T3C Treatment Foster Family Care Support Services
Continuous Quality Improvement Model
Intensive Treatment Package-Specific CQI Process per T3C Blueprint Requirements
Treatment Foster Care CQI Framework
This CQI model is specifically designed for monitoring and improving intensive therapeutic services for children with serious emotional and behavioral disorders.
Builds upon Basic and Mental Health CQI processes with intensive clinical quality metrics, behavioral support monitoring, and 90-day review cycles.
Treatment Foster Family Care Support Services CQI Cycle
PLAN
Beginning of 90-Day CycleTier 1-2 (Basic/MH):
- Review Logic Model
- Set TBRI®-aligned goals
- Schedule therapy services
TFC-Specific:
- Plan intensive therapy (weekly minimum per T3C p.137)
- Develop intensive behavioral intervention plans (PBIS/FBA)
- Schedule psychiatric consultations
- Plan crisis prevention strategies
- Set behavioral data collection protocols
- Review maximum 2-child-per-home compliance
DO
Days 1-75Tier 1-2 (Basic/MH):
- Implement TBRI® daily
- Provide therapy services
- Document services
TFC-Specific:
- Deliver weekly individual therapy (minimum)
- Conduct family therapy with intensive focus
- Implement behavior support plans (1:6 specialist ratio)
- Execute Functional Behavior Assessments
- Provide 24/7 crisis response with therapist on-call
- Monitor psychiatric medications daily
- Collect behavioral data continuously
STUDY
Days 76-85Tier 1-2 (Basic/MH):
- Analyze data
- Review CANS results
- Identify trends
TFC-Specific:
- Review 90-day CANS 3.0 with behavioral focus
- Analyze behavioral incident data trends
- Assess crisis intervention effectiveness
- Evaluate therapy attendance and progress
- Review medication effectiveness and side effects
- Assess step-down readiness criteria
- Calculate length of service (max 365 days)
ACT
Days 86-90Tier 1-2 (Basic/MH):
- Adjust service approaches
- Update plans
- Enhance training
TFC-Specific:
- Modify intensive therapy frequency/modality per clinical need
- Update behavior support plans with FBA data
- Adjust crisis protocols based on incident analysis
- Coordinate psychiatric medication adjustments
- Plan step-down to Mental Health or aftercare
- Document Treatment Director 90-day review
- Complete Program Director confirmation (15-day)
Treatment Foster Care
Logic Model
TBRI® Foundation
+ Intensive Clinical
+ Behavioral Support
90-Day Review Cycle
Treatment Foster Care CQI Timeline
Beginning of 90-Day Cycle
Program Director, Treatment Director, QA Team
- • Review TFC service delivery
- • Set intensive treatment targets
- • Plan intensive therapy schedules
- • Develop behavioral intervention plans
- • Schedule psychiatric consultations
- • Review crisis protocols
Days 1-75
Therapists, Behavior Specialists, Case Managers, Foster Parents
- • TBRI® implementation
- • Weekly individual therapy (minimum)
- • Family therapy sessions
- • Behavioral interventions (1:6 ratio)
- • FBA implementation
- • 24/7 crisis management
- • Medication monitoring
Days 76-85
QA Coordinator, Treatment Director
- • Compile intensive therapy data
- • Analyze CANS 3.0 results
- • Review behavioral data trends
- • Assess crisis interventions
- • Evaluate medication compliance
- • Determine continued stay
- • Assess step-down readiness
Day 86-90
Full TFC CQI Team
- • Intensive treatment team meeting
- • Review all clinical outcomes
- • Adjust intensive treatment plans
- • Modify therapy frequency
- • Update behavioral plans
- • Plan step-down/aftercare
- • Treatment Director review
Treatment Foster Care CQI Metrics
| Logic Model Component | TFC-Specific Metrics | Target/Threshold | Review Frequency |
|---|---|---|---|
| TBRI® Implementation | • Staff TBRI® Practitioner competency in intensive context • TBRI® fidelity in intensive therapy sessions • Treatment foster parent TBRI® application scores • Crisis de-escalation using IDEAL Response® | ≥90% competency Documented in all sessions ≥85% fidelity 100% utilization | Quarterly assessment Monthly review |
| Intensive Therapeutic Services | • Weekly individual therapy attendance (vs as-needed Basic) • Family therapy participation (intensive focus) • Group therapy engagement • Psychiatric consultation frequency • Licensed Therapist ratio (1:11) | 100% weekly minimum Bi-weekly minimum As clinically indicated Monthly minimum Maintained | Weekly monitoring Monthly review |
| Behavioral Support Services | • Functional Behavior Assessments completed • Behavior support plan implementation fidelity • Behavioral incident frequency trends • Behavior Specialist ratio (1:6) • In-home coaching contacts | 100% for target behaviors ≥90% fidelity ≥40% reduction in 90 days Maintained Weekly minimum | Weekly data Monthly analysis 90-day comprehensive |
| CANS 3.0 Assessment | • 90-day CANS completion (vs 6-month Basic) • Behavioral/emotional domain improvements • Risk behavior reductions • Life functioning improvements • Treatment response indicators | 100% on time ≥20% improvement Significant decrease Measurable gains Clinical progress | Every 90 days |
| Crisis Management | • Crisis intervention frequency • Response time to crisis • Therapist on-call consultation utilization • De-escalation success rate • Psychiatric hospitalization rate • Crisis Staff ratio (1:25) | Decreasing trend (≥75%) <1 hour 100% availability ≥85% ≤1 per year Maintained | Weekly tracking Monthly analysis |
