Multidimensional Treatment Foster Care

OVERVIEW

Multidimensional Treatment Foster Care (MTFC) is designed to serve as an alternative to residential treatment and to deter subsequent incarceration among a high risk population. Adolescent youth with severe criminal behavior who exhibit antisocial or delinquent behavior are considered to be at an increased risk for future criminal offenses. The goal of MTFC is to provide these youth with the skills, resources, supervision and structure necessary to reduce delinquency in place of more prosocial and adaptive behaviors. The program relies on the involvement of trained foster families, therapists, and case managers to provide youth with the skills and structure to modify behavior. The ultimate goal of MTFC is to return youth to their biological or adoptive families, who are also involved throughout the process. Overall, MTFC has been evaluated and shown to decrease rates of incarceration, arrests, and drug use among its youth participants.

DESCRIPTION OF PROGRAM

Target population: Adolescent youth with severe criminal behaviors

Multidimensional Treatment Foster Care (MTFC) was designed by the Oregon Social Learning Center to provide alternative residential placements for youth with serious criminal behavior. MTFC is, as the name implies, a comprehensive program that goes beyond simply proving foster care to at-risk youth. The program incorporates multiple people and systems, all of whom exert influence over youth and lasts for approximately six to nine months. Each youth who participates in MTFC receives an individualized program that emphasizes behavioral skills training, discipline and reinforcement, and positive relationships. The foster families, biological families and youth are the primary participants and although services for all three are interrelated, MTFC will be described in detail as it pertains to each participant.

Case managers serve as the primary contact for youth and families and are responsible for coordinating nearly all aspects of MTFC implementation. They are trained in social learning theory and typically have a minimum of a bachelor's degree in fields related to adolescent development and psychology. All staff members participate in a 3-day training prior to program implementation.

The first component of MTFC involves recruitment and training of MTFC foster families. Foster families receive twenty hours of training before placements are made and receive monthly stipends to cover expenses during the youth's stay. The cornerstone of MTFC is the individualized plan created by the case manager and foster family. The plan emphasizes behavioral management techniques and the foster home environment. The home environment is meant to provide youth with structure, limits, and rules at the same time it fosters the strengths and assets of the youth. The plan encompasses behavioral skills training, such as interpersonal skills and prosocial behaviors, discipline techniques, role modeling, establishing rules and consequences for youth, eliminating exposure to negative peer influences, and providing youth with positive and productive relationships. One primary component of the foster placement and plan is a three level points system to monitor and reward behavior and provide youth with daily feedback and structure. As youth progress through the three levels during the course of the placement, standards and expectations of youth behavior become increasingly more demanding which correspond, in turn, with increased privileges and a reduction in supervision. Youth are not permitted any unsupervised free time during the course of the placement. During the course of the placement, staff members make daily phone calls to foster families to assess progress and difficulties that may arise. These reports are constantly reviewed by case managers who meet weekly with foster families. During these assessments, case managers review weekly progress and the individualized plans. The continual supervision and assessments allow for the plan to be constantly modified to meet the needs of MTFC participants.

At the same time youth are placed with foster families, biological or adoptive families receive MTFC services in the form of family therapy. The ultimate goal is to return youth to their biological families so this component of MTFC primes families in the methods used by foster families in the home environment, the individualized plan, and the youth's progress. The youth's families attend weekly treatment sessions during which they learn specifically about the MTFC home environment and the individualized program in addition to more general topic such as supervision, discipline, and reinforcement techniques. Youth participate in supervised home visits which are intended to provide families an opportunity to practice MTFC methods. These home visits take place throughout the program. Although one to two hours in length initially, home visits usually develop into overnight stays. Home visits are reviewed by the family therapist and case manager, both of whom are in frequent contact with families.

In addition to participating in the daily behavioral management plan at the MTFC foster home, youth participate in individual, skills-based therapy on a weekly basis. The primary purpose of these therapy sessions is to support the youth's adaptation and progress throughout the placement. Other mental health services are provided as needed. Youth participants continue to attend school while in their foster placements. Homework, attendance, peer interactions and behavior are closely monitored to ensure that progress achieved during MTFC is maintained and sustained throughout time and context. The case manager also holds weekly clinical meetings with the individual and family therapists to track progress and modify the plan accordingly.

Once the youth return home, parents receive aftercare support in the form of weekly group meetings run by case managers and MTFC foster families. During this time, parents meet with other families to learn additional skills, discuss problems and review home practice techniques. Case managers continue to provide families with supervision and consultations as needed. Parents also receive phone calls to assess daily or weekly progress, as the MTFC foster families did initially. Aftercare services are offered as long as necessary and typically run for a year after youth return home.

