Multidimensional Treatment Foster Care–Adolescents (OJJDP Model Program Guide)

Office of Justice Programs, Innovation - Partnerships – Safer Neighborhoods

Office of Juvenile Justice and Delinquency Prevention (OJJDP) Serving Children, Families and Communities

PREVENTION

IMMEDIATE SANCTIONS

INTERMEDIATE SANCTIONS

RESIDENTIAL

REENTRY

MPG HOME SEARCH HOME SEARCH ENTIRE PROGRAM DATABASE SEARCH USING RISK & PROTECTIVE FACTORS PROGRAM TYPES RATING SYSTEM REFERENCES NOMINATE PROGRAMS RELATED LINKS RESOURCES DMC-REDUCTION BEST PRACTICES DATABASE DSO BEST PRACTICES DATABASE

Multidimensional Treatment Foster Care–Adolescents

Intervention:

Multidimensional Treatment Foster Care (MTFC) is a behavioral treatment alternative to residential placement for adolescents who have problems with chronic antisocial behavior, emotional disturbance, and delinquency. There are three versions of MTFC, each serving specific age groups. The versions are MTFC–P (for preschool children, ages 3 to 5), MFFC–L (for latency-aged children, 6–11), and MTFC–A (for adolescents, 12–17).

MTFC based on the Social Learning Theory model that describes the mechanisms by which individuals learn to behave in social contexts and the daily interactions that influence both prosocial and antisocial patterns of behavior. The intervention is multifaceted and occurs in multiple settings. The intervention activities include

Behavioral parent training and support for MTFC foster parents
Family therapy for biological parents (or other aftercare resources)
Skills training for youth
Supportive therapy for youth
School-based behavioral interventions and academic support
Psychiatric consultation and medication management, when needed

There are three components of the intervention that work in unison to treat the youth: MTFC Parents, the Family, and the Treatment Team.

1. MTFC Parents. The program places a youth in a family setting with specially trained foster parents for 6 to 9 months. The foster parents are recruited, trained, and supported to become part of the treatment team. They provide close supervision and implement a structured, individualized program for each child. MTFC parents are supported by a case manager who coordinates all aspects of their youngster’s treatment program. In addition, MTFC parents are contacted daily (Monday through Friday) by telephone to provide the Parent Daily Report (PDR) information, which is used to relay information about the child’s behavior over the last 24 hours to the treatment team and to provide quality assurance on program implementation. MTFC parents are paid a monthly salary and a small stipend to cover extra expenses.

2. The Family. The birth family receives family therapy and parent training. Families learn to provide consistent discipline, to supervise and provide encouragement, and to use a modified version of the behavior management system used in the MTFC home. Therapy is provided to prepare parents for their child’s return home and to reduce conflict and increase positive relationships in the family. Family sessions and home visits during the child’s placement in MTFC provide opportunities for the parents to practice skills and receive feedback.

3. The Treatment Team. The MTFC treatment team is led by a program supervisor who also provides intensive support and consultation to the foster parents. The treatment team also includes a family therapist, an individual therapist, a child skills trainer, and a daily telephone contact person (PDR caller). The team meets weekly to review progress on each case, review the daily behavioral information collected by telephone, and adjust the child’s individualized treatment plan.

Evaluation Methodology:

Study 1
In this evaluation of the Multidimensional Treatment Foster Care–Adolescents (MTFC–A) program conducted by Chamberlain and Reid (1998), 85 boys referred for community placement in the juvenile justice system were randomly assigned to either MTFC–A or Group Care (GC). Six boys dropped out for lack of parental consent, and five boys assessed at baseline failed to be placed and were sent home. Boys were 12–17 years old (mean=14.9 years), with histories of serious chronic delinquency averaging 14 previous criminal referrals and more than four felonies. The mean age at first criminal referral was 12.6 years. All were mandated to out-of-home care by a committee of juvenile court, and all lived in the Pacific Northwest. The large majority (85 percent) were white, 6 percent were African American, 5 percent were Hispanic, and 3 percent were Native American. There were no significant differences between the two groups on any of the baseline variables.

