All staff and caregivers working with children in the Treatment Foster Care package must complete training in the foundational TBRIĀ® model and Mental Health enhancements before receiving specialized intensive treatment training.
1. Treatment Model Framework and Structure
Our Child Placing Agency implements Trust-Based Relational InterventionĀ® (TBRIĀ®) as our foundational treatment model, enhanced with intensive clinical interventions for providing the T3C Treatment Foster Family Care Support Services. TBRI provides the evidence-based, trauma-informed foundation while incorporating specialized behavioral health practices for children with serious emotional, mental, and behavioral disorders requiring the most intensive level of therapeutic support in a family setting.
The selection of TBRI as our foundation recognizes that children requiring treatment foster care have experienced significant relational trauma and attachment disruptions. These children need both the therapeutic relationships that TBRI provides and the intensive clinical structure necessary to address serious behavioral and emotional challenges. Our enhanced model maintains TBRI's core commitment to healing through relationships while incorporating the behavioral interventions, psychiatric coordination, and crisis management required for children with the most complex needs.
The enhanced TBRI framework maintains three interconnected principles adapted for children requiring intensive treatment-level services. See the foundational TBRIĀ® Resource Guide for detailed information on the core principles.
- Daily therapeutic check-ins using validated assessment tools
- Therapeutic communication techniques integrated into all daily interactions
- Relationship-based crisis de-escalation strategies
- Connection maintained even during behavioral crises
- Individualized engagement approaches based on trauma history and attachment patterns
- Medication management integrated into daily routines with psychiatric oversight
- Sensory accommodations and environmental modifications based on individual assessment
- Comprehensive crisis prevention planning with individualized safety strategies
- Teaching and practicing coping skills and emotional regulation techniques
- Regular health monitoring and coordination with multiple service providers
- Positive Behavioral Interventions and Supports (PBIS) framework
- Functional Behavior Assessment (FBA) for all persistent challenging behaviors
- Individualized Behavior Support Plans with data-driven modifications
- Teaching replacement behaviors at developmentally appropriate levels
- Natural and logical consequences within therapeutic framework
- Progress monitoring with regular team review and plan adjustments
Service Integration
Our model integrates intensive therapeutic services within the specialized treatment foster home environment:
| Service Component | Description |
|---|---|
| Therapeutic Services | ā¢ Individual therapy at frequency determined by clinical need (minimum weekly) ā¢ Family therapy to support caregiver-child relationships and address systemic issues ā¢ Group therapy for social skill building and peer interaction ā¢ Psychiatric services for medication management and diagnostic clarification ā¢ Wraparound services coordinated through STAR Health when eligible ā¢ 24/7 crisis intervention with Licensed Therapist on-call consultation |
| Staffing Structure | ā¢ Treatment Director meeting T3C qualifications with supervision of all Licensed Therapists ā¢ Licensed Therapists (1:11 ratio) specializing in serious emotional and behavioral disorders ā¢ Behavior Support Specialists (1:6 ratio) providing direct behavioral consultation ā¢ Crisis Management Staff (1:25 ratio) available for immediate crisis response ā¢ Case Managers with mental health specialization (1:6 ratio) ā¢ Aftercare Case Manager (1:25 ratio) for transition support ā¢ 24/7 on-call availability of case management level or above staff |
| Treatment Home Parameters | ā¢ Maximum 2 children in care per treatment foster home ā¢ 50+ hours annual training for treatment foster parents ā¢ Weekly case manager support (1:6 ratio) ā¢ Weekly behavior specialist coaching and consultation ā¢ Respite care availability to prevent caregiver burnout |
T3C Blueprint p.138 - Unique to Treatment Foster Family Care
Treatment Foster Family Care requires 24/7 access to an On-Call Licensed Therapist trained in the agency's Evidence-informed Treatment Model (TBRIĀ®). This requirement ensures immediate clinical support for high-acuity situations.
