Multidimensional Treatment Foster Care (MTFC)

OVERVIEW

Multidimensional Treatment Foster Care (MTFC) is designed to serve as an alternative to residential treatment and prevent later incarceration among a high-risk population of adolescents and youth. Adolescents and youth exhibiting severe criminal, 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 and promote 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 needed to modify behavior. The goal of MTFC is to return youth to their biological or adoptive families who are involved throughout the process. MTFC has been shown to reduce rates of incarceration, arrest, and drug use among its participants. The program was also found to increase positive social behavior and reduce several types of criminal behaviors.

DESCRIPTION OF PROGRAM

Target population: Adolescents and youth with severe criminal, antisocial, or delinquent behaviors

Multidimensional Treatment Foster Care (MTFC) was designed by the Oregon Social Learning Center (OSLC) to provide alternative residential placements for youth with serious criminal, antisocial, or delinquent behavior. Each adolescent or youth who participates in MTFC receives an individualized program that emphasizes behavioral skills training, discipline and reinforcement, and positive relationships.

Case managers serve as the primary contact for the participant and his or her family. The case managers 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 case managers also participate in a 3-day training program prior to implementation of the MTFC program.

The first component of MTFC involves 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 participant’s stay. The basis of MTFC is the individualized plan created by the case manager and foster family. The plan emphasizes behavioral management techniques and a foster home environment that promotes development of prosocial behaviors. This home environment is meant to provide youth with structure, limits, and rules and also to develop the strengths and assets of the adolescent or youth. The plan relies on behavioral skills training, such as interpersonal skills and prosocial behaviors, discipline techniques, role modeling, establishing rules and consequences for the youth, eliminating exposure to negative peer influences, and providing the adolescent with positive and productive relationships. One component of the foster plan is a three-level points system to monitor and reward behavior and provide the youth with daily feedback. As the adolescent progresses through the three levels during the course of the placement, standards and expectations of the youth’s behavior become increasingly more demanding which correspond, in turn, with increased privileges and a reduction in supervision. The adolescent is not permitted any unsupervised free time during the course of the placement. During placement, staff members call foster families daily to assess progress and difficulties that may arise over the course of placement. These reports are continually reviewed by case managers who meet weekly with the foster families. During these meetings, case managers review weekly progress and the individualized plan designed for the adolescent or youth. This frequent supervision and assessment allows for continual modification of the treatment plan so that it meets the individual needs of the MTFC participant.

The adolescent or youth is also placed with a foster family, the biological or adoptive family of the adolescent receives MTFC services in the form of family therapy. The family therapy component primes the family in the MTFC theory and methodology as well as the adolescent or youth’s progress in the program. The participant’s family attends weekly treatment sessions during which they learn specifically about the MTFC home environment and the participant’s individualized program in addition to more general topics such as supervision, discipline, and reinforcement techniques. After this training, the youth participates in supervised home visits with the biological or adoptive family. These home visits are intended to provide an opportunity to practice MTFC methods in a controlled environment. These home visits take place throughout the program and begin at one to two hours in length initially; later, the home visits gradually develop into overnight stays. The family therapist and case manager, both of whom are in frequent contact with families during this time, review home visits. The family therapy and visitation components are central to the MTFC program as the main goal of the program is to eventually return the participant to their biological or adoptive family.

In addition to participating in the daily behavioral management plan at the MTFC foster home, the adolescent or youth also participates in individual, skills-based therapy on a weekly basis. The primary purpose of these therapy sessions is to support behavioral adaptation and progress throughout the placement. Additionally, other mental health services are provided as needed. The youth participant continues to attend school while in his or her foster placements. Homework, attendance, peer interaction and behaviors are closely monitored to ensure that progress made during MTFC is maintained.

Once the participant returns home, biological or adoptive 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 the adoptive or biological families with supervision and consultations as needed. Parents also receive phone calls to assess daily or weekly progress. Aftercare services are offered as long as necessary and typically run for a year after the adolescent or youth returns home.

On average, treatment for each child costs between $200 and $225 per day, which includes both program and implementation costs. Implementation costs for the first year are about $59,550, which includes program materials, readiness process, first-year implementation services, and travel costs to attend training. Costs in the second year are generally about $29,775, and costs to maintain fidelity in subsequent years are about $5,000 to $8,000.

EVALUATION(S) OF PROGRAM

Chamberlain, P., & Reid, J. B. (1998). 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: Seventy-nine adolescent and youth male offenders in Oregon ages 12-17 were evaluated. Boys in the sample averaged thirteen prior arrests and 4.6 prior felonies.

Approach: 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 all emphasized a positive peer culture approach and included both 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 behavior under supervision, discipline, relationships with adults, and association with deviant peers than their GC counterparts. MTFC boys also reported fewer daily problem behaviors than GC boys but this was not consistent with caretaker-reports, which rated the MTFC and GC 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 more likely to report no further arrests post-treatment. Finally, boys receiving MTFC treatment reported less criminal and delinquent behavior.

Kerr, D. C. R., Leve, L. D., & Chamberlain, P. (2009). Pregnancy rates among juvenile justice girls in two randomized controlled trials of multidimensional treatment foster care. Journal of Consulting and Clinical Psychology, 77, 3, 588-593.

Evaluated Population: A total of 166 girls who were referred to the study because of chronic delinquency were evaluated. The girls ranged in age from 13 to 17 years (mean age of 15.3 years). The girls in the study had at least one criminal referral in the past year, were not currently pregnant, and were placed in out-of-home care within one year following referral. The sample was 74 percent Caucasian, 7 percent Hispanic, 4 percent Native-American, 2 percent African-American, 1 percent Asian, and 13 percent reported mixed ethnic heritage.

