Assessments and foster care placements

Mental and behavioral health remain one of the most significant — and persistent — unmet health needs among children and youth in foster care. The American Academy of Pediatrics notes that this population experiences disproportionately high rates of trauma, depression, anxiety, and behavioral challenges, yet continues to face barriers to timely, appropriate care.

Foster family homes, with either relatives or non-relatives, are the most common placement settings. Treatment options through home-based settings may include outpatient and community-based services delivered through schools, local agencies, or private providers. 

Research indicates that children have better outcomes when they remain safely in a family, home-based setting with someone familiar to them. In instances where children must be placed outside their own home, the first option should be “kinship care,” allowing children to remain with members of their extended family or close family friends. 

Residential placements, which include non-family foster homes and congregate care settings, are typically highly structured out-of-home settings with 24-hour supervision. 

The impact of placement type and service accessibility on clinical outcomes

Recent federal data reveal that approximately 34,000 youth currently reside in residential facilities. The goal of states is to ensure children and youth in foster care are placed in the setting that best meets their needs. While residential placements can provide a secure environment for children and youth in need of specialized treatment, many are placed in these settings due to the limited availability of family-based placements and community support. 

When children and youth are placed in residential settings for reasons unrelated to treatment needs, the consequences are meaningful. They are separated from family settings that help them thrive and from community supports crucial to their wellbeing and long-term success. Prolonged residential stays can disrupt developmental milestones, delay reunification, and divert public resources. 

Fewer residential placements through early, evidence-based interventions

States are leading transformative efforts to reduce reliance on residential placements and ensure youth with behavioral health needs receive timely, appropriate care in community and family-based settings. 

The Family First Prevention Services Act (FFPSA), enacted in 2018, reinforces this commitment by aligning federal funding with prevention and family stability. 

The FFPSA encourages states to invest in early, evidence-based interventions that allow children to remain safely at home or in the least restrictive setting, offering the most family-like environment. 

With up to 80% of children in foster care meeting criteria for significant mental health issues, their behavioral healthcare needs must be considered when determining interventions, treatments, services, and the setting. Importantly, Title IV-E funding for residential care is limited to Qualified Residential Treatment Programs (QRTPs) that meet high standards for trauma-informed, clinically driven care and provide ongoing aftercare supports post-discharge. 

Placements informed by person-centered assessments

States are advancing the FFPSA vision by ensuring that residential care is used only when clinically appropriate — and that every placement decision reflects a complete understanding of a child’s needs, strengths, and family context. Data-driven assessments and individualized treatment planning are central to this shift, helping align services with each child’s best interests.

Many states have adopted the Child and Adolescent Needs and Strengths (CANS) assessment tool for its reliability, accessibility, and collaborative design. CANS gathers input from the child or youth, family members, foster parents, and service providers. Face-to-face interviews empower children and youth to share their perspectives, making them active participants in shaping their care. This person-centered approach results in placement decisions that prioritize wellbeing, stability, and the least restrictive environment possible.

From policy to practice 

The FFPSA offers states both the framework and the incentive to move away from default placements to those that serve the best interests of children and youth. Consistent with the FFPSA, residential care is most appropriate for youth whose significant emotional or behavioral needs cannot be met safely or effectively in a family-based setting. When such placements are necessary, they are intended to be time-limited, therapeutic interventions within QRTPs, determined through objective assessments.

Yet policy alone cannot change outcomes; people and processes do. States that embrace evidence-based assessments, break down bureaucratic silos, allow data to drive informed decision-making, and engage in meaningful collaboration will be the ones to set a new standard for child welfare reform.