An Overview of Treatment Foster Care
By Pat Sullivan

Foster care is certainly not a new concept; in fact, references can be found to caring for the children of others as far back as the New Testament and the Talmud. In the 1500s, children without families were served in the Almshouses in England. By the 1800s, the so-called Orphan Trains were organized by the first child welfare organization in America, the Children's Aid Society in New York. These trains transported children whose families could not care for them to western states where they were taken in by families to work on farms. A highly publicized case of child abuse involving a girl named Mary Ellen illustrated the fact that the laws which protected animals from abuse were stronger than those that protected children. As a result of this case, the first child abuse laws in the United States were enacted, and some states began providing subsidies to families that took in foster children.

In 1909, the problems facing children in America were recognized by the first White House Conference on Children. This, the first White House Conference on any subject, signaled a new era where government increasingly recognized its responsibility to its youngest citizens.  In fact, after a 38 year hiatus, legislation has been introduced to Congress this year that proposes a 2010 White House Conference on Children to mark the 100 year anniversary of this historic event and to renew our attention and focus on the problems faced by children and families in this new century.

The roots of Treatment Foster Care are found in the 1950s, 1960s and 1970s, when agencies began to train foster families to provide more than just a home to their foster children. This model has, at its core, evolved to believe that a foster family, provided with specialized training, supervision, and other clinical supports, can be a powerful agent of change for a child with special behavioral, emotional and/or medical needs. Unlike traditional foster care, where a child's primary need is for placement, in treatment foster care, the positive aspects of a nurturing family environment are combined with active and structured treatment interventions. 

From the initial experiments in small agencies around the country, the popularity of the model grew as the deinstitutionalization movement of the 1970s became the national policy of the 1980s. In the 1990s,research demonstrated that the model produced outcomes that in many cases were comparable to residential treatment and, when compared to traditional foster care, had 20 - 30% fewer disrupted placements. Many states used the Medicaid program to expand the availability and service intensity of  Treatment Foster Care. Today, Treatment Foster Care is widespread and a viable alternative to residential treatment, with foster parents receiving specialized, intensive training to help their foster children heal while residing in normalized family settings.

Ken Olson is a Foster Care and Family Services Regional Director for KidsPeace, overseeing treatment foster care programs in Maine, Georgia and North Carolina to help children with a multitude of emotional, psychological, social and behavioral needs. Having started out as a treatment foster parent in 1975, Ken has seen the system from both sides and always keeps the challenges faced by foster parents in mind when making decisions. He definitely understands when foster parents describe their work as "the hardest job you'll ever love." He relates when foster parents are having a particularly bad day or worrying about how the foster child's meltdown will affect their biological children or how they will be able to do everything they need to do in a day and still take their foster child to treatment or for a supervised visit with the birth parents. Ken also has no problem explaining to foster parents that they will be held accountable for the safety and well-being of their foster children, and that they must never use physical restraint or punishment on their foster children.

According to 2005 U.S. Adoption and Foster Care Analysis and Reporting System (AFCARS) estimates, there were 513,000 children in our nation's foster care system that year, with more than 114,000 waiting for adoption. Those estimates also indicate that, while 24% were in foster care in the home of a relative, 46% were living in foster homes with which they had had no prior contact. Quite obviously, more trained foster parents are needed.

"The federal mandate is to reduce 'drift,' which means kids being placed in home after home, which is very damaging to their ability to attach and their self-esteem. It is therefore the job of organizations such as ours to be extremely selective when interviewing potential foster families and providing them with in-depth training and support to deal with any crises that arise, 24/7," Ken explained. "At KidsPeace, we pay close attention to the matching process and do everything in our power to make our placements successful. We want our kids to stay in one foster home until they are returned to their families or are adopted, often by their foster families."

According to Ken, trends in foster care are to reduce the number of kids in the system and their time in the foster care system. This has resulted in an explosion of home-based services that were not available 10 years ago, allowing many kids to remain at home while receiving the treatment they need, even if that means counselors visiting a home three times weekly to work with the children and their families.

