Designing systems and developing families for treatment foster care

The challenge

Child welfare agencies face a crisis in finding foster families who are available and willing to accept children and youth with higher emotional or behavioral, developmental, or medical needs.

Our clients asked us to gain insight into how jurisdictions could recruit more families who can take on this level of care, known as therapeutic or treatment foster care (TFC).

We worked with Marina Nitze from the Child Welfare Playbook along with The Contingent, a nonprofit that mobilizes community and digital strategies to recruit and retain foster homes. We focused on 2 of the states The Contingent currently works in, Arkansas and Indiana.

Legislation and policy shifts over the last 70 years have created a gap between foster care and residential treatment programs, or congregate care settings. For many good reasons, facilities and group homes have started closing and placing children in less restrictive settings. These shifts have meant that child welfare agencies are having to find home settings to care for children and youth who don’t have their needs met in traditional foster care.

TFC has filled this gap by providing:

1. Highly skilled caregivers
2. Enhanced case management
3. Coordination of trauma-informed care

The project

We interviewed 9 subject-matter experts, which included child welfare staff in other jurisdictions to understand their approach to TFC and innovations in professionalized foster care. This built on prior work we did around teens in the foster care system and long-term foster families.

In Arkansas and Indiana, we spoke with 5 state agency staff and 15 private child placing agency staff to understand child or youth needs assessments, recruitment and training practices, and the types of support provided across the different levels of foster care. We also spoke with 15 TFC families in both states to understand their characteristics and experiences of being recruited, trained, and supported as caregivers.

In our initial research and interviews, we found several emerging themes about children and youth with higher emotional or behavioral, developmental, or medical needs:

• Before being placed with a family, children and youth are not always assessed to find out if they need TFC-level care. Often, they need to experience a mental health crisis or distress before qualifying.
• Tying family reimbursement rates to the level of need can be discouraging, because when children and youth improve, families may need to accept lower levels of pay. This can lead to children needing to leave those families and less stability overall.
• Generally, agencies don’t offer TFC-type training as a preventative service, even though our findings suggest that preventative training would benefit youth and families.
• Kin (relatives or people with existing ties to the youth) are often not considered for TFC placement options, even though youth generally have better outcomes when they remain with kin. Kin are often less resourced, and looking at kin would require training and supporting kin in the same way as non-kin TFC. When children or youth get classified as needing TFC support, they generally have to work with private child placing agencies.
• Many families don’t know or aren’t intentionally deciding to sign up for TFC, meaning agencies aren’t targeting recruitment according to families’ level of experience.

In this project, we had conversations that had us step back and look at the bigger picture of the different levels of care that child welfare agencies offer for children or youth and how foster parents are being recruited into those levels. We heard from experts who identified how supporting kin to become licensed as TFC providers and equipping them with that level of support, is an essential part of the strategy for developing and retaining more foster parents. This had us think more holistically in our recommendations to propose a developmental model that meets the needs of both kin caregivers and non-kin foster parents.

The result

Ultimately we found that child welfare agencies and partners may benefit from focusing less on recruiting as the main problem—and more on developing families. Keeping, retaining, and training foster families to support youth along the continuum of placement needs is critical.

We made 6 main recommendations for child welfare agencies who are looking to close the gap of high-need children and youth with available families:

• Review child welfare programs from various perspectives to refine how they fit together, which can be done by mapping the placement continuum.
• Expand program offerings so that more children and youth get emotional and behavioral support earlier, long before crises occur.
• Expand TFC programs to in-home (prevention services) and in kinship homes.
• Extend the benefits of TFC to all families, including traditional foster families.
• Use a developmental model to create foster homes, and approach recruitment by supporting families to grow their skills gradually.
• Use human-centered case management at the state to improve communication with foster families.

The Contingent, our client in this work, described how they are using the research to inform their approach to foster family recruitment in Arkansas, Indiana, and Tennessee, and how their state partners can also use the learnings.