| Medication Management | • Medication compliance rate • Medication effectiveness assessments • Side effect monitoring and documentation • Psychiatric follow-ups • Medication adjustments based on data | ≥90% Monthly evaluations Daily checks documented Monthly minimum Data-driven | Daily monitoring Weekly/Monthly review |
| Treatment Foster Home Parameters | • Maximum 2 children per home compliance • Weekly case manager contact (1:6 ratio) • Treatment foster parent training (50+ hrs) • Respite utilization rates • Foster parent satisfaction/retention | 100% compliance 100% weekly contact 100% completion As needed/available ≥85% satisfaction | Monthly verification Quarterly assessment |
| Length of Service | • Average length of service tracking • Maximum 365-day compliance • Step-down readiness assessment • Transition planning timelines • Aftercare service engagement | Tracked per child 100% within maximum By 9 months 60 days prior 100% at discharge | Monthly tracking Every 90-day review |
| Treatment Director Review | • 90-day continued stay reviews • Written confirmations within 15 business days • Step-down recommendations • Treatment effectiveness evaluation • Clinical oversight documentation | 100% on time 100% within timeline Data-driven Comprehensive Fully documented | Every 90 days |
| Service Plans | • Initial Service Plan completion • 60-day Service Plan reviews • Therapy frequency justification • Goal achievement progress • Service coordination documentation | 100% within 30 days 100% on time Clinical need documented Measurable progress Comprehensive | 30/60-day cycles |
Crisis Pattern Analysis
Required at Each 60-Day Continued Stay Review (FC-TFFC-01 §13.4)
Review Components:
Crisis Incident Frequency
Count per 60-day period
Trigger Pattern Analysis
Identify common triggers
Intervention Effectiveness
What worked / didn't work
Intensity Trends
Escalating, stable, or decreasing
Step-Down Readiness Indicators:
Significant reduction
May indicate step-down readiness
Stable without improvement
Treatment adjustment needed
Increasing frequency/intensity
Step-down not appropriate
Crisis-free extended period
Strong step-down readiness
Program Director - TFC Responsibilities
- • Oversee TFC intensive service package delivery per T3C Blueprint
- • Monitor TBRI® implementation in intensive treatment context
- • Review continued stay criteria every 90 days
- • Provide written confirmations within 15 business days
- • Lead TFC-specific CQI reviews with intensive clinical focus
- • Approve Logic Model modifications based on outcome data
- • Ensure maximum 2-child-per-home compliance
Treatment Director - TFC Specific
- • Complete 90-day continued stay reviews (written confirmations within 15 business days)
- • Supervise all licensed therapists (1:11 ratio)
- • Review intensive treatment effectiveness
- • Oversee behavioral support services
- • Coordinate psychiatric services and medication management
- • Lead clinical case consultations for complex cases
- • Approve step-down transitions and aftercare plans
Licensed Therapists - TFC Team
- • Provide weekly individual therapy (minimum) using TBRI®
- • Conduct intensive family therapy with TBRI® integration
- • Determine therapy frequency based on clinical need
- • Document treatment progress per T3C requirements
- • Collaborate on TBRI®-informed behavioral plans
- • Participate in 60-day Service Plan reviews
- • Provide on-call consultation for crisis response
Behavior Support Specialists - TFC Enhanced
- • Conduct Functional Behavior Assessments (FBA)
- • Develop individualized behavior support plans
- • Provide weekly in-home coaching (1:6 ratio)
- • Analyze behavioral data trends continuously
- • Recommend intervention modifications based on data
- • Support treatment foster parents during behavioral crises
- • Integrate TBRI® principles into all behavioral interventions
Case Managers - TFC Intensive
- • Implement TBRI® in all intensive therapeutic contexts
- • Coordinate all TFC services per Service Plan
- • Provide weekly support to treatment foster parents (1:6 ratio)
- • Ensure therapy attendance (100% weekly minimum)
- • Monitor medication compliance daily
- • Document behavioral incidents using TBRI® framework
- • Facilitate intensive family engagement per TBRI®
Crisis Management Staff - TFC Support
- • Provide 24/7 crisis response availability (1:25 ratio)
- • Document and analyze all crisis interventions
- • Coordinate Licensed Therapist on-call consultation
- • Implement crisis de-escalation protocols using TBRI®
- • Recommend crisis prevention strategies based on data
- • Support treatment foster parents during crises
Treatment Foster Care CQI Outcomes
🧠 Clinical Stabilization
Achieved through intensive therapy, behavioral support, and psychiatric coordination
📊 Behavioral Improvement
Supported by FBA, individualized plans, and data-driven interventions
🚨 Crisis Reduction
Accomplished via 24/7 response, prevention strategies, and therapist consultation
⬇️ Successful Step-Down
Enabled by therapeutic progress, reduced service needs, and comprehensive aftercare
TBRI® is a registered trademark of the Karyn Purvis Institute of Child Development at Texas Christian University
"A home is in the heart of every child."
Last Revised: December 10, 2025