This article examines the use of psychotropic medications among youths in residential community-based placements. Data are from a study funded by the National Institute of Mental Health of therapeutic foster care (June 1999 through May 2001) and group homes (January through June 2001). Data were collected from staff by means of in-person interviews. Many youths in both settings received psychotropic medications, and approximately one-half were taking multiple psychotropic medications. After the authors controlled for demographic and clinical factors, the youths in group homes were nearly twice as likely as the youths in therapeutic foster care to receive medication. However, residential setting was not related to polypharmacology. Additional work is needed to study the appropriateness of use and implications of such patterns for research on intervention outcomes.

Little is known about what additional services youth receive while they reside in out-of-home treatment settings. However, such information may be crucial for explaining effectiveness and variation in outcomes for youth in such settings. Our research examines patterns of multi-sector service use for youth in two settingsTherapeutic Foster Care and group homes. Data come from in-person interviews with Treatment Foster Parents and Group Home Staff for a NC state-wide sample of youth with psychiatric disorders and aggressive behavior. Findings indicated high rates of service use by youth in both settings. Analyses indicated significant differences in service types used by youth in each setting, yet similar volume of service use between settings. Clinical and demographic factors did not significantly influence types of services received. Differences in service patterns between the two groups indicated that youth in TFC were more likely to receive communitybased, individualized services while youth in group homes were more likely to receive more restrictive services.

In this article we examine conformity to the Program Standards for Treatment Foster Care (Foster Family-Based TreatmentAssociation, 1995).Treatment foster care (TFC) is an increasingly common community-based residential placement option for youth with emotional and behavioral disorders.At present, findings from model programs suggest that TFC can be effective for producing desired outcomes. However, little is known about variations of TFC in real-world practice.The standards of care developed by the Foster Family-Based Treatment Association are used to examine variations in conformity to the standards in a statewide sample of TFC programs. Findings suggest fair to good overall conformity, with considerable variation among programs.The article includes a discussion of methodological and substantive considerations for future research and evaluation using this approach.