What is TFFC?

Treatment Foster Family Care (TFFC) is a program designed to provide innovative, multi-disciplinary treatment services to a child in a highly structured family home environment. The target population for TFFC is children in DFPS conservatorship with very high needs and complex trauma history requiring treatment services.

The goal of Treatment Foster Family Care is to stabilize children at risk of placement in a congregate care setting or psychiatric hospital who experience emotional, behavioral, or mental health difficulties. TFFC promotes successful transitions to less restrictive placements upon completion of the program. Treatment Foster Family Care serves children ages 17 and younger.

In considering whether this program might be helpful for you as a foster parent, see the examples of children in the program and success stories.

If you are already participating in this program, or have other questions, continue reading the program overview and check out the Q&A at the bottom of this page. If you can't find an answer you are looking for about the TFFC program, you may send your question to the TFFC mailbox.

How is a TFFC foster home different from other foster homes?

Treatment Foster Family Care (TFFC) home is uniquely focused on engaging the next caregiver in service planning and coordination at the beginning of placement. Any child receiving services through TFFC should have an identified caregiver who will engage with the foster parent throughout the placement. The TFFC treatment team includes the identified caregiver in treatment planning meetings and provides coaching, resources, and after-care services to ensure the child’s needs continue to be met. These efforts help ensure the child is successful after he or she transitions from the TFFC program. If there is not an identified caregiver, then the goal is to step down to a traditional foster home setting, and the same services will be offered to next placement.

Treatment Foster Family Care homes have:

  • Specialized evidence-based parenting training in mental health and behavioral health of high needs children.
  • 24-hour on-call case management to ensure the child's safety and sense of security, which includes frequent one-to-one monitoring with the ability to provide immediate on-site response.
  • Wraparound services with a highly trained treatment team.
  • Low child to caregiver ratio with professional foster parents.

How long is placement in the TFFC program?

The DFPS Treatment Foster Family Care Program is limited to nine months, with an option of a one time three month extension authorized by the Associate Director of Placement.

TFFC is intended to be a short term treatment option that leads to permanency. If no permanency option is identified, the focus should be on stepping down to a traditional foster home.

Discharge planning starts at the beginning of a placement into the TFFC home. CPS must prepare and plan for the subsequent placement of a child no later than the 30th day after a child is placed in TFFC.

State Office may schedule a meeting at discharge to discuss permanency options and next steps.

What after-care services are available after discharge?

After discharge, the Treatment Foster Family Care provider will continue to provide ongoing support for the youth and their next placement for six months. After-care services will consist of continued behavioral support, regular follow-ups, home visits, and possible respite options. If a placement breakdown occurs, the Treatment Foster Family Care provider will be contacted regarding possible placement options.

Who are the TFFC providers?

There are currently three Child Placing Agencies in Texas that provide Treatment Foster Family Care:


Examples of Children in the TFFC Program

  • Anna
  • John
  • Nicole

Anna

Anna is a 12-year-old female with specialized level of care.
Anna is a smart child with a loving heart in need of stability, accountability, patients, love, and structure. Since experiencing a disrupted adoption in 2015, Anna’s behavior has steadily declined due to the emotional hurt of rejection and nonacceptance that she will not return to the adoptive home. Anna has multiple tantrums, and more recently her behaviors have become physically aggressive towards peers. Other behaviors include stealing, lying, destroying property, and bed wetting. Anna was admitted to a psychiatric hospital once in 2020. This resulted after Anna had a tantrum and destroyed property (breaking windows) and was self-harming. She is at risk of an RTC placement.

Psychological Evaluation April 22, 2021
Diagnosis: Unspecified Disruptive, Impulse-Control, Conduct Disorder; Disruptive Mood Dysregulation Disorder; Attachment Disturbance

Notes/Stressors
Long-term placement in foster care; loss of all biological family members; numerous changes in placement since removal; breakdown of adoptive placement; educational and peer problems

John

John is a 7-year-old male with specialized level of care.
John is currently hospitalized at a psychiatric hospital. John will need a placement upon being released. According to CPS, John was sent there after he was caught running down the halls at school stating that he was going to kill himself. John has emotional outbursts when he is upset. He exhibits tantrum behaviors when redirected, which includes rolling on the ground, covering his ears, or hitting the walls. John has been physically aggressive with foster siblings, hitting, pushing and pinching. Occasionally he has acted out in public places. On good days, he can follow instructions and be respectful. John is a good-natured young boy who is very talkative and likes to draw pictures. Currently, John is not a danger to himself or to others. There is no noted sexual aggression. John has had incidents of making suicidal ideations but has never acted on them. He doesn't have any physical illnesses. John has a composite IQ of 111. He is in the 2nd grade and is in regular classes. There are no family visits.

