Therapeutic Foster Care to Reduce Violence

Research Gaps

Prior to and during the literature review and data analysis, the review team and the Community Preventive Services Task Force attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as "research gaps." Research gaps can be pulled together in the form of a basic set of questions to inform a research agenda for those in the field.

Identified Research Gaps

Effectiveness

Cluster therapeutic foster care for children with severe emotional disturbance. Evidence on the effects of cluster therapeutic foster care for pre-adolescent children with severe emotional disturbance was insufficient to determine their effectiveness (for the reduction of violence). Only two studies of this form of therapeutic foster care assessed violent outcomes. The studies we reviewed suggest either no effect or, for girls, possible harm. Further research on the effectiveness of therapeutic foster care with this and other child and adolescent populations would clarify other possible benefits (or harms) of this intervention. Follow-up studies should determine short-term as well as long-term effects.

Program-intensive therapeutic foster care for adolescents with a history of chronic delinquency. The evidence we have reviewed indicates a benefit of therapeutic foster care for the reduction of violence in adolescent populations with a history of chronic delinquency. As indicated earlier, the population that might benefit is a large one. Given such a large potential need, it will be useful to conduct research, perhaps in the form of demonstration projects, to make the intervention more effective or efficient. Because the foster care programs in current use are heterogeneous and differ in content, organization, personnel, intensity, and other characteristics, questions that should be addressed regarding the effectiveness of therapeutic foster care for the prevention of violence include the following:

• Are there populations of juveniles for whom therapeutic foster care works best?
• Which program components work best with which populations?
• Which program components are essential, which dispensable?
• What is the optimal intensity and duration of the program?
• Are there circumstances in which therapeutic foster care does not work, or in which additional intervention is necessary (e.g., with abused juveniles)?
• What characteristics of foster families are associated with greater program effectiveness?
• What community factors are essential for program success?
• How would therapeutic foster care compare with programs more effective than group residential treatment with which therapeutic foster care is usually compared?
• What after-care (post-discharge) conditions and services would promote the optimal sustained program gains?

Applicability

The studies examined to determine the effectiveness of therapeutic foster care for adolescents with chronic delinquency were conducted by a single established research center in one region of the United States. The applicability of findings to similar interventions implemented by others in other geographic areas is unknown. In addition, the effectiveness of therapeutic foster care programs for the prevention of violence among juvenile populations with other problems is unclear. The body of evidence was sufficient to determine effectiveness only for the target population of adolescent youth with a history of severe, chronic delinquency.

The effectiveness of therapeutic foster care among female populations is less clear than for males. The effects of therapeutic foster care may vary by gender, indicating a need to modify programs to accommodate such differences.

Of the studies assessed in our review, most did not include information on the race or ethnicity of participants. Of those that did provide such information, the majority of participants were white. It is still unclear whether other racial or ethnic populations would benefit as did the populations studied, and whether modifications of the intervention, (e.g., employing foster parents of the same ethnicity as the youth in the program), would enhance success for these populations.

More research is needed to determine effectiveness among children with severe emotional disturbance and among other populations, such as mentally retarded children, children who have been sexually abused, and children with AIDS, for whom foster care may be a viable alternative to other treatment options.

Evidence review

Hahn RA, Bilukha O, Lowy J, et al. The effectiveness of therapeutic foster care for the prevention of violence: a systematic review. Am J Prev Med 2005;28(2S1):72-90.