Hannah Donor

Ultimate Guide to Becoming a Treatment-level Foster Parent Among the many types of foster care provided by compassionate individuals in Missouri is a specialized form of care known as Treatment Foster Care (TFC). The foster parents who take in children and youth for TFC are among our hardest-working and most passionate care providers, experiencing some of the most fulfilling outcomes and making a difference in the lives of the youth who need it most. In this e-book, you’ll learn all the ins and outs of TFC, from the day-to-day responsibilities of treatment-level foster parents to the unique needs of youths in this program as well as how you can become a TFC provider. What is Treatment Foster Care? Treatment Foster Care (TFC) is a short-term program that combines foster care with the kinds of clinical treatment a youth may experience in a residential setting. Youths in the TFC program have access to a full team supporting the youth toward success with the goal of setting them up for permanency and stabilization in the community. Usually, a TFC placement is not a child’s first foster care placement. The youth may be at risk of disruption from their current placement or being placed in a residential treatment facility. “TFC is our final effort to really stabilize that child in a community-based setting—in a home environment,” says Jessica Elliot, Senior Director for KVC Missouri’s Child Placing Agency. “We want to do everything possible to keep these kids out of residential whenever it’s safe to do so.” Treatment vs. Traditional Foster Care The main difference between what you may typically think of as foster care and treatment-level care is the youths and families we serve. Youths who qualify for the TFC program tend to have very high needs. They may be coming out of multiple disrupted placements and at risk of entering a residential facility or even coming out of a residential facility and in need of support reintegrating into the community. The ultimate goal is to help that youth stabilize in whatever form that takes, whether reunification with their biological family or transitioning to an independent living program. Another unique aspect of TFC is that this program helps support youths in almost any setting. The youth may be in foster care, a relative placement or even in their biological home. Regardless of the setting, the youth will receive clinically focused treatment planning and safety planning alongside their TFC provider, giving them the tools they need to stabilize in the community. How Long is a TFC Placement? The length of a TFC placement varies depending on medical necessity as determined by insurance. When KVC considers a youth eligible for TFC, we provide clinical documentation to the youth’s insurance, which determines medical necessity and applies a timeframe to meet that child’s needs. This could be anywhere from 90 days to 120 days or more. While this program is designed to be short-term and focused on helping the youth achieve stability and permanency in the community, the youth’s TFC Specialist (TFCS) at KVC Missouri may submit further documentation to request an extension if needed. Types and Levels of Treatment Foster Care When a youth qualifies for TFC, insurance assigns them as either Level One or Level Two, which determines the intensity of care they will need. The main difference between these levels is that youths assigned Level One receive two visits per month from their TFCS whereas those assigned Level Two (who one of our CPA Directors affectionately refers to as “spicy”) receive weekly home visits. These levels can also help a TFC provider better understand what to expect with a youth placed in their care and work alongside KVC Missouri to decide whether that youth is a good fit for their home. There are also a few different types of TFC related to how a child enters the program: Relative Care In a relative care setting, the youth stays in the care of a relative or known adult (family friend, teacher, etc.) while going through the TFC program. Foster parents in this situation receive the exact same support and pay as other TFC providers since they are providing the same service and intensity of care that a non-related TFC provider would. Child-Specific TFC This form of TFC is unique because it doesn’t involve the child being removed from their current living situation and placed in a separate foster home. Regardless of whether the child is currently in a traditional foster home or in their biological home, the youth and their family will receive the services and support of the TFC program without experiencing disruption. Transitional TFC When a family is ready for reunification after foster care or a residential facility but the youth still has high needs that qualify for treatment-level care, that family can receive TFC-level services to help that youth remain in the home. Typical Needs of Youths in TFC The needs of youths in the TFC program vary greatly and are supported by individualized, evidence-based treatment planning through KVC Missouri. “We have kids who are struggling in multiple domains,” says Elliot. “They may be struggling in school, at home or in the community and really can benefit from that higher level of care and having an additional player on the team so it’s not just their foster parent, it’s not just their case manager, it’s really a full team that’s supporting that youth in being successful in their home.” In terms of the needs met by their treatment-level foster parent, these are largely social and emotional needs. Tamara Moore, Director of KVC Missouri’s