EVALUATION(S) OF PROGRAM

Chamberlain, P., & Reid, J.B. (1997). Comparison of two community alternatives to incarceration for chronic juvenile offenders. In D. S. Elliott (Ed.), Blueprints for Violence Prevention (Vol. 8). Boulder, CO: Venture Publishing and C & M Press.

Evaluated population: Adolescent male juvenile offenders in Oregon

Approach: This study evaluated the impact of MTFC on a sample of 79 adolescent males ages 12 to 17. Boys in the sample averaged thirteen prior arrests and 4.6 prior felonies. Boys had been mandated by juvenile courts to receive out-of-home care and were randomly assigned to either MTFC (n=37) or Group Care (n=42) placements. Group Care (GC) placements took place at one of eleven programs throughout the state. Although GC programs varied, they generally emphasized a positive peer culture approach and included individual and group therapy. There were between six and fifteen youth at each placement and youth attended in-house schools.

Boys were evaluated at baseline, three months into treatment, and then every six months for two years following treatment. Measures were based on self-report, caregiver-report and official arrest data and included delinquent and criminal activity, supervision, discipline, positive relationships with adult caregivers, and association with deviant peers.

Results: At three months, MTFC boys were rated significantly better on measures of being supervised, receiving more consistent discipline, better relationships with adults and less association with deviant peers than their Group Care counterparts. MTFC boys also reported fewer daily problem behaviors than GC boys but this was not consistent with caretaker-reports which rated the boys similarly. At one year post-treatment, MTFC boys had significantly fewer arrests and were incarcerated significantly less often than GC boys. MTFC participants were also significantly more likely to report no further arrests post-treatment. Finally, boys receiving MTFC reported significantly less criminal and delinquent behaviors.

Chamberlain, P., & Reid, J.B. (1991). Using a specialized foster care community treatment model for children and adolescents leaving the state mental hospital. In D. S. Elliott (Ed.), Blueprints for Violence Prevention (Vol. 8). Boulder, CO: Venture Publishing and C & M Press.

Evaluated population: Emotionally disturbed children ages 9-18 in Oregon

Approach: This evaluation studied 20 children and adolescents (8 male; 12 female) leaving a state mental hospital in Oregon. Subjects had experienced extreme rates of hospitalization in the year prior to the evaluation due to conduct disorder, schizophrenia and personality disorders. Subjects were randomly assigned to receive MTFC (n=10) or treatment-as usual in the community (n=10). Treatment-as usual typically consisted of institutional placements. Measures were based on adult and child report and included problem behaviors, psychiatric symptoms and rehospitalization rates. Participants were assessed post-referral, and again at three and seven months post-treatment.

Results: No differences were found between groups on rehospitalization rates or child-reported psychiatric symptoms. MTFC participants received significantly better scores adult-reported daily problem behaviors.

One limitation of the study was the time difference between referrals and actual placements; the mean length between referral and placement for MTFC subjects was 81 days in comparison to 182 days for control youth. Due to the difficult nature of treatment-as-usual placements, some control subjects were still in the hospital during follow-up assessments.

SOURCES FOR MORE INFORMATION

References

Chamberlain, P., & Mihalic, S.F. (1998). Multidimensional Treatment Foster Care. In D. S. Elliott (Ed.), Blueprints for Violence Prevention (Vol. 8). Boulder, CO: Venture Publishing and C & M Press.

Website: http://www.mtfc.com/implementation.html

Program categorized in this guide according to the following:

Evaluated participant ages: 9-18

Program age ranges in the Guide: 6-11, 12-14, 15-21

Program components: clinic-based, provider-based, or miscellaneous; counseling/therapy; home visiting; parent or family component

Measured outcomes: social and emotional health and development; life behavioral problems; mental health

KEYWORDS: High Risk, Youth, Juvenile Offenders, Delinquency, Behavioral Problems, Skills Training, Counseling/Therapy, Family Therapy, Substance Abuse, Adolescents, Adolescence (12-17), At-Risk, Social/Emotional Health and Development, Mental Health, Home Visitation, Education, Life Skills Training, Middle Childhood (6-11), Gender Specific (Male Only), Caucasian or White, African American or Black, Hispanic or Latino, American Indian or Native American, Urban, Violence, Clinic-Based, Provider-Based.

Program information last updated 3/16/07

		© Child Trends 2004