By Laura Boyd, Foster Family-based Treatment Association

What is treatment or therapeutic foster care? Many in the child welfare ranks do not know; many are confused and unsure about TFC.

Treatment or Therapeutic Foster Care (TFC) is specialized foster care consisting of intensive behavioral health services delivered usually in foster homes by licensed mental health clinicians and supported 24/7 by the active participation of highly trained foster parents in the overall clinical plan for each foster youth. TFC is proven to be an effective treatment for children with complex emotional, mental, and physical problems. Its uniqueness is in demonstrating healthy desired outcomes with this vulnerable population of youth ages birth to 21 in the context of home and community, thereby keeping these same children and youth out of higher and more expensive levels of care.

Meet Josh and Johnny. Shortly after entering state custody, Josh and Johnny were admitted to a TFC home through a state licensed child-placing agency. As brothers they were place together: Josh as a TFC child and Johnny as a traditional foster child. Josh was 4 years old and Johnny was 3. Both boys experienced early childhood trauma due to neglect by the mother and her girlfriend, each of whom was reported to be mentally ill.

Josh displayed lengthy breath holding spells, causing him to pass out and turn blue. He was hospitalized two times during the month prior to admission to TFC.

Evaluation confirmed that these spells were triggered by strong emotions including fear, anger and anxiety. Medical causes were ruled out. Josh had difficulty with self-regulating behaviors and emotions. He had difficulty communicating needs. At age 4, he was diagnosed with Generalized Anxiety Disorder stemming from neglect. His medical diagnosis included Failure to Thrive.

Through the special training of TFC foster parents and the support and clinical skills of TFC therapists and staff, these two young brothers were able to heal from the trauma of abuse and neglect, learn to self-soothe and self-regulate feelings and behaviors, and eventually learn to trust other individuals to meet their needs and emotional development. Most importantly, they were able to heal together as siblings. Josh and Johnny were adopted by their TFC foster family and today continue to approach normal child development levels for their ages.

How different this situation might have been had Josh and Johnny been placed in separate foster homes. How different if Josh’s breath-holding spells had frightened untrained and unsupported foster parents who felt overwhelmed and unable to maintain this placement. How different might the progress and development of either or both boys been if they had not had access to the skills and treatment planning of therapists highly trained in trauma, neglect, and child development. Finally, how different things would be today if the TFC foster parents were not supported through the challenges of treating these two youth so that those bonds of commitment and trust might grow on all sides of this family and culminate in the joy of adoption.

That is what we do in therapeutic foster care. We take the most vulnerable of state custody youth and we address their needs, behaviors, and limitations in a home environment with special services and supports. We take children who at the time of admission are ‘not adoptable’ and we work with them toward adoption, reunification, or some other permanency plan.

But all is not equal in the United States for TFC youth. Every state offers either TFC care or intensive outpatient services for the same population of foster youth. However, there is confusion among public child welfare entities, state Medicaid administrators, and private TFC agencies as to what services they may offer the TFC youth and what services are reimbursable. Courts of jurisdiction do not know which services to order for which youth or even that TFC services are an option in some states. Foster parents are confused and compromised when a child they were hoping to help is clearly in need of a higher level of care and services than are appropriate in their traditional foster home.

FFTA and 54 other national child advocacy organizations are appealing to CMS and the Obama Administration to create a baseline definition of TFC, its services and appropriate reimbursement methodologies. This baseline is needed to create a minimally level playing field for our most vulnerable youth across states and jurisdictions. Such a definition would go a long way to enhancing research and best practices for TFC youth and to raising the bar for services and outcomes for our most highly vulnerable and emotionally complex foster youth.

Without this guidance, too many children slip into foster care below their level of need or are relegated to institutional care when they could have been served in their community. Too many well-intended foster parents miss the supports they could have had in therapeutic foster care settings. Too many child welfare workers, Medicaid officers, and juvenile court judges are frustrated and unsure of what options are possible.  And sadly, too many children may miss the right to a permanent home in which to grow and heal.

Let’s be smart about what we have and what we can do. Let’s define and support this service so that we don’t miss important opportunities to make a difference for vulnerable youth. 

(Editor’s Note: The Foster Family-based Treatment Association is the only national association of providers of TFC in North America. )