On-Call Therapist Functions:
- Crisis consultation via phone 24/7
- In-person crisis response when clinically indicated
- Clinical guidance for foster parents during emergencies
- Coordination with Treatment Director for adjustments
- Psychiatric emergency triage and hospital liaison
Implementation:
- Contracted therapists with STAR Health credentialing
- Staff therapists with on-call rotation
- Treatment Director serving as clinical backup
- All on-call therapists trained in TBRIĀ® principles
2. Meeting Custom Physical, Emotional, Social, and Spiritual Well-being Needs
Our intensive TBRI-enhanced model addresses all domains of well-being with the highest level of clinical precision and support:
Children requiring treatment foster care often experience complex physical health issues related to serious mental health conditions and medication regimens:
- Comprehensive health assessments with psychiatric focus
- Daily medication administration and side effect monitoring
- Coordination with psychiatrists for medication adjustments
- Sleep hygiene programs with clinical oversight
- Physical activity as therapeutic intervention
- Nutritional planning addressing medication effects
- STAR Health and wraparound service coordination
- Regular medical monitoring and preventive care
Intensive emotional support addresses the complex needs of children with serious emotional and behavioral disorders:
- Daily mood monitoring using validated tools
- Comprehensive crisis safety planning
- Intensive emotion regulation skill training
- Trauma-focused interventions adapted to individual needs
- Multiple therapeutic outlets (individual, family, group)
- CANS assessment every 90 days with clinical interpretation
- Weekly therapy sessions (minimum)
- 24/7 crisis intervention availability
Serious behavioral and emotional symptoms significantly impact relationships, requiring intensive structured support:
- Evidence-based social skills training with practice
- Supported and supervised peer interactions
- Intensive family therapy and caregiver education
- Close school collaboration with IEP support
- Gradual community integration with clinical support
- Relationship repair strategies after incidents
- Therapeutic recreation activities
- Values development at appropriate developmental level
- Cultural identity support and exploration
- Supported inclusion in faith communities when desired
- Meaning-making opportunities within therapeutic context
- Hope-building interventions
- Connection to purpose and future orientation
3. Evidence and Data Informing Treatment Model Selection
California Evidence-Based Clearinghouse for Child Welfare (CEBC) Rating:
TBRIĀ® Caregiver Training is rated as a "Promising Practice" based on scientific research showing improved outcomes for children who experienced trauma, abuse, and neglect.
Title IV-E Prevention Services Clearinghouse:
TBRIĀ® is recognized for mental health prevention and treatment, making it eligible for use in programs requiring evidence-based, trauma-informed interventions.
Implementation Support:
The Karyn Purvis Institute of Child Development (KPICD) provides ongoing support including coaching, site visits, teleconferencing, and email support to ensure fidelity to the model.
Fidelity Measures:
TBRIĀ® includes "Rate Your Understanding" assessments to ensure consistent delivery across all caregivers and settings.
Research Foundation
The integration of TBRI with intensive clinical interventions represents current best practices in treatment foster care. Research demonstrates:
- Treatment foster care models achieve better outcomes than residential care for most children
- Trauma-informed approaches significantly improve placement stability and behavioral outcomes
- Evidence-based therapies delivered in the context of therapeutic foster care produce lasting change
- Family-based treatment with intensive supports enables children to avoid or step down from institutional care
- Behavioral interventions (PBIS, FBA) in family settings show superior generalization compared to clinic-only services
Quality Monitoring
Our Continuous Quality Improvement process ensures effective intensive service delivery through:
- CANS assessments every 90 days with clinical interpretation
- Daily behavioral incident documentation and weekly data analysis
- Weekly therapy attendance tracking
- Crisis intervention frequency and effectiveness monitoring
- Treatment Director 90-day continued stay reviews
- Medication compliance and effectiveness tracking
- Foster parent satisfaction and retention assessment
- Step-down readiness evaluation every 90 days
4. Trauma-Informed Approach for Children Who Have Experienced Abuse and Neglect
Children requiring treatment foster care have experienced significant trauma, often including multiple placements, severe abuse or neglect, and complex relational trauma. Our trauma-informed approach recognizes that challenging behaviors are adaptations to traumatic experiences.
