Examining Relationships Between Number of Youth in the Home, Treatment Processes, and Outcomes in Treatment Foster Care

Practice guidelines for Treatment Foster Care (TFC) recommend placing one youth in each TFC home, with a possibility of increasing to 2 with “special justification.”  Current data from the field suggest that actual number of youth placed in homes varies considerably. Literatures on parenting practices, youth outcomes, and treatment integrity raise questions about potentially negative effects of increased number of youth per home. However, there is currently discussion within the field on whether the 1 youth/home recommendation should be relaxed.

The current study examines existing placement practices in terms of number of youth per home and whether variation in number of youth per home is related to treatment processes and youth-level outcomes.  

Data come from an NIMH-funded randomized trial of TFC in a southeastern state.  The sample included 247 youth and their treatment parents. Data were collected at baseline and every 6 months for 2 years. At baseline, youth displayed an average of 5.8 problem behaviors per day (s.d., 4.8), and had an average score of 86.8 on the Behavioral and Emotional Rating Scale (BERS) (s.d., 15.9), suggesting that this sample resembles other samples of youth in TFC and a nationally normed sample of youth with emotional and behavioral problems.

Total household size ranged from 2 to 9, with a median of 4. For 31% of youth, there were other TFC youth simultaneously living in the home. For these youth in “multi-TFC-youth” homes, 77% included 2 TFC-placed youth, 23% included 3-4 TFC youth. However, TFC-placed youth were not the only youth residing in these homes. In the majority of homes there were at least 2 youth (TFC, regular foster, biological/adopted, etc.) (number of other youth per home ranged from 1 to 6).

Total number of youth in the home was related to target TFC youths’ behavior and strengths. Having more youth in the home (regardless of whether they were foster youth, TFC youth, and/or biological/natural youth of the treatment parents) was related to lower strengths (BERS)  ratings for the focal TFC youth (p<.1). More (regular) foster children in the home was related to higher levels of problem behavior for the TFC youth (p<.05).

In terms of in-home processes/factors, having more youth in the home (TFC or any) was related to less adult-child time together per child. In homes with more total children, treatment parents engage in less perspective-taking (understanding the youth's point of view), but also less adult-child conflict. Ongoing analyses are extending and clarifying these emerging mediating factors.

Findings suggest total number of youth in a home may be related to processes and outcomes in TFC. Current focus in the literature and field has been on number of TFC youth placed in a home. However, results here suggest that total number of youth in the home, regardless of children’s origins or placement type, may minimize the opportunities and gains for TFC youth. These results suggest the need for additional attention to overall child-placing patterns and capacity issues in determining environments that are likely to optimize outcomes for high-risk youth.