"At KidsPeace, we work with families during supervised visits on parenting and psychoeducational issues, medical problems and dealing with behavior disorders in order to get the kids back home as quickly as possible," Ken said. "When reunification is impossible, we work to find the appropriate adoptive family, which is often the foster family that has grown to know and love the child. This is a blessing, but it also can reduce the number of trained foster parents available due to the number of children in the home." Most states limit foster families to one or two foster kids unless the family takes a group of siblings, which all agencies strive to keep together.

The Past 25 Years
Ken discussed how treatment foster care has changed over the past few years. "It has become more focused on permanence as an outcome," he said. "We are seeing kids who present with great emotional and behavioral acuity. This poses many more challenges in terms of finding and training foster parents. Additionally, Medicaid, which provides a source of funding for TFC in about 50% of our states, is under increasing pressure to cut the amount it spends, requiring higher standards to qualify for funding, which, in turn, creates a mountain of additional paperwork."

Funding and some aspects of the model are different in each state, depending on whether treatment foster care is considered a  "mental health" or "child welfare" program. "What we have learned," Ken explained, "is that best practices mean that services need to be integrated, and integrated services need to wrap around the kid and blend treatment with daily living." Foster parents are seen as professionals in some states and volunteers in others. Regardless of how their roles are defined, Ken described foster parents as the most powerful agents for change in foster children's lives.

Treatment foster families come from a wide variety of backgrounds and are by no means strictly defined. While the screening process to become a foster parent can be cumbersome, it is imperative to ensure the safety and well being of any child placed in the home. Home studies are conducted with all families to ensure that the right children are matched with the right family. There are background and criminal history checks, personal interviews about attitudes and prior experiences and comprehensive training. According to Ken, it can take anywhere from three to six months to become a licensed foster parent, and annual training is ongoing for the entire time one remains a licensed foster parent.

Aging Out
Ken said that one of the "huge problems" with the foster care system is that kids age out at 18 without the skills, resources or support to move on to independent living. He believes that, in this regard, the system has poorly prepared our foster kids socially. Ken said that studies have shown that few kids from any background are ready to live on their own at 18 or 19 years old. There need to be more programs that prepare foster kids to transition into independent living and help them avoid the pitfalls of homelessness, unemployment, dropping out of high school or not attending college, illegal activities and drug and alcohol abuse.

The Future
Finding new foster parents can be challenging, but, according to Ken, foster parents are the best recruiters, showing family and friends how rewarding foster parenting can be and being walking, talking advertisements for the program. "Friends visit their homes and see what goes on, and then they call us to see if they qualify to be foster parents, and the word of mouth just keeps spreading," Ken said. "Our foster parents develop a fantastic support system for each other, and our staff go above and beyond to do everything possible to help our foster families stay together. The most difficult recruitment issue we experience is finding families for teens. They can be the most difficult age group to place because they can be the most difficult to control and reach and often have the greatest number of emotional and behavioral problems."

Ken is optimistic by nature, and is hopeful about the future of foster care, predicting that it will continue to evolve. He believes that government agencies are getting better at understanding which kids are best served by the foster care model and that other foster care organizations will improve their matching processes. Ken also looks forward to permanency options improving for foster kids, with many states establishing policies to terminate parental custody after one year of foster care, freeing the children up for adoption sooner. Foster parents are also helping birth parents with parenting skills and becoming role models for parents, as well as for their foster children. Ken predicts that kinship foster care will continue to grow, especially with the assistance of technology that can help locate relatives who live far away from other family members.

Ken asked readers to "Call us. Let us show you how you can become a foster parent and how you can have a really positive impact on the life of a child. It is an extraordinary experience that will change you forever."

For more information on KidsPeace Foster Care Programs across the country, please call 800-8KID-123 or visit

ABC News. Facts on foster care in America - A grim picture for many kids, but there are reasons for hope (May 2006).

Child Welfare Information Gateway. Children's Bureau/ACYF. Foster Care.

Child Welfare League of America. Quick facts about foster care (2007).

The PEW Charitable Trusts. Time for reform: Aging out and on their own (May 2007).

U.S Department of Health & Human Services, Administration for Children & Families. Trends in foster care and adoption. (January 2007).

U.S. Department of Health & Human Services, Administration of Children & Families. Administration for Children and Families, Administration on Children, Youth and Families. The AFCARS Report, Preliminary FY 2005 Estimates as of September 2006 (2006). Available on



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