Assessment and Treatment Planning
Comprehensive Assessment: The CANS 3.0 serves as our primary assessment tool, administered every 90 days to track progress and inform treatment. This is supplemented by:
- Functional Behavior Assessments for challenging behaviors
- Trauma-specific assessments as clinically indicated
- Ongoing behavioral data collection and analysis
- Regular psychiatric evaluation when medication is involved
Individualized Service Planning: Each child's Service Plan is developed collaboratively within 30 days of admission and reviewed every 60 days. Plans include:
- Trauma-informed goals addressing both symptom reduction and skill development
- Specific therapeutic interventions matched to trauma history
- Behavioral support strategies based on functional assessment
- Crisis prevention and response protocols
- Coordination of all services and supports
Clinical Interventions
Evidence-Based Therapies: Our Licensed Therapists utilize trauma-focused, evidence-based approaches including:
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) adapted to developmental level
- Attachment-focused interventions building on TBRI foundation
- Cognitive-behavioral strategies for emotion regulation and coping
- Family therapy to heal relationships and build caregiver capacity
Behavioral Support: Behavior Support Specialists work directly with foster parents to:
- Implement individualized behavior support plans
- Teach therapeutic parenting strategies beyond basic TBRI
- Provide in-home coaching and support
- Analyze behavioral data and modify interventions as needed
- Support crisis prevention and response
Foster Parent Preparation and Support
Treatment foster parents receive extensive training and ongoing support:
Enhanced Training:
- 20 hours of Treatment Foster Care specific training beyond pre-service
- Advanced TBRI techniques for complex trauma presentations
- Crisis intervention and de-escalation strategies
- Working with psychiatric medication and side effects
- Understanding serious mental health diagnoses
- Implementing behavior support plans with fidelity
Ongoing Support:
- Weekly contact from case manager (1:6 ratio enables intensive support)
- Regular consultation with Behavior Support Specialist
- Access to Licensed Therapist consultation
- 24/7 crisis support with in-person response capability
- Respite care to prevent caregiver burnout
- Peer support connections with other treatment foster parents
5. Appropriateness of the Treatment Model for T3C Treatment Foster Family Care Support Services
Service Package Alignment
Our enhanced TBRI model directly addresses each requirement specified in the T3C Treatment Foster Family Care Support Services package:
| T3C Requirement | Our Implementation |
|---|---|
| Regular individual, family, and group therapy | Licensed Therapists determine frequency based on clinical need; minimum weekly individual therapy |
| CANS 3.0 every 90 days | Administration with clinical interpretation informing Service Plan adjustments |
| 24/7 crisis availability | Case manager level or above staff available; Licensed Therapist on-call consultation |
| Service Plans within 30 days, reviewed every 60 days | Collaborative development with measurable, individualized goals |
| Maximum 2 children in care per home | Ensures intensive, individualized attention in family setting |
| Maximum 365-day length of service | Policy includes anticipated length of service; step-down planning begins at admission |
Quality Assurance Process
90-Day Continued Stay Review:
Every 90 days, the Treatment Director reviews each child's progress and continued need for Treatment Foster Care services. This written review, completed within 15 business days, evaluates:
- Progress on Service Plan goals using CANS 3.0 and other outcome data
- Reduction in behavioral incidents and crisis episodes
- Psychiatric stability and medication effectiveness
- Therapy engagement and therapeutic alliance
- Educational progress and school stability
- Placement stability and caregiver satisfaction
- Readiness for step-down to lower level of care
Step-Down Criteria: Children demonstrating sustained progress may transition to T3C Mental & Behavioral Health Support Services or T3C Basic services based on:
- Achievement of Service Plan goals enabling step-down to lower level of care
- Placement stability with reduced intensive supports
- Caregiver capacity to manage child's needs with standard foster care supports
- Connection to ongoing community-based services
- Reduced crisis episodes (ā„75% reduction from admission)
- Behavioral stabilization (ā„40% reduction in incidents)
Expected Outcomes
Based on research and best practices in treatment foster care, we establish measurable goals:
90-Day Goals
- 75% reduction in crisis episodes requiring emergency intervention
- Measurable improvement in at least 2 CANS 3.0 priority areas
- Consistent engagement in therapy services
- Behavioral support plan implementation with fidelity
6-Month Goals
- 85% placement stability (no unplanned moves)
- Functional improvement allowing participation in normalized activities
- Reduced medication needs or stabilization on appropriate regimen
- Progress toward permanency goal
Discharge Goals
- Achievement of Service Plan goals
- Step-down to lower level of care
- Permanency achievement (reunification, adoption, or APPLA)
- Connection to ongoing services
- Sustained stability for 6 months
By integrating intensive behavioral health interventions with TBRI's proven approach to healing trauma through relationships, we ensure that children with the most serious emotional and behavioral challenges receive both the clinical structure they need and the healing family environment essential for lasting change. This balanced approach enables children to remain in family settings while receiving treatment-level services, supporting progress toward permanency and successful functioning in their communities.
Related Resources:
- Complete TBRIĀ® Resource Guide (Basic Foster Family Home) - Foundational treatment model, education plan, and implementation materials
- Mental & Behavioral Health Treatment Model - Mid-tier enhancement for therapeutic services
- Treatment Foster Care Logic Model - Visual representation of intensive treatment implementation
- Treatment Foster Care CQI Model - Continuous quality improvement process for intensive services
TBRIĀ® 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