Standards for public agencies

2020 Edition

Child and Family Services (PA-CFS) 19: Treatment Foster Care

Children with significant emotional, behavioral, medical, or developmental needs receive structured treatment within a therapeutic family setting that promotes well-being, family connections, and community integration.

NA The agency does not provide treatment foster care services.
2020 Edition




Child and Family Services promote child and family well-being, protect children’s safety, stablilize and strengthen families, and ensure permanency.
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions; exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement. 
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.  
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.  
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  
  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.   
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner. 
  • Service quality or agency functioning may be compromised.   
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.  
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Treatment planning and review procedures


  • Criteria for selection of treatment foster parents
  • Table of contents of training curricula for treatment foster parents
  • Worker contact procedures
  • Discharge procedures
  • Formal agreements with therapeutic facilities and/or providers that serve children and families in the program
  • Training curricula for treatment foster parents
  • Documentation tracking treatment foster parent completion of required training
  • On-call schedule for treatment foster care programs for the past six months
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Treatment team members
    4. Parents served
    5. Children served
    6. Treatment foster parents
  • Review case records
  • Review treatment foster parent records


PA-CFS 19.01

Treatment foster care services are delivered by individualized treatment teams that include: 
  1. family members; 
  2. treatment foster parents; 
  3. child welfare agency workers;
  4. treatment foster care program personnel, including the program supervisor, case managers, and clinicians or clinical consultants;
  5. education representatives or personnel; and
  6. a range of specialized providers, as appropriate to children’s emotional, behavioral, medical, and/or developmental needs.


 The treatment team should include at least two agency or contract employees who have an advanced degree in social work or a related field experience and at least two years of professional experience working with children with specialized treatment needs.
Examples: Depending on the needs of children, specialized providers may include, but are not limited to: behavior support specialists; nurses and physicians; psychiatric nurses and psychiatrists; and rehabilitation therapists. 


PA-CFS 19.02

Preliminary treatment plans developed prior to placement identify: 
  1. diagnoses;
  2. strategies to ensure children’s adjustment to treatment families; and
  3. short-term goals for the first 30 days of out-of-home care.


PA-CFS 19.03

Within 30 days of placement, treatment teams develop individualized, comprehensive treatment plans that:  
  1. identify, incorporate, and build on children’s strengths and assets;
  2. specify diagnoses and presenting problems that prompted the referral to treatment foster care or were identified during assessment;
  3. address needs in major developmental areas;
  4. specify short- and long-term therapeutic interventions; and
  5. address stressors in the children’s environment that are trauma reminders or contribute to their emotional or behavioral issues.


PA-CFS 19.04

Treatment plans are: 
  1. discussed weekly by the treatment team to coordinate an effective response to current issues and behaviors;
  2. reviewed monthly to evaluate progress towards treatment goals; and 
  3. officially updated every 90 days to evaluate progress and the continued need for treatment foster care.


PA-CFS 19.05

The agency coordinates and ensures the provision of needed therapeutic, rehabilitative, and support services, including specialized treatment services. 

Examples: Needed services may include, but are not limited to: 
  1. individual, family, and/or group therapy, 
  2. social skills groups, and 
  3. medical treatment. 
Providing formal and informal support to other service providers can help the agency maximize service benefits and best meet the specialized needs of the children in the program.

Fundamental Practice

PA-CFS 19.06

Formal relationships are established with:  
  1. mental health facilities, medical institutions including neonatal and pediatric facilities, and other rehabilitation service providers to ensure the availability of requisite medical and mental health services; and 
  2. a board-certified physician with experience appropriate to the level and intensity of service, and the needs of the population served, who assumes responsibility for medical elements of a program that serves children with acute medical needs.
Examples: The board-certified physician can provide service as an employee or contractor, or through a formal arrangement. 

Fundamental Practice

PA-CFS 19.07

The agency selects treatment foster parents based on established criteria that include:  
  1. proven experience as resource parents, work experience in a setting such as a group home or residential center, or specialized training in treatment foster care; 
  2. three non-relative references; and 
  3. attainment of at least twenty-one years of age.


PA-CFS 19.08

Treatment foster parents assume primary responsibility for: 
  1. implementing in-home treatment strategies;
  2. assisting children to understand treatment goals and interventions; 
  3. documenting children’s behaviors and progress in targeted areas; and
  4. acting as liaisons with clinical personnel.

Fundamental Practice

PA-CFS 19.09

Treatment foster parents receive the support they need to carry out their role, including:  
  1. initial and ongoing training designed to help them assume their responsibilities;
  2. weekly contact by the assigned worker; 
  3. in-person contact every two weeks and more frequently when indicated; 
  4. on-call crisis intervention 24-hours a day, seven days a week; and 
  5. the availability of additional personnel and technical assistance, as needed.



Additional personnel should be available during critical or stressful periods, such as the time from the end of the school day until bedtime.


PA-CFS 19.10

Discharge reports are tailored to support the transition to the next home or program, and document: 
  1. the course of treatment and treatment recommendations;
  2. the transfer of records and appointment information; and
  3. the nature, frequency, and duration of follow-up services, when applicable.