Psychological Evaluation March 30, 2021
Diagnosis: Major Depressive Disorder, Recurrent, Moderate; Attention-Deficit/Hyperactivity Disorder, Combined Presentation; Unspecified Trauma and Stressor Related Disorder

Nicole

Nicole is a 16-year-old female with intense level of care.
Nicole is in the office without placement. She has been cooperative with staff and has not exhibited any major behaviors. She was recently discharged from a psychiatric hospital after successfully meeting her therapeutic goals there. That was her 3rd hospitalization in the last year. She struggles with depression, anxiety, and has self-harming tendencies. Nicole has trouble expressing her emotions in a safe and positive way. Nicole is a victim of sexual abuse and has a history of suicidal ideations. She takes medication and attends 10th grade special ed classes. Her IQ is 82. She has made some progress identifying her triggers and wants to work on her anger.

Psychological Evaluation January 4, 2021
Diagnosis: Adjustment Disorder with Mixed Disturbance of emotions and conduct; Disruptive Mood Dysregulation Disorder; Depressive Disorder


Success Stories

  • Y.S.'s Story
  • Alice and Trevor's Story
  • A.S.'s Story
  • José's Story

Y.S.'s Story

Y.S. was 10-years-old when she was placed in a Treatment Foster Care (TFC) home. Y.S. had a history of depression and suicidal ideations. Also, Y.S. displayed non-suicidal self-injurious behaviors, such as scratching her arms with pencils or her own fingernails. The goal was for Y.S. to be reunified with her biological mother, who was completing services to get Y.S. back in the home.

While in the program, Y.S. was able to talk about her trauma. Y.S. collaborated in developing a safety plan to help her avoid causing harm to herself or others. Y.S. learned to cope with her trauma by journaling, going for walks, and asking a trusting caregiver for help. Y.S.'s treatment team also worked with her mother. The mother learned how to help Y.S. during a crisis, what coping skills have worked for Y.S., and some of Y.S.'s triggers. Upon completing the program, Y.S. was reunified with her mother.

Through aftercare support contact, Y.S.'s mother stated that the family was participating in family and individual therapies. Y.S. was doing well, as evidenced by self-reports and the mother's report. Y.S. remained in the home with her family, and the mother reported no incidents. Y.S. was able to get off her depression and insomnia medication. Lastly, the mother stated that she was able to get full custody of Y.S. and her sibling.

Alice and Trevor's Story

Siblings Alice and Trevor successfully completed the TFC program in December of 2020. Alice and Trevor came into CPS care due to a background of neglect, physical, and emotional abuse. When they first came into the program, they struggled with verbal and physical aggression towards each other. Although they certainly had sibling love for one another, these kids had not lived together for an extended time, and this transition back to living under the same roof was challenging. However, Alice and Trevor grew tremendously through this program. Not only did their episodes of aggression decrease in intensity and duration, but they were open to trying new activities such as cooking, participating in church activities, and creating art. With motivation from their foster parents, Alice and Trevor ended up doing well in school and passed their classes. During their time in the program, the kids were able to go on outings, including a trip to New Jersey to meet their foster parent’s relatives! These kids made progress in their application of healthy coping skills, using respectful words, and using conflict resolution skills when disagreeing. Their hard work, openness, and persistence led to a successful completion of the TFC program and even resulted in them transitioning all the way to a moderate level of care!

A.S.'s Story

A.S. was 5-years-old when he was placed in a Treatment Foster Care home. A.S. had a history of neglect and was diagnosed with Generalized Anxiety Disorder, PICA, ADHD, and Enuresis. A.S.'s treatment team noticed how he struggled with sensory integration. For example, A.S. would try to meet his needs for sensory input in ways that were disruptive to others. A.S. would jump on furniture or try to bump into others. The foster parent followed the treatment team's recommendations and requested an evaluation to determine if A.S. would qualify for occupational therapy. Then A.S. started his therapies for sensory integration with an occupational therapist. A.S. also qualified for speech therapy for expressive language disorder. A.S. participated in individual therapy. He learned about boundaries, coping skills, and how to use his words to express his needs.

The foster parent reported a decrease in the frequency, intensity, and duration of A.S.'s anger outbursts. A.S. responded well to Trust-Based Relational Interventions and liked having choices and being offered compromises. A.S. demonstrated that he could find ways to meet his needs in healthy ways, such as jumping on the trampoline, swinging, or asking for help when appropriate. Also, the foster parent noted how A.S. stopped trying to eat inedible objects, like he did when he first was diagnosed with Pica. A.S. was able to go on outings with minimal concerns. The foster parent noted how much progress A.S. had made, from not staying in his car seat, to remaining seated on short trips. A.S. was successfully discharged from the program and was able to go to a traditional foster home.

José's Story

José came into the program on November 30, 2019 due to his cousin not be able to handle his behaviors. He was hitting his cousin, his brother, and his teachers on a regular basis. His cousin did not know if she would be able to continue to have José in her home due to these behaviors. Through therapy, the program, and consistency, José gradually stopped exhibiting these behaviors. The therapist had family therapy with the foster family, José, and José’s cousin, as well as family therapy for José and his brother and cousin. José continued to learn to control his anger by using coping skills. He began to do day visits, weekend visits, and he was placed back with his cousin on June 30, 2021. José and his cousin stay in contact with the foster family, and he can call or go over and visit them whenever he likes. 


