatment, Vol. 13(1): 64-75

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