Approach: Participants were randomly assigned to either the experimental MTFC condition (N=81) or a comparison condition of Group Care Services (GC) (N=85). Participants were assessed for delinquency through measures of criminal referrals, sexual activity, and pregnancy history at baseline through 24 months.

Results: The MFTC treatment group was found to have decreased pregnancy rates compared with the GC treatment group.

Leve, L. D., & Chamberlain, P. (2005). Association with delinquent peers: Intervention effects for youth in the juvenile justice system. Journal of Abnormal Child Psychology, 33, 339-347.

Evaluated Population: A total of 153 youth and adolescents (72 boys and 81 girls) ages 12 to 17 (mean age of males=14.4 and mean age of females=15.3) were evaluated. The sample was 74 percent Caucasian for girls and 83 percent Caucasian for boys with the majority of the remaining participants being African-American, Hispanic, or American Indian. Participants averaged from 11.9 to 13.5 criminal referrals depending on sex and ethnicity.

Approach: Participants were randomly assigned to the MTFC treatment condition (N=73) or a comparison condition of Group Care (GC) (N=80). Data were collected at baseline, 3-, 6-, 12-, 18-, and 24-months after placement and assessed self-reported delinquent peer association and caregiver-rated delinquent peer association.

Results: MTFC treatment group had lower levels of delinquent peer associations when compared to the GC treatment group at 12-months. Delinquent peer association was found to decrease over time for both treatments.

Leve, L. D., Chamberlain, P., & Reid, J. B. (2005). Intervention outcomes for girls referred from juvenile justice: Effects on delinquency. Journal of Consulting and Clinical Psychology, 73, 1181-1185.

Evaluated Population: A total of 103 girls referred to the study because of chronic delinquency were evaluated. The girls ranged in age from 13 to 17 years (mean age=15.3). The girls in the study had at least one criminal referral in the past year, were not currently pregnant, and were placed in out-of-home care within one year following referral. The sample was 74 percent Caucasian, 2 percent African-American, 9 percent Hispanic, 12 percent Native American, 1 percent Asian, and 2 percent mixed ethnicity.

Approach: Participants were randomly assigned to either the experimental MTFC condition (N=37) or a comparison condition of Group Care Services (GC) (N=44). Participants were assessed for delinquency through measures of days in locked settings, criminal referrals, caregiver-reported delinquency, and self-reported delinquency at baseline and 12-months later.

Results: The MTFC group spent significantly fewer follow-up days in locked settings compared with the GC group. MTFC girls had fewer follow-up criminal referrals that GC girls, however, this did not reach significance. No significant effect on delinquency measures were found among the MTFC and GG groups.

Eddy, J. M., Whaley, R. B., & Chamberlain, P. (2004). The prevention of violent behavior by chronic and serious male juvenile offenders: A 2-year follow-up of a randomized clinical trial. Journal of Emotional and Behavioral Disorders, 12(1), 2-8.

Evaluated Population: Seventy-nine chronic delinquents in an urban area of the Pacific Northwest were evaluated. The participants ranged from 12 to 17 years old (mean age=14.9). The sample was 85 percent Caucasian, 6 percent African-American, 6 percent Hispanic, and 3 percent American Indian.

Approach: The adolescents and youth were randomly assigned to either the MTFC treatment condition (N=37) or a comparison condition of Group Care Services (GC) (N=42). The participants were assessed at baseline, 6-, 12-, 18-, and 24-months of treatment using official criminal referrals for violent offenses and self-reported violence measures.

Results: The MTFC group reported significantly fewer incidents of violence compared to the GC group. The MTFC group also had significantly fewer criminal referrals for violence in the two years after intervention than participants in the GC condition.

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: Twenty emotionally disturbed children, adolescents, and youth ages 9 to 18 who were leaving a state mental hospital in Oregon were evaluated. Subjects had experienced extreme rates of hospitalization in the year prior to the evaluation due to conduct disorder, schizophrenia, and personality disorders. Eight were male and twelve were female.

Approach: 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. Assessments were based on adult and child reports and included problem behaviors, psychiatric symptoms, and rehospitalization rates. Participants were assessed post-referral and again at 3- and 7-months post-treatment.

Results: MTFC participants received significantly better scores on adult-reported daily problem behaviors compared with participants in the treatment-as usual condition.

No differences were found between groups on rehospitalization rates or child-reported psychiatric symptoms.

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

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.

Leve, L. D., & Chamberlain, P. (2005). Association with delinquent peers: Intervention effects for youth in the juvenile justice system. Journal of Abnormal Child Psychology, 33, 339-347.

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

Contact Information

Gerard J. Bouwman

541-343-2388

Gerardb@mtfc.com

KEYWORDS: High-Risk, Youth (16+), Juvenile Offenders, Delinquency, Other Behavioral Problems, Skills Training, Counseling/Therapy, Family Therapy, Adolescents (12-17), Home Visitation, Education, Life Skills Training, Children (3-11), Male Only, Female Only, Caucasian or White, Urban, Clinic-Based, Provider-Based, Cost Information is Available, Other Relationships, Aggression, Conduct/Disruptive Disorders, Other Mental Health, Males and Females, Sexual Activity, Teen Pregnancy.

Program information last updated 4/3/2012.

		© Child Trends 2004