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Treatment Foster Care Oregon

Blueprints Program Rating: Model

A therapeutic foster care program that serves as an alternative to residential treatment by placing chronic delinquents in foster homes in the community with the goals of reuniting the families, reducing delinquency and teen violence, and increasing prosocial behavior and participation in prosocial activities. The program includes behavioral parent training and support for foster parents, family therapy for biological parents, skills training and supportive therapy for youth, and school-based behavioral interventions and academic support.

Since TFCO is a type of foster care program, entitlement funding (Title IV-E) is typically used to support the program for children in foster care. State funds are available for youth placed in foster care by a court. TFCO is also appropriate for other children with serious behavioral health challenges, not only those in foster care. Federal support can be accessed from Medicaid for any Medicaid-eligible child in addition to covering TFCO as a State Medicaid plan service, some states may also include TFCO as a covered service for Medicaid home and community based waiver programs. State and local general revenue and mental health block grant funds can also be used for non-Medicaid eligible youth. The high start-up costs can justify debt financing such as a Social Impact Bond. A Reinvestment Compact may also be useful for start-up funding.

Improving the Use of Existing Public Funds

Reinvestment: TFCO can often provide an alternative to expensive group home care, and can shorten the average length of stay in out-of-home placement, leading to cost savings that can be reinvested in program sustainability. Performance contracts can be used to incentivize improved performance, share the benefits of improved performance with providers and reinvest savings in program sustainability.

Allocating State or Local General Funds

Since TFCO is often provided to youth in foster care with an entitlement to services, most programs receive funding from state foster care funds. For eligible youth, these funds may serve as state match to federal funding programs (Title IV-E and Medicaid). State or local general funds also can be used for children not involved in foster care either as match for Medicaid funding or to cover non-Medicaid eligible children.

Maximizing Federal Funds

Entitlements: TFCO, as a type of foster care, can take advantage of two federal entitlement programs.

  • Since it provides what is considered to be a therapeutic placement, Medicaid is used to support TFCO in some states. If a bundled per diem rate is used, a state can consider billing the full cost of the program to Medicaid. An alternative to this approach is to identify the costs of the actual treatment components of the service and bill just those to Medicaid. State matching funds are required for any Medicaid option. Medicaid and general fund treatment dollars that are in a managed care arrangement often have flexibility not found in Medicaid fee-for-service programs. Medicaid managed care companies can use administrative dollars to support training and start-up and then can use both treatment dollars and reinvestment dollars to support evidence-based programs like TFCO.
  • Federal Title IV-E Foster Care Program funds can also support TFCO. Title IV-E pays for maintaining a child in placement and can thus be used for the room and board part of the cost. Title IV-E is a good fit with Medicaid when that funding is used for the treatment components of care. Title IV-E administrative funds might also be available for some administrative and case management costs. Title IV-E training funds can be considered to fund foster parent and provider training activities. Title IV-E also requires state matching funds.

Formula Funds: The core juvenile justice, child welfare, and behavioral health formula funds are potentially options for needed start-up funding, or to cover ongoing staffing, technical assistance and fidelity monitoring costs that are not billable under IV-E or Medicaid. They can also be used to pay for children not eligible for Medicaid, or IV-E.

  • Juvenile Accountability Block Grant (JABG) Funds are focused on reducing juvenile offending through efforts that promote accountability, including providing effective early intervention through mental health screening and treatment.
  • OJJDP Formula Funds support a variety of improvements to delinquency prevention programs and juvenile justice programs in states. Evidence-based programs are an explicit priority for these funds, which are typically administered on a competitive basis from the state administering agency to community-based programs.
  • The Mental Health Services Block Grant (MHSBG) can fund a variety of mental health promotion and intervention activities and is a potential source of support for TFCO programs.
  • Title IV-B, Parts 1 & 2 provides fairly flexible funding to state child welfare agencies for child welfare services including prevention and family preservation activities.

Discretionary Grants: Relevant grants are administered by the federal Office of Juvenile Justice and Delinquency Prevention (OJJDP), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Children’s Bureau within the Administration for Children and Families.

Foundation Grants and Public-Private Partnerships

Foundation funding can support the expensive costs to start a TFCO program. A Reinvestment Compact can be considered as a form of public-private partnership.

Debt Financing

Debt financing is appropriate for start-up funding for TFCO because a source of repayment funds exists in the potential savings from group home care. A Social Impact Bond is one potential way to structure debt financing.

All information comes from the responses to a questionnaire submitted by the purveyor of TFCO, TFCO Consultants, Inc., to the Annie E. Casey Foundation.