For the intervention group, daily phone contact with MTFC parents and a 2-hour weekly supervision meeting for MTFC–A parents were provided. Case managers and individual and family therapists were supervised in weekly 2-hour meetings with the project director and clinical consultants. Individual and family therapy sessions were videotaped and reviewed in these meetings. MTFC parents were taught how to implement an individualized plan for each youth. A three-level system was used in which the boy’s privileges and level of supervision were based on his compliance with program rules, adjustment in school, and general progress. Each boy attended weekly individual therapy emphasizing skill building in solving problems, social-perspective taking, and nonaggressive methods of self-expression. All boys were enrolled in public school, and 45 percent attended some special education classes. Boys carried a card to each class, and teachers had to sign off on attendance, homework completion, and attitude. Consequences were delivered for even minor rule infractions (such as being 2 minutes late to class). These included loss of points and privileges, extra chores, or in extreme cases stays in detention.

In the GC condition, the programs concentrated on establishing prosocial norms through therapeutic group work, during which youth confronted one another about negative behavior and participated in discipline and decision-making.

Outcome measures included number of days each month a youth was in care, on the run, in detention, or in State training school. Delinquent and criminal activities were assessed from official criminal referral data recorded by the Oregon Youth Authority, which included all officially reported misdemeanor and felony offenses on the youth’s record from 1 year prebaseline until 1 year postprogram, discharge, or expulsion. In addition, all boys completed the Elliott Behavior Checklist, a self-report questionnaire about criminal or delinquent behaviors during a specified time period. Three subscales were examined: general delinquency, index offenses, and felony assault.

Study 2
The subjects for this study by Chamberlain, Leve, and DeGarmo (2007) were 103 girls referred by Juvenile Court Judges in Oregon between 1997 and 2002. The girls had been mandated to out-of-home care because of chronic delinquency and were randomly assigned to the experimental condition (n=37) or the control condition (n=44). The average length of stay in the randomized placement was 174 days, and the average time between baseline and intervention was 47 days. The girls were 13 to 17 years old at baseline. Seventy-four percent were white, 12 percent Native American, 9 percent Hispanic, and 2 percent African American, 1 percent Asian American, and 2 percent were designated as “other.”

Foster parents of the girls assigned to the intervention group received daily phone contact, during which the Parent Daily Report Checklist was completed. Weekly fidelity data was collected on parent implementation of an individualized, in-home daily reinforcement system for the girls. Weekly foster parent group training, supervision, and support meetings were led by experienced program supervisors. School functioning was closely monitored with a daily school card signed by teachers.

In the control condition, most programs reported endorsing a specific treatment model, with the primary philosophy being behavioral (70 percent), eclectic (26 percent), or family style (4 percent) Seventy percent of the programs reported delivering therapeutic services at least weekly.

Outcomes included the number of criminal referrals; girls’ self report of total days spent in detention, correctional facilities, jail, or prison; and girls’ self report of delinquency measured by the Elliott General Delinquency Scale. Delinquency was based on a composite of the three measured variables. Structural equation modeling and latent growth curve models were used to analyze the data.

Evaluation Outcome:

Study 1
Official Criminal Referral
In the Chamberlain and Reid (1998) study, Multidimensional Treatment Foster Care–Adolescents (MTFC–A) boys showed a larger drop in official criminal referral rates than Group Care (GC) boys did at 1 year posttermination. Forty-one percent of MTFC–A boys had no criminal referrals, compared with 7 percent of GC boys.

Self-Reported Criminal and Delinquent Behavior
Using the Elliot Behavior Checklist, MTFC–A boys reported significantly fewer criminal activities than GC boys at 1 year postbaseline on general delinquency (12.8, compared with 28.9), index offenses (3.2, compared with 8.6), and felony assaults (1.2, compared with 2.7).

Youth Participation
Fewer MTFC–A youths than GC boys ran away from their placement (30.5 percent versus 57.8 percent), and more MTFC–A boys completed their treatment program (73 percent versus 36 percent).

