The Office of the Assistant Secretary for Planning and Evaluation (ASPE) in HHS has released new findings on Therapeutic Foster Care that analyzes the benefits and challenges of TFC. Therapeutic Foster Care is intended to help children in care who have behavioral or emotional disorders. It is provided in a family-based setting by an expanding rage of parents starting with foster parents, kin parents and more recently biological parents. The ASPE research is outlined in four separate reports:

Challenges and Opportunities in Treatment Foster Care, which provides the summary and highlights of the findings from HHS. State Practices in Treatment/Therapeutic Foster Care, which takes a closer look at how TFC is implemented and funded by states. It also examines state strategies on how states provide supporting services, such as case management and behavioral health care. This report includes an appendix with detailed profiles of Connecticut, Illinois, New York, North Carolina, North Dakota, and Tennessee. Patterns of Treatment/Therapeutic Foster Care and Congregate Care Placements in Three States, is a report which focuses in on three of those states to look at characteristics and care trajectories of children in Illinois, New York, and Tennessee. It also examines TFC services compared with those children and youth receiving congregate care, traditional, non-kinship foster care, and kinship foster care. It describes whether TFC can help states meet the new requirements and restrictions through the Families First Act on congregate care placements. The fourth paper, Research Brief: Patterns of TFC and Congregate Care Placements in Three States, highlights primary findings of the third report listed here.

CWLA has supported for several congresses efforts to standardize definitions of TFC under Medicaid in an effort to streamline and expand its use. The ASPE research finds that states have used a range of strategies to increase Medicaid funding for TFC. These strategies include defining it as a service in the state Medicaid plan, categorizing it as a rehabilitative service, and using waivers authorized by Section 1115 under the Social Security Act. Additionally states may attempt to supplement some of the cost with the use of Title IV-E funds.

The research finds that evidence based TFC models have been rigorously evaluated in some instances and in fact have shown improved outcomes in participants’ behavioral health, and delinquency experiences. However, states have varied in their application of TFC models and practices. Children placed in TFC setting with their increased need would likely be placed in congregate settings without the TFC option in these states. It can also serve as a step down from more intensive residential care. A key part of the service is intensive case management with access to community-based services including behavioral health.

The challenges include finding trained parents, effective programs, the needed community services and of course the need to create a complex funding strategy of Medicaid and federal and state Title IV-E foster care dollars.

The third ASPE research report focused on three states and their variations in use and results. In terms of the first placement for a child or young person, in Illinois, kinship foster care is the most common initial placement while non-kin foster care is the common first placement in both New York (54 percent) and Tennessee (55 percent). TFC is not generally used as a first placement in any of the three states examined up close however in Tennessee seven percent of children had an initial first placement in TFC. A high percentage of children in TFC were initially placed in congregate care ranging from 18 to 45 percent between the three states. That initial placement into congregate care tends to be for older children or youth (youth ages 13 to 17).

Based on the assessment of the three states the ASPE report suggests:

TFC can be a vital service for children with significant behavioral and emotional needs who require out-of-home placement. TFC can also be a strategy for states to ensure that children with intensive needs are not placed in congregate care unnecessarily, remain in a community setting, live in a family home, and participate in typical childhood experiences…

…this brief identifies some promising patterns showing that states may have already begun using
TFC as a substitute for congregate care. However, other patterns point to a need for additional support for increased TFC resources…

Last month Senator Tammy Baldwin (D-WS) and Senator Rob Portman (R-OH) reintroduced the Treatment Family Care Services Act, S 1880. On July 9, 2019, HR 3649, a House version of the bill was introduced with Congresswoman. Rosa DeLauro (D-CT), Congressman. Tom Cole (R-OK), and Congressperson Karen Bass (D-CA).

The Child Welfare League of America has endorsed the legislation. Hopefully the new ASPE research will motivate Congress to assist in ways that will expand the use of TFC by eliminating funding barriers so that more children and youth can access community-based services and remain in families.

About the Author:

John Sciamanna is CWLA's Vice President of Public Policy.

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