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There's been a decline in the number of licensed foster homes across the U.S. For example, in the past five years, Nevada lost 40% of its licensed foster homes. South Carolina lost 60%. And of available foster homes, few are willing or able to take in kids with complex behavioral and mental health challenges. In Ohio, the state says a pilot program it's running may be the start of a solution. The Ohio Newsroom's Erin Gottsacker reports.

ERIN GOTTSACKER, BYLINE: Samantha Stewart has always wanted a big family. So over the past few years, the door to her home has been rotating. She and her husband have fostered seven kids. Right now, two of them are playing in the living room, doing somersaults and singing songs from "Frozen."

UNIDENTIFIED CHILD: (Singing) Let it go. Let it go.

GOTTSACKER: One of them, a 5-year-old, faces challenges a lot of kids her age don't.

SAMANTHA STEWART: Our daughter with autism - she had gotten kicked out of a couple of different day cares because of her behaviors that stem from her autism and neglect.

GOTTSACKER: Stewart is a nurse, so she's had professional experience working with kids with autism and was eager to work with them personally, too, as a foster parent.

STEWART: And I knew that I would be able to give them the resources that they needed to succeed in life with my nursing background. I knew what kind of therapies they would need.

GOTTSACKER: So she signed up for a novel program, a treatment foster care partnership, where she learned about trauma-informed care and how to respond to tricky behaviors. Now, she's one of 10 treatment foster homes in her area licensed to care for kids with high behavior needs. There are a lot of kids in need of care like this, says Rachel Mackey with the National Association of Counties. She recently compiled a report on county priorities for the child welfare system and found that, in nearly every state of the country, there aren't enough foster families to care for all the kids that need help. And it's an even bigger challenge for county agencies to find foster care for kids with mental illnesses, intellectual disabilities and histories of juvenile delinquency.

RACHEL MACKEY: The continuum just doesn't support a lot of these youth at this moment in time, and that's why we have, you know, kids sleeping in hotels or in social workers' offices or overstaying at the ER.

GOTTSACKER: Melanie Allen, the director of the Department of Job and Family Services in Northwest Ohio's Sandusky County, is familiar with this struggle. She says it's gotten more intense since the pandemic.

MELANIE ALLEN: The problem we were having was we couldn't get a regular foster home to take a high-acuity 10-year-old. So we were placing kids younger and younger in congregate care.

GOTTSACKER: That's a problem for a few reasons, she says. For one, group homes aren't always the best setting for 10-year-olds to grow up in. Plus, they're really expensive. Allen knows of one child in particular that stayed in a group home at a cost of nearly $500 a day. When she moved to a foster home, the cost dropped to just $50 a day. On top of that, group homes can be hours from a child's biological parents, making it hard for them to visit. But if a child can stay in a local treatment foster home, parents can not only visit. They can learn how to manage their child's challenging behaviors by working alongside foster parents.

ALLEN: We want them to be able to transfer skills. We want them to be able to talk about - this is how I've managed to this behavior.

GOTTSACKER: But finding and training treatment foster parents isn't easy, especially for a small department like Allen's. So they partnered with neighboring counties to hire a shared social worker solely dedicated to the task. They've trained 10 treatment foster homes across a five-county area so far. Another five families are in the process of being licensed. And now, the state has dedicated $2 million to replicate this model across Ohio. It's another step in the effort to find foster families and treatment for children with disabilities and mental illnesses who need a home.

For NPR News, I'm Erin Gottsacker in Upper Sandusky, Ohio.

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