Lessons from the Evaluation of the Therapeutic Foster Care Pilot in Illinois
This report includes findings from a multifaceted evaluation of the Illinois Department of Children and Family Services (DCFS) implementation of a 5-year pilot program of Therapeutic Foster Care (TFC). The TFC Pilot specifically targeted children and youth who need more support than is typically provided by traditional foster care and who may otherwise be placed in residential care. TFC offers safe and nurturing care in a structured environment provided by foster parents with specialized training.
What We Did
The Illinois legislature required DCFS to implement a 5-year pilot of therapeutic, or multi-dimensional treatment, foster care (Illinois Public Act 099-0350). Further, DCFS was required to arrange for an independent evaluation of the pilot that would culminate in a report with findings and recommendations for DCFS leadership and legislators. Chapin Hall conducted this comprehensive evaluation, which included four distinct studies:
- Benefit-cost study: We drew from existing studies of evidence-based interventions to assess whether the benefits of TFC outweigh the costs of treatment as usual.
- Distance-from-home study: We examined TFC and post-TFC placement types and the proximity of these placements to the youth’s home community in consideration of distance as a barrier to sustained community connections.
- Outcome study: We assessed how TFC participants fared on key safety, well-being, and permanency outcomes compared with youth who needed residential care but did not participate in TFC.
- Process study: We conducted focus groups with TFC program staff and DCFS staff involved in the TFC Pilot to better understand the context and processes of TFC implementation and to explore the feasibility of the TFC model as a community-based alternative to residential care in the Illinois child welfare system.
What We Found
- Significant cost-savings were seen after youth exited their TFC placement, as they tended to move into and remain in less restrictive and less expensive settings, such as traditional foster care/relative and specialized foster care.
- The overall estimated net benefit of TFC per youth is $94,294.26, including the lifetime benefit, compared to youth in residential care.
- None of the TFC Pilot youth moved to residential care immediately after the initial TFC placement.
- In all post-initial TFC placements, 59% were placed in specialized foster care, home of parent/relative/kin, or other home-based settings; 25% were at psychiatric hospitals; and 10% were in residential care.
- Among all post-initial TFC placements, 39% and 54% of post-initial TFC placements in the home of parent/relative/kin placements were within 5 miles and 10 miles, respectively, of youth’s home community, compared to only 7% and 15% of post-initial TFC placements in psychiatric hospitals.
- Using DCFS administrative data and data provided by the community-based agencies implementing TFC, we analyzed 13 outcomes related to safety, well-being, and permanency. We individually evaluated three key intervention groups and their comparison groups.
- Two of the three intervention groups had a significantly greater percentage of discharges from TFC to family and fictive kin caregivers than their comparison groups. Further, one group had a significantly shorter length of stay in foster care than their comparison group.
- Some of the other statistically significant results favored the comparison group and the rest of the results were mixed and did not achieve statistical significance. These inconsistent results are partly tied to the small number of youth in the study.
Six key themes emerged in the qualitative analysis from the focus groups.
- The TFC model provides youth with trauma-informed support.
- More successes are observed among younger TFC youth.
- Finding a stable aftercare home is both essential for successful youth outcomes and a major challenge.
- TFC parents need to understand, buy in to, and follow the TFC model.
- TFC parents and aftercare families play vital roles in the TFC model and successful outcomes of youth.
- Team communication, support, and continuity are key.
What It Means
Collective findings across the four studies of the DCFS TFC Pilot suggest that continuing TFC in Illinois may be feasible for DCFS and beneficial for youth and families.
- There is long-term cost benefit to continuing the TFC Pilot in Illinois.
- TFC youth can be maintained in less restrictive, home-based settings, though subsequent placement instability or placements in psychiatric hospitals can be expected. The stabilization of TFC youth in community placements may be bolstered by their closer proximity to youth’s home community.
- Collective outcomes associated with the three TFC intervention groups provided modest but promising evidence that youth generally benefited more from the interventions compared with youth in the comparison groups.
- TFC could be a viable, community-based alternative to residential care.