Q&A

What if a child needs longer than 9 months of treatment?
  • Consult with the child’s CPS team and any other parties to determine if more time is needed.
  • If it is determined the child is not ready for discharge, the Child Placing Agency completes an extension request and submits it to the Centralized Placement Unit (CPU) for the child’s legal team.
  • CPS will complete the rest of the extension process for approvals.
  • Please ensure that the Treatment Foster Family Care extension request form clearly states supporting information to justify the request for extension. What goals are to be reached in the extension period? What services/plan are in place to allow the child to reach those goals?
If there is a placement change, what do we do?
  • All placement changes or requests must go through the Regional Centralized Placement Unit.
  • If a Child Placing Agency wants to move the child to a new Treatment Foster Family Care placement, the Centralized Placement Unit must be notified and approve.
What happens if a child is disrupting?

If a child is disrupting a Treatment Foster Family Care placement, notify the Centralized Placement Unit (CPU). This ensures the CPU is aware of all placement changes and new requests.

What if the child needs to move to another foster home within the same agency?
  • If the treatment team feels it is in the best interest to move the child to a new Treatment Foster Family Care placement, the caseworker must be notified, and they must approve and complete any new paperwork. Then the DFPS Centralized Placement Unit must be notified.
  • In the rare event that a child must be transitioned from one Treatment Foster Family Care home to another within the same agency, the 9 month time-frame will re-start unless requested otherwise. However, the change in homes still requires approvals and due diligence checks by DFPS. This is also true for any transition of foster homes within an agency, so the contractor must submit Form 2109 Discharge Notice to the Caseworker, Supervisor, Regional Centralized Placement Unit (CPU), and the Treatment Foster Family Care mailbox.
When do I contact the Centralized Placement Unit (CPU)?
  • Contact the CPU when there is any kind of placement change, including a disruption or admission to a psychiatric hospital with a 24-hour discharge notice.
  • Child Placing Agencies should have a plan for respite or transition. CPU does not have to approve respite.
How often is a child reviewed?
  • The Child Placing Agency oversees sending a child into Youth For Tomorrow (YFT) :
    • 45 days prior to discharge
    • At an emergency discharge
  • It is vital to send the child into YFT before the child leaves the home, so there is not a gap in service levels.
  • You may contact YFT at help@yft.org.
Where do I send a discharge notice?

Send the discharge notice to the child’s Regional Centralized Placement Unit mailbox and CC the CPS caseworker, supervisor, and TFFC mailbox.

When do I send a discharge notice?

Send Form 2109 Discharge Notice in any of the following scenarios:

  • At least 30-45 days prior to successful discharge.
  • If there is an emergency discharge or any other type of unsuccessful discharge.
Who do I notify about new openings for Treatment Foster Family Care homes?
  • Send an email to the TFFC mailbox.
  • Also make the updates in the General Placement Search (GPS) application. This will allow Centralized Placement Unit to see the opening.
What if I receive a referral?
  • Review each referral received.
  • Reply to Centralized Placement Unit and/or the DFPS TFFC mailbox on each referral received. If no homes are available reply “No home available”. 
Who qualifies to be a Treatment Foster Family Care foster parent?

Answer: One or two foster parents who are highly trained to meet the specific needs of the child population. Note: Single parents may qualify as long as quality care can be assured.

Quality of care is defined as all identified needs of the child are being met (medical, behavioral, cultural, educational, spiritual, etc.). All employed persons must demonstrate to the Contractor how their employment will allow a flexible schedule to meet the child’s individual needs. The Contractor will continue to evaluate the TFFC home and their ongoing ability to meet the needs of the child. When requested, State Office TFFC Program Specialist will be available to assist in determination.

What if CPS or a Judge is requesting therapy notes or other child-related records?

Therapy notes and other records help the worker and other CPS staff understand the child’s strengths and needs more accurately.

The Child Placing Agency must make any and all records and information concerning the child available to DFPS upon verbal request in emergency situations. Emergency requests for records can include, but are not limited to:

  • The need to review the child’s service level to make a placement change
  • Emergency Behavior Intervention (EBI) Reports and Serious Incident Reports
  • Court ordered requests
  • Attorney requests

The Treatment Foster Family Care contracts are beholden to the RCC 24-Hour Requirements, except as exempted or changed in the Programmatic Conditions, which is Section III of the Special, Supplemental, and Programmatic Conditions document, Attachment D.

Within the RCC 24-Hour Requirements is Section 1721 Providing Access to DFPS:

“DFPS has absolute right of access to, and copies of, Child case records or other information relating to a Child served by the provider. The provider makes available any and all records and information concerning the Child to DFPS upon written request. The provider must forward legible records and information to DFPS within 14 calendar days of receiving the request.”

Additionally, records requests could come from the Texas State Auditor’s Office (SAO), the Federal Government, and their authorized representatives, and records must be provided.

If the TFFC provider does not know what is going on with the CPS case, who should be contacted?

Email the TFFC mailbox to request a staff member to discuss the case and next steps.

What if I have general questions?

Please send any questions you have to the DFPS Treatment Foster Family Care mailbox.