Child Placing Agency for the eastern region, emphasizes the importance of providing these youth with unconditional love and support. “We service a lot of youths who have been through traumatic situations that have hindered their ability to be as fully resilient as people who haven’t experienced those adverse experiences,” explains Moore. Youth in TFC need a sense of stability and security in their placement, giving them a sense that their foster parent won’t give up on them and that they can still move forward and improve after making poor choices or mistakes. Misconceptions About TFC Just as with traditional foster care, there are many misconceptions about how TFC works and what it’s like to be a treatment-level foster parent. Here are some of the most common assumptions and questions we receive about TFC: MYTH: “Foster parents do TFC because it pays well.” FACT: TFC pays more than traditional foster care because it is hard work. Becoming a TFC provider involves a lot more responsibilities and expectations than any other form of foster care. Foster parents providing TFC are held to a contract and a much higher standard, providing truly round-the-clock care. TFC is extremely taxing on a family, taking them through the highest highs and the lowest lows, so no family is out there doing it for the wrong reasons! MYTH: “Teens in treatment-level care are set in their ways.” FACT: These teens are not beyond help! The whole vision behind TFC is based on the fact that these teens are not beyond help and are capable of being successful. Youths would not be in this program if they were so set in their ways they could not be helped. Because TFC placements are short-term, what the youth needs may not be a “parent.” What they need is support on a less authoritative level. They need stable care from someone who can act as a mentor or a teacher and they may or may not want the mom/dad relationship as well. MYTH: “TFC Providers have no say in the placements they receive.” FACT: It’s a mutual selection process! Before a youth is placed in the home of a TFC provider, our team will have thoughtful conversations about whether the child will be a good fit for that provider’s home—a process we call “mutual selection.” Amanda Everson, Director of KVC Missouri’s Child Placing Agency for the Western Region, says that this is one of the most common misconceptions she hears from prospective foster parents, and she wants everyone to know that it’s not true! We understand that youths in the TFC program have high needs and may not always be the right fit for a given TFC foster home. “We will have those conversations prior to a placement happening,” says Everson. “We’re not just going to drop kids off at your house!” MYTH: “KVC decides whether a youth qualifies for TFC.” FACT: TFC must be deemed medically necessary by insurance. Some foster parents may have youths with high needs that they believe should receive TFC, but the decision is ultimately not up to KVC Missouri—it is determined by the youth’s insurance provider, who provides the funding for the treatment piece. If we believe a child is a good fit for the TFC program, we submit clinical documentation to the insurance provider who determines whether to authorize or deny treatment. Additionally, insurance decides whether the youth is Level One or Level Two. Qualifications/Requirements for TFC Providers First and foremost, all TFC providers must first meet the basic qualifications to become a foster parent in Missouri: ●​ INSERT QUALIFICATIONS HERE FOR ALL FOSTER PARENTS Training Requirements For foster parents interested in becoming a TFC provider, there are several other requirements, mostly revolving around training: ●​ 27 additional hours of training focused on preparing them to support children with elevated needs ●​ 10 Continued Education Hours in addition to the 30 required by traditional foster parents. These hours should be based specifically on the unique needs of the youth in their home. ●​ Quarterly Trainings with KVC for TFC providers focused on parenting and supporting youths with trauma. Availability Requirements TFC providers need to have very flexible schedules at all times to be available when the youth in their care needs them. “Historically, the state required at least one parent to be a stay-at-home parent, however, we have gotten flexible with that,” says Everson. The intent behind this requirement was that a parent needed to always be available in case something unexpected happened with the youth during the day, such as school suspension. This requirement has become more relaxed, instead requiring a parent to have a flexible enough schedule to be able to accommodate the youth’s needs as they may arise. This could look like having a job where the parent can leave unexpectedly in the middle of the day, or it could even mean building out a support network of trusted individuals on standby for pickup when the parent is unable to leave work. Bonus “Qualifications” While not requirements, there are a few other experiences and backgrounds that may make you even better prepared to be a TFC provider. If you fit any of these categories, you could be a good fit to become a treatment-level foster parent: ●​ Previous experience as a foster parent (in Missouri or another state) ●​ An academic background in psychology or a related field ●​ Experience with special needs youth (especially your own children) ●​ LGBTQ+ affirming (or even a member of the LGBTQ+ community!) Day-to-Day Responsibilities of a TFC Provider: The daily responsibilities of a TFC provider are in a lot of ways the same