Days in Detention and Reunification With Family
MTFC–A boys spent significantly fewer days than GC boys spent in lockup. Overall, MTFC–A boys spent approximately 60 percent fewer days incarcerated than GC boys did, including fewer days in local detention facilities (32 days, compared with 70 days) and fewer days in the State training schools (21 days, compared to 59 days). MTFC–A boys also spent nearly twice as much time living with their parents as GC boys spent (59 days, compared with 31 days).

Study 2
Reduction in Delinquency
Overall, Chamberlain, Leve, and DeGarmo (2007) found that at the 2-year follow-up the effects that had been found at 1 year were maintained at the 2-year follow-up assessment, with a slightly larger effect size for Multidimensional Treatment Foster Care–Adolescents (MTFC–A) girls. MTFC–A was associated with a significantly greater reduction in delinquency, as measured by the delinquency construct and controlling for age (older girls exhibited lower levels of 2-year delinquency). However, there were no significant differences between the groups on self-reports of delinquency as measured by the Elliott Delinquency Scale.

Criminal Referral
At 2 years posttreatment, GC girls had an average of 0.22 criminal referrals, compared with 0.13 for MTFC–A girls. However, this difference was not significant, though it did approach significance (p<0.06).

Days in Locked Settings
MTFC–A girls spent significantly fewer days than GC girls did in locked settings during the 2 years posttreatment. MTFC–A girls spent 100 fewer days than GC girls in locked settings (the average difference was 104.82 days).

Other Information:

Costs: A recent publication from the Washington State Institute of Public Policy (Aos et al. 2011) found that the Multidimensional Treatment Foster Care had a benefit-to-cost ratio of 5.28:1.00, meaning that for every $1 invested in the program, $5.28 in benefits (including a reduction in juvenile crime) were accrued.

Implementation: Specific information about implementation and training can be found at the MTFC Web site: http://www.mtfc.com/index.html

References:

Aos, Steve, Stephanie Lee, Elizabeth Drake, Annie Pennucci, Tali Klima, Marna Miller, Laurie Anderson, Jim Mayfield, and Mason Burley. 2011. Return on Investment: Evidence-Based Options to Improve Statewide Outcomes. Document No. 11–07–1201. Olympia, Wash.: Washington State Institute for Public Policy. Available at: http://www.wsipp.wa.gov/rptfiles/11-07-1201.pdf

Chamberlain, Patricia. 1998. “Treatment Foster Care.” Juvenile Justice Bulletin. Washington, DC: Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. Available at: http://www.ncjrs.gov/pdffiles1/ojjdp/173421.pdf

Chamberlain, Patricia, and Sharon F. Mihalic. 1998. Blueprints for Violence Prevention, Book 8: Multidimensional Treatment Foster Care. Boulder, Colo.: Center for the Study and Prevention of Violence. Available at: http://www.ncjrs.gov/pdffiles1/Digitization/174201NCJRS.pdf

Chamberlain, Patricia, and J. Reid. 1991. “Using a Specialized Foster Care Community Treatment Model for Children and Adolescents Leaving the State Mental Hospital.” Journal of Community Psychology 19(3):266–76.

Chamberlain, Patricia, S. Moreland, and K. Reid. 1992. “Enhanced Services and Stipends for Foster Parents: Effects on Retention Rates and Outcomes for Children.” Child Welfare 71(5):387–401.

Chamberlain, Patricia, and J. Reid. 1998. “Comparison of Two Community Alternatives to Incarceration for Chronic Juvenile Offenders.” Journal of Consulting and Clinical Psychology 66(4):624–33.

Chamberlain, Patricia, Leslie D. Leve, and David S. DeGarmo. 2007. “Multidimensional Treatment Foster Care for Girls in the Juvenile Justice System: 2-Year Follow-Up of a Randomized Clinical Trial.” Journal of Consulting and Clinical Psychology 75:187–93.

Curtis, P.A.; G. Alexander; and L.A. Lunghofer. 2001. “A Literature Review Comparing the Outcomes of Residential Group Care and Therapeutic Foster Care.” Child and Adolescent Social Work Journal 18(5):377–92.

Hahn, Robert A., Jessica Lowy, Oleg Bilukha, Susan Snyder, Peter Briss, Alex Crosby, Mindy T. Fullilove, Farris Tuma, Eve