Exploring Therapeutic Foster Care

by Valarie Edwards

Each morning, Richmond, Virginia resident Patrice Hazelwood rises before 5 to spend about an hour in prayer and meditation. The stillness of early mornings are “me-time” for the foster and adoptive mother who is also an independent caregiver to adults with learning disabilities.

This April marks two years since Hazelwood became a licensed therapeutic foster parent, after decades as a traditional foster caregiver to nearly three dozen children. She’s able to provide her 10-year-old son — the first child to come to her home under her therapeutic treatment license — with specialized one-on-one care while separated from his first family. Like most boys his age, Hazelwood’s son is a fan of Minecraft. He’s adjusted to his new surroundings and the pair have settled into a routine that fits them both with few bad days.

“He likes to relax and likes to know where I am at all times,” said Hazelwood. “He’s funny and not a behavior problem at all. Real respectful, very loving. We may have some things where he can be persistent that he might want to do, but that’s not a norm. We talk about it and I’ll give him space and he normally comes back around and, it kind of moves on.”

Therapeutic Versus Traditional Foster Care

While therapeutic foster care and traditional foster care are similar in that both are temporary as they prepare children either for reunification, adoption or independent living, the two differ in three critical areas:

  1. Children assessed eligible for therapeutic foster care have severe emotional, behavioral or medical needs and require specialized care in a community setting;
  2. Therapeutic foster care providers receive specialized training over and above training required for traditional foster parents;
  3. Families usually care for one child at a time, unless breaking up a sibling group poses a detriment to the child in treatment.

“There’s a lot of support in treatment foster care I didn’t necessarily get with traditional care,” said Hazelwood. “To be able to have a therapist and a counselor pretty much involved every other week — they’re able to direct me to resources if he needs help, without having to wait a month or more for a referral.”

Team Focused

At the state level, children who enter care in the Commonwealth of Virginia, are assessed by caseworkers who determine if they are eligible for treatment foster care. At the community level, agencies like United Methodist Family Services, conduct nearly 30 hours of instruction for potential resource parents. Training covers adolescent issues such as behavioral interventions, learning disabilities and understanding childhood sexual abuse. A self-assessment upon completion of training allows potential therapeutic foster parents to decide for themselves if treatment foster care is for them.

United Methodist Family Services, founded in 1900, offers an array of services, including traditional foster care services, adoption and post-adoption services as well as therapeutic foster care services. The group currently has more than 100 therapeutic families on its roster of resource families, all of whom are trained to see behind the behaviors. Parents and children have 24-hour access to the agency’s services and caseworkers.

“We’ve trained our parents to know what a true emergency is, and we’ve equipped them to be able to handle some of the issues just in terms of day-to-day parenting. So if they’re calling us, it’s an emergency,” said Jewel Cooper, director of United Methodist Family Services’ Tidewater Regional Center in Virginia Beach.

Parents at United Methodist Family Services also receive instruction addressing the after-affects of sexual abuse. Cooper estimates nearly 90% of the group’s children have been sexually abused. Subsequently, parents are trained to assume sexual abuse, until it’s been disproven.

For children with learning disabilities, treatment foster care is available using a behavioral intervention called collaborative problem solving. “It’s where we teach our parents how to demonstrate to our kids how to solve problems,” said Cooper, a former special needs adoption social worker.  “We take one issue at a time and work on that one issue before we move forward to the next. Because if you’re trying to address several things at one time, you’re not gonna get it.”

Following the initial assessment and using a team-based approach — including resource parents and biological parents whenever possible, therapists and caseworkers — a course of treatment is chosen and the length of stay determined, although children can stay in treatment until they achieve independence if necessary. Physical therapy and educational support is also available.

Lack of Guidelines, Resources

Central to therapeutic foster care is serving children and families, said Ryan Dowis, executive director of New-Jersey based Family Focus Treatment Association, a national organization focused on promoting best practices for “policies that support families in their care and treatment for children.”

“One of the most significant positives that come from therapeutic foster care is placement stability, providing support to the families and limiting caseloads for staff who are doing the work,” Dowis said. “When you put those things together, youth are more likely to stay in placement, they’re connected to (biological) family, a stable education and they’re able to maintain relationships.”

While experts agree therapeutic foster care is preferable to and more effective than in-patient or congregate care, defining therapeutic foster care and the services to be provided, is difficult because of the absence of federal guidelines.

States are paralyzed, unable to design a program which addresses the emotional needs of kids in care, said Dowis. “What’s most concerning to me is that there are kids who need the services and can’t access them,” said Dowis. He said some states are hesitant to design a therapeutic foster care program because they’re unsure they’ll have access to federal dollars to pay for the more costly program.

And while most states offer some form of therapeutic foster care, a critical shortage of resources means children most in need are missing out.

A 2018 report from the U.S. Department of Health and Human Services reveals a lack of potential parents willing to invest time in training beyond what’s required for traditional resource care leading to a dearth of available homes. There’s also a shortage of case managers with the “skills, qualifications, and flexibility needed for the role.”  Finally, budgetary constraints means not all states can afford to provide therapeutic foster care. California is one notable exception. The state relies on its self-funded Medi-Cal program to provide therapeutic foster care for children younger than 21.

The Evolution of Therapeutic Foster Care

In 2022, Sen. Tammy Baldwin (D-WI), introduced a measure to change the purpose and name of therapeutic foster care to treatment family care. Under the bill, Dowis said support would extend to fictive, adoptive and kinship caregivers providing behavioral and mental health services. Children and families would be served in placing rather than removing the child to foster care. The bill made it to the Senate Finance Committee but failed to gain traction on the Hill.

If the current Congress takes it up and it’s passed, Dowis believes states that don’t currently offer therapeutic foster care might be encouraged to sign-on to treatment family care. “It sounds nuanced, but it’s significant because it says a set of core services can work in other families as well, and we should make those services available to improve well-being and mitigate trauma,” Dowis said, adding that with a national definition, agencies would have the freedom to design something that works for them.


Valarie Edwards is the assistant editor for Fostering Families Today. She and her sisters spent nearly a dozen years in foster care. Nominated for an Emmy and the recipient of numerous journalism awards, Edwards is an alum of UC Berkeley’s Graduate School of Journalism.