Therapeutic Foster Care in New Hampshire: What It Is and Who It's For

Not every child in New Hampshire foster care has the same needs. A child who experienced a single episode of neglect at age seven is in a fundamentally different situation than a teenager who has cycled through a dozen placements since age five, or a 14-year-old leaving a residential facility who needs a family setting but comes with a history that standard foster care families often aren't equipped to handle.

Therapeutic foster care — called "Specialized Care" in New Hampshire's licensing framework — exists for children at the more complex end of the needs spectrum. If you're considering it, here's what the state's system actually looks like.

Specialized Care: New Hampshire's Licensed Category for Higher-Needs Placements

New Hampshire does not license "therapeutic foster care" as a separate formal category. Instead, the equivalent is the Specialized Care license, issued under He-C 6446. This license allows approved foster parents to care for children who have been assessed as having significant medical, emotional, or behavioral needs that exceed what general foster care can address.

To be eligible for Specialized Care licensure, you must:

• Already hold a General Foster Care license and have at least one year of active foster care experience
• Complete 21 additional hours of specialized training beyond the initial 23-hour pre-service requirement

The specialized training focuses on the specific types of needs your placements will present — trauma-informed care, behavioral intervention strategies, attachment disorders, mental health conditions, complex medical needs, or the behavioral sequelae of prenatal substance exposure.

Specialized Care Stipend Rates

The financial difference between general and specialized care is substantial:

The specialized rate reflects the additional time, training, and support requirements that come with higher-needs children.

Private Agencies Offering Intensive Therapeutic Models

Beyond DCYF's standard Specialized Care license, several private agencies in New Hampshire operate more structured therapeutic foster care programs with intensive wraparound support:

NFI North — Individual Service Option (ISO)

NFI North, headquartered in Contoocook, operates the Individual Service Option (ISO) program, which is one of New Hampshire's most intensive community-based treatment models. ISO is designed for children with serious emotional and behavioral challenges who need a level of structured support that standard foster care cannot provide. ISO families receive:

• Higher stipend levels than standard Specialized Care
• A dedicated treatment team including a case manager, therapist, and behavioral specialist
• 24/7 on-call support
• More frequent contact with agency staff

ISO placements are typically for children who would otherwise be in residential treatment — the goal is to keep them in a family setting with intensive professional backup rather than in congregate care.

Easterseals New Hampshire

Easterseals operates specialized foster care programs focused on teenagers and children with disabilities. Their programs are designed for youth who need both the support of a family environment and the expertise of caregivers trained in disability-specific and developmental needs.

Ascentria Care Alliance

Ascentria provides respite and specialized therapeutic care, with particular focus on children with complex needs who require caregivers with advanced training and support infrastructure.

Spaulding Academy & Family Services

Spaulding operates community-based and specialized services, with expertise in children coming from residential settings who need a graduated transition to family life.

What "Therapeutic" Actually Means Day-to-Day

Therapeutic foster care in any of its forms is not therapy delivered by a foster parent. The foster parent's role is not clinical — it is to provide a stable, trauma-informed, structured family environment. The "therapy" comes from the professional team (therapist, case manager, treatment team) that wraps around the placement.

What specialized foster parents actually provide:

• Consistent daily routines and predictable responses to behavior
• Trauma-informed responses to challenging behavior — understanding that a child screaming or destroying property is usually communicating a need, not simply misbehaving
• Support for and transportation to frequent therapeutic appointments
• Regular communication with the treatment team about what's happening at home
• Stability under conditions that would destabilize many households

The children placed in therapeutic or specialized care have often been in multiple prior placements. Many have experienced serious trauma. Some have behaviors that can be frightening or exhausting — aggression, self-harm, dissociation, hypersexualized behavior. Specialized foster parents are not expected to handle these situations alone, but they are expected to hold steady through them.

How to Move into Specialized Care

If you are currently a licensed general foster parent with one year of experience and you want to pursue specialized licensure:

1. Talk to your Resource Worker about your interest in specialized placements
2. Identify the additional 21 hours of specialized training that aligns with the types of children you want to serve
3. Submit documentation of your training completion to be added to your license file
4. Work with your district office or private agency to be matched with children whose needs fit your training and capacity

If you are a new applicant who ultimately wants to reach specialized care, the path is sequential — you must first complete general licensure and one year of active fostering before the specialized track opens up.

The New Hampshire Foster Care Licensing Guide covers the specialized licensing pathway in detail, including the training requirements, the agencies that provide intensive support models, and what to realistically expect when caring for children with higher-level needs.

Frequently Asked Questions

Is therapeutic foster care the same as Specialized Care in New Hampshire?

Effectively, yes. New Hampshire's licensing framework uses the term "Specialized Care" for what is often called therapeutic or treatment foster care in other states. Private agencies like NFI North operate ISO programs that are even more intensive than the standard Specialized Care license.

Do I need a clinical background to be a specialized foster parent?

No. You do not need to be a therapist, social worker, or healthcare professional. You do need additional training in the specific needs of the children you'll care for, and you need the temperament and support system to hold a structured, trauma-informed environment.

Can I apply for specialized foster care from the beginning?

No. Specialized Care licensure requires a minimum of one year of active general foster care experience plus 21 additional training hours. You must hold a General Care license first.

What age of children are typically placed in therapeutic or specialized care?

There is no fixed age range, but children in therapeutic placements skew toward school-age and older — children who have already accumulated more placement history, more trauma exposure, and more complex needs. Infants can be in specialized placements (particularly those with neonatal abstinence syndrome or complex medical needs), but the population is predominantly older.

Do specialized foster parents get additional support from DCYF?

Specialized foster parents should receive more frequent contact with their caseworker than general foster care families. Private agencies operating therapeutic programs provide additional wraparound support including treatment teams and 24/7 availability. The specific support structure depends on whether you are DCYF-direct or working through a private agency program.

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