Journal of Social Service Research, 36:174–187, 2010 Copyright c  Taylor & Francis Group, LLC ISSN: 0148-8376 print / 1540-7314 online DOI: 10.1080/01488371003697897 Service Process and Quality in Therapeutic Foster Care: An Exploratory Study of One County System Thomas W. Pavkov Richard W. Hug Ira S. Lourie Sesen Negash ABSTRACT. This study assesses the quality of services in the therapeutic foster care programs used by one county in the Midwest. Using a consultative quality assurance review methodology, evaluators examined 67 randomly sampled cases across seven agencies to assess the service quality issues experienced by children. Following interviews with staff, foster parents, and children, and a review of case records, reviewers observed failures in service and in adherence to national program model standards and state regulations. The research indicates the need for consistent monitoring of child-placing agencies and the need for additional research linking service quality with foster care outcomes. KEYWORDS. Therapeutic foster care, service quality, quality assurance, monitoring of service quality, child welfare, evidence-based practice In 2007, foster care agencies served an estimated 783,000 children (U.S. Children’s Bureau, 2008). Youth in foster care exhibit significantly greater reactive externalizing behaviors than youth in other settings (e.g., Armsden, Pecora, Payne, & Szatkiewicz, 2000; Heflinger, Simpkins, & Combs-Orme, 2000; McIntyre & Keesler, 1986; Newton, Litrownik, & Landsverk, 2000). Some estimates suggest that the number of youth in foster care with Thomas W. Pavkov, PhD, is Associate Professor of Psychology and Director of the Institute for Social and Policy Research, Purdue University Calumet, Institute for Social and Policy Research, Hammond, IN. Richard W. Hug, PhD, is Associate Professor of Public and Environmental Affairs, Indiana University Northwest, School of Public and Environmental Affairs, Gary, IN. Ira S. Lourie, MD, is Psychiatric Consultant, Human Service Collaborative, Haggerstown, MD. Sesen Negash, MS, is doctoral student, Florida State University, Program in Marriage and Family Therapy, Tallahassee, FL. Address correspondence to: Thomas W. Pavkov, PhD, Purdue University Calumet, Institute for Social and Policy Research, 2200 169th St., Hammond, IN 46323 (E-mail: tpavkov@calumet.purdue.edu). emotional, behavioral, or developmental chal- lenges stands at approximately 30% (Craven & Lee, 2006). At the same time, the demand to use less restrictive environments (i.e., therapeutic foster care [TFC] vs. residential treatment) to care for and treat emotionally and behaviorally challenged foster care children and youth con- tinues to grow. Although treatment modalities such as treatment foster care are becoming more popular and are identified as evidence-based 174