as any other parent or foster parent. A TFC provider is responsible for seeing to the physical and emotional support needs of the youth. You are their caregiver, their first line of support, their transportation coordinator and their greatest advocate. Some of the more technical routine responsibilities include: ●​ Managing appointments which may include occupational/physical/behavioral therapy, medical appointments and parental visits ●​ Partnering with the youth’s support team from the family support team (case managers, attorneys) to the regular meetings with their TFCS ●​ Availability for midday school pick-up Connection before Correction Your role as a TFC provider is primarily to be a support system, not a disciplinarian. On good days, there may not be many differences to just having an additional youth in your care. By building in time to connect with the youth in your care, the difficult days will be easier to de-escalate and provide guidance as the relationship will already be present. This unconditional support and patience isn’t always easy. As Moore explains, “It’s hard to pour love into somebody who will at times throw it back at you and make it seem like they don’t care about it. It’s at those times that you persevere through that and continue to show that unconditional love that really breaks the barriers.” We understand this is a lot for one person or one couple to handle, which is why KVC Missouri is there with an incredible support team to back you up every step of the way! Partnering with the Support and Treatment Team Partnering with the youth’s support and treatment team ultimately means working hand-in-hand with anyone involved in the youth’s care and treatment. This includes their TFCS, case managers, legal advisers, therapists, doctors and even biological parents. As a TFC provider, you are the best equipped to advocate for the youth in your care regarding their treatment, legal proceedings and anything else dictating their case. Being an advocate means attending all of their meetings and either attending court with them or submitting a letter on their behalf if you are unable to attend court. When advocating for the youth in court, we always encourage using the sandwich method: start with the good (what’s going well), follow this with the struggles (what’s not going well) and end with how we’re working through those barriers. Additionally, TFC providers should attend IEPs for the youth in their care to help them find academic success. Resources and Support Provided by KVC Missouri KVC Missouri partners with our TFC providers every step of the way so you’re never on this path alone! We provide FREE evidence-based training both prior to a foster parent’s first TFC placement and ongoing throughout the calendar year to cover relevant topics for families. Our TFC Specialists are prepared to coach foster parents and help them address the specific needs of the youth in their care as well. 24/7 On-Call Support One of the greatest resources KVC Missouri provides with this program is 24/7 on-call crisis support. “It’s beneficial not only for kids with behaviors but also the parents and foster parents having to navigate those behaviors to be able to call us and have help with verbal de-escalation and navigating situations,” says Moore. “Knowing that you have someone there to support you and your youth 24/7 is a really beneficial and impactful piece of our program.” Just as you are the youth’s biggest advocate, KVC Missouri is your biggest advocate when it comes to case managers and other agencies. Your TFCS will also help you by intentionally staying connected and providing support as often as needed, including connecting you with external resources like therapists and evaluations. Continued Success Meetings As a foster parent, you may sometimes feel like you don’t get to decide when the youth’s support team meets, but that is not the case! Continued Success Meetings are a special support team meeting that can be requested by the foster parent to discuss any difficulties or barriers they are facing and need to collaborate with the TFCS, case manager and other members of the child’s support network on. Foster Family Networking It truly takes a village, and one thing we love to do is help our foster parents build theirs! Through foster parent appreciation events, the trainings we offer and both in-person and virtual support groups, KVC Missouri offers multiple opportunities to connect with other foster families who may be going through similar situations and able to offer insights, advice or just an empathetic listening ear. Financial Support and Other Benefits We understand how much more intense it is to be a treatment-level foster parent, which is why our TFC providers receive the highest level of compensation of any foster home in Missouri! In addition to this, our advancement team works hard to ensure every family has the resources they need to provide for the children in their care, from back-to-school supplies to holiday gifts. TFC providers also receive more vacation time and respite care than other foster families, with two week of vacation every calendar year and 48 hours of respite care each month. Therapeutic Techniques and Strategies A big distinguishing feature of treatment-level care is the clinical, therapeutic approaches implemented in the home setting. These techniques are all grounded in evidence-based trainings that all KVC Missouri TFC Specialists go through, but the application of these strategies looks different for each child. Every youth has a different story and unique needs, which is