title: Development and piloting of a treatment foster care program for older youth with psychiatric problems.
abstract: BACKGROUND
  Older youth in out-of-home care often live in restrictive settings and face psychiatric issues without sufficient family support. This paper reports on the development and piloting of a manualized treatment foster care program designed to step down older youth with high psychiatric needs from residential programs to treatment foster care homes.
  
  
  METHODS
  A team of researchers and agency partners set out to develop a treatment foster care model for older youth based on Multi-dimensional Treatment Foster Care (MTFC). After matching youth by mental health condition and determining for whom randomization would be allowed, 14 youth were randomized to treatment as usual or a treatment foster home intervention. Stakeholders were interviewed qualitatively at multiple time points. Quantitative measures assessed mental health symptoms, days in locked facilities, employment and educational outcomes.
  
  
  RESULTS
  Development efforts led to substantial variations from the MTFC model and a new model, Treatment Foster Care for Older Youth was piloted. Feasibility monitoring suggested that it was difficult, but possible to recruit and randomize youth from and out of residential homes and that foster parents could be recruited to serve them. Qualitative data pointed to some qualified clinical successes. Stakeholders viewed two team roles - that of psychiatric nurse and skills coaches - very highly. However, results also suggested that foster parents and some staff did not tolerate the intervention well and struggled to address the emotion dysregulation issues of the young people they served. Quantitative data demonstrated that the intervention was not keeping youth out of locked facilities.
  
  
  CONCLUSIONS
  The intervention needed further refinement prior to a broader trial. Intervention development work continued until components were developed to help address emotion regulation problems among fostered youth. Psychiatric nurses and skills coaches who work with youth in community settings hold promise as important supports for older youth with psychiatric needs.
authors.affiliation: School of Social Service Administration, University of Chicago, 969 E. 60th, Chicago, IL 60636 USA.
authors.forename: J Curtis
authors.initials: JC
authors.lastname: McMillen
authors.affiliation: Graduate College of Social Work, University of Houston, 110HA Social Work Building, Houston, TX 77204 USA.
authors.forename: Sarah Carter
authors.initials: SC
authors.lastname: Narendorf
authors.affiliation: Washington University School of Medicine, Campus Box 1007, St. Louis, MO 63105 USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Robinson
authors.affiliation: School of Social Work, University of Illinois, 1010 W. Nevada Street, Urbana, IL 61801 USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Havlicek
authors.affiliation: Research Consultant, Charlottesville, VA USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Fedoravicius
authors.affiliation: St. Louis University School of Nursing, 3525 Caroline St, St. Louis, MO 63104 USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Bertram
authors.affiliation: Jackson County (Ohio) Board of Developmental Disabilities, 822 Sellars Drive, P.O. Box 607, Jackson, OH 45640 USA.
authors.forename: David
authors.initials: D
authors.lastname: McNelly
keywords: Emerging adulthood; Emotion regulation; Foster care; Treatment foster care