Therapeutic Foster Care to Reduce Violence
Therapeutic foster care is used to describe two distinct forms of treatment.
- One form, that we refer to as “program-intensive therapeutic foster care” is an alternative to incarceration, hospitalization, or other forms of group and residential treatment for adolescents with a history of chronic antisocial behavior, or delinquency.
- Another form, that we refer to as “cluster therapeutic foster care” is provided to children with severe emotional disturbance (SED), most often by “clusters” of foster families that cooperatively care for a group of children.
Summary of Task Force Recommendations and Findings
The Community Preventive Services Task Force recommends therapeutic foster care for adolescents ages 12-18 with a history of chronic delinquency based on sufficient evidence of effectiveness in preventing violence among this population.
There is insufficient evidence to determine its effectiveness for preventing violence among children with severe emotional disturbance because of too few studies with inconsistent findings.
About the Interventions
In both types of therapeutic foster care, participants are:
- Placed for several months in foster families who are specially trained and compensated for their work
- Provided a structured environment where they are rewarded for positive social behavior and penalized for disruptive and aggressive behavior
- Separated from their delinquent or troublesome peers and provided close supervision at school and at home
Results from the Systematic Review
“Program intensive” therapeutic foster care for reduction of violence by chronically delinquent adolescents
Three studies qualified for the systematic review.
- Therapeutic foster care for chronically delinquent adolescents was found to reduce violent crime by approximately 71.9%, when compared with similar youth in standard group residential treatment facilities (3 studies).
- Participants were 12-18 years of age.
- Average duration of these programs was 6-7 months.
- Net benefits (i.e., benefits minus costs) of program intensive foster care for this population ranged from $20,351 to $81,664 per youth. It is estimated that, for every dollar invested in therapeutic foster care, approximately $14 are saved in justice system costs (one study).
“Cluster” therapeutic foster care for the reduction of violence by children with severe emotional disturbance
Two studies qualified for the systematic review.
- Study 1 outcomes: Compared a cluster therapeutic foster care intervention (called a parent-therapist program) to group residence for the treatment of SED among youths aged 6-12 years.
- Change in conduct disorders: 31.3% increase for girls and a negligible effect (a 0.2% decrease) for boys
- Study 2 outcomes: Effects of New York State's version of cluster therapeutic foster care, Family-Based Treatment, on externalizing behavior among children aged 6-13 years with SED
- Change in externalizing behavior among children: increase of 2.5%
These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to therapeutic foster care.
- Analytic Framework - See Figure 1 on page 76 [PDF - 206 kB]
- Evidence Gaps
- Summary Evidence Table [PDF - 49 kB]
- Included Studies
Hahn RA, Bilukha O, Lowy J, et al. The effectiveness of therapeutic foster care for the prevention of violence: a systematic review. [PDF - 206 kB] Am J Prev Med 2005;28(2S1):72-90.
Task Force on Community Preventive Services. Recommendations to reduce violence through early childhood home visitation, therapeutic foster care, and firearms laws. [PDF - 71 kB] Am J Prev Med 2005;28(2S1):6-10.
Task Force on Community Preventive Services. Violence. [PDF - 340 kB] In : Zaza S, Briss PA, Harris KW, eds. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press;2005:329-84.
Read other Community Guide publications about Violence Prevention in our library.
The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.
The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Therapeutic foster care to reduce violence. www.thecommunityguide.org/violence/therapeuticfostercare/reduceviolence.html. Last updated: MM/DD/YYYY.
Review completed: June 2002
- Page last reviewed: March 20, 2014
- Page last updated: March 20, 2014
- Content source: The Guide to Community Preventive Services