why our specialists provide foster parents with individualized solutions to better support the child in their care. Here are some of the therapeutic approaches we draw from to tailor treatment to each child in the TFC program: Together Facing the Challenge There are only two evidence-based models for treatment-level foster care in the nation, and Together Facing the Challenge (TFTC) is one of them! KVC Missouri is certified to provide this trauma-informed model both as a pre-service training for families and to equip TFC Specialilsts to coach families through situations as they arise for effective treatment in the home. By educating provideres and specialists alike on key behavioral theories, core TFTC practices and effective in-home interventions, TFTC is an approachable and effective approach to treatment-level foster care that not only equips our providers to care for their children, but also provides ongoing, child-focused support. Trust-Based Relational Intervention KVC Missouri has multiple Trust-Based Relational Intervention (TBRI®) practitioners on staff and ready to provide additional training as well as in-home consultation with this evidence-based training. This trauma-informed, attachment-based intervention is comprised of three elements targeting the needs of vulnerable children like those experiencing TFC: ●​ Empowering Principles for physical needs, ●​ Connecting Principles for attachment needs, ●​ and Correcting Principles to disarm fear-based behaviors Other Curriculums Because no two children (or families!) are alike, we are constantly educating ourselves and our TFC team on the best curriculums and interventions to care for vulnerable children in Missouri. Here are a few other curriculums we often pull from: ●​ Resource Parent Curriculum by The National Child Traumatic Stress Network ●​ CORE Teen ●​ Other Curriculums for TFC Specialists to use with TFC providers in the home: ○​ Resource Parent Curriculum (through National Traumatic Stress Network) ○​ Core Teen (?) Success Story: Success After Disrupting Tamara Moore has seen countless impactful success stories come out of the TFC program, even from seemingly impossible situations! Moore shared the story of one youth she worked with back when she was a foster care supervisor. This 16-year-old teen had been in a stable foster care placement for nearly two years and considered his foster parent his mom when it abruptly disrupted after he did something illegal that became the breaking point. Faced with the loss of stability and possible legal ramifications, he was on the path to in-patient treatment when a TFC provider took a chance on him. The unconditional, positive support this young man received from his treatment-level foster parent gave him just what he needed to make it through some very trying times, and he moved on from there to be very successful in an independent living program! “It took one person to come in for suh a short amount of time and show him unconditional love and support to truly launch him into that next phase of adulthood,” shares Moore. Nowadays, that teen who had everyone give up on him is doing well and maintains a positive relationship with the TFC provider who gave him a home and a source of support in his time of need. Considering Becoming a TFC Provider? The children and youths who end up in the TFC program have had a lot of people give up on them in their lives. In a lot of cases, they have experienced multiple placements and been taught through their circumstances that relationships aren’t important and people don’t care about them. As a TFC provider, you have the opportunity to show these children they are worthy of love and that there are people in this world who will stick it out for them. You’re coming alongside these children and saying, “We’re not going to give up on you, no matter what.” Giving these youths a chance to build a real relationship with you and learn how to have a healthy relationship doesn’t just set them up for success in your household, but in every relationship they have moving forward into adulthood! How to Get Started as a TFC Provider If you’re interested in learning more about becoming a treatment-level foster parent in Missouri, we’d love to talk with you about our program! Contact a foster parent recruiter to get started, but we also urge you to continue educating yourself on treatment foster care. Take a look at the trainings we provide, read stories of children and families in the program and similar programs around the country and remember that you’ll never be in it alone—you have a huge support network with you every step of the way! “We have the absolute best treatment foster care workers and supervisors who love this work and are so passionate and really go above and beyond the call of duty,” says Elliot. “They get just as invested in having success with families and youth.” Feel free to reach out and ask for opportunities to talk with TFC Specialists and providers who can share more personally what they’ve learned and experienced as part of treatment-level care. Not Ready to Take the Leap? Become a Respite Care Provider! If you’re not quite ready to commit to being a TFC provider but still want to get involved, we also need respite providers who are trained to take on TFC respite! This is the perfect opportunity to test the waters and see if this is something you’re ready to take on for more than a day or two. Becoming a TFC-certified respite care provider only requires an additional eight hours of training, and you’ll become an essential resource for the families doing this difficult work!