Outcomes of an Agency-Developed Treatment Foster Care Model for Adolescents

Background/Purpose: Adolescents constitute a large proportion of youth in foster care, but few foster care models specifically concentrate on their developmental or treatment needs. Treatment foster care (TFC) models probably come the closest to meeting the specific needs of adolescents in foster care and have thus become a lynchpin service for adolescents with serious emotional and behavioral challenges. This research hypothesized a mediation model wherein the effect of age at time of admission on day-to-day functioning at discharge will be mediated by time spent in treatment for adolescents who participate in a TFC model designed specifically for adolescents, Pressley Ridge Treatment Foster Care (PR-TFC).

Methods: This study used administrative data to examine outcomes from 2008-2011 from 16 PR-TFC program sites. Participants included 612 youth ages 11.99-18.91. Youth were included in the study if they had complete data for age, pre-test Child and Adolescent Functional Assessment Scale (CAFAS) score, and post-test CAFAS score. Preliminary analyses were conducted to test if the study variables and covariates presented significant associations at the bivariate level using a Pearson’s correlation coefficient. A Structural equation modeling path analysis was used to test the theoretical mediation model between age at entry, days spent in treatment, and post-test CAFAS score with covariates (race, number of diagnoses, pre-test CAFAS score).

Results: Results indicated that participants who spent more days in treatment (r=-.33, p<.001), had fewer clinical diagnoses (r=.15, p<.001), and had lower CAFAS scores at entry (r=.36, p<.001) had lower CAFAS scores at discharge, indicating better functioning. Results also indicate that participants who were older at time of admission (r=-0.24, p≤.001), who had higher CAFAS scores at entry (r=-0.11, p≤.001), who had higher CAFAS scores at discharge (r=-0.33, p≤.001), or who were European American (r=0.09, p≤.05) were likely to spend fewer days in treatment. At the multivariate level, we found a statistically significant association between age at time of entry and CAFAS scores at discharge, indicating that older youth were more likely to have better functioning at discharge than younger youth. As hypothesized, there was a significant, positive indirect effect of age at entry on CAFAS score at discharge through days spent in treatment. In addition, there was a significant negative indirect effect of covariates race and positive indirect effect of pre-test CAFAS on post-test CAFAS through days spent in treatment.

 Conclusions/Implications: Findings indicate that, overall, youth in PR-TFC treatment typically improve in day-to-day functioning as they age, and youth who enter the PR-TFC homes at an older age generally function better at discharge than younger youth who stayed comparable amounts of time. The clinical importance of these findings is highlighted by the decrease in CAFAS scores from entry to discharge from 92.97, which is above the clinical threshold of moderate impairment (90), to 69.81, which is well within the range of moderate impairment (50-90). The fact that youth who enter PR-TFC at an older age tend to do better in terms of day-to-day functioning at discharge contradicts popular opinion and a large faction of research in the field.