Improving Opportunities for Transition Age Youth: Service Provision in TFC

Background: Transition-aged youth with mental health problems and/or foster care experience are at elevated risk for poor outcomes in adulthood.  Working at the intersection of mental health services and child welfare, Treatment foster care (TFC) has a unique opportunity to increase opportunities for positive transitions and adult outcomes for such youth. TFC is a family-based mental health treatment option that provides intensive treatment and opportunities for community-based development for youth with emotional/behavioral disorders. Although TFC has been shown to be effective for many youth, less is known about transition-aged adolescents who are at risk of “aging out” of the child-serving system. While independent living services are required for older youth in foster care, TFC’s straddling of the mental health/child welfare system creates added complexities and possibilities but has received limited research attention. Given the potential of TFC to provide a framework and critical time period to increase opportunities and reduce inequalities via transition-focused services, it is important to understand how/whether this is occurring to examine current practice, potential benefits, and opportunities for improvement.

Methods: Data come from a larger NIMH-funded study of TFC (Farmer, et al., 2010; Farmer & Lippold, 2016). Of the 247 youth enrolled in the overall study, 126 who were 14-17 at the time of admission form the focal sample for the proposed presentation. Data were collected at baseline, every 6 months while the youth was in TFC, and for up to 24 months after discharge. Post-discharge data were collected on nearly 80% of enrolled youth.

Results: Results show high rates of mental health problems and trauma (95% with at least one DSM diagnosis, and 75% had experienced child maltreatment). Data from youth suggest both optimism and fear around future success. Treatment parents were more guarded in their projections for success – they thought that 47% of the youth were “very likely” to graduate from high school, 15% were similarly likely to go to college, only 17% were very likely to be able to live/sustain themselves independently as adults, etc. However, they also were optimistic that services provided within TFC could increase odds of positive outcomes. Provision of transition-focused instruction, however, was not maximally delivered [e.g., fewer than half received instruction on learning to drive (39%), applying for a job (41%), using a bank (47%), or how to find a place to live (31%)]. Analyses suggest that relationships between the treatment parents and the transition-aged youth were one of the strongest predictors of more positive outcomes for youth and that additional training and supervision for treatment parents resulted in better implementation of desired services.

Implications: TFC remains a well-regarded and heavily utilized treatment setting for older youth. Data suggest that treatment parents are well aware of the potential challenges for youth with whom they work and that youth benefit tremendously when they develop strong relationships with treatment parents.  There are tremendous opportunities for TFC to more fully implement transition-preparation approaches and foci into the intervention to improve youths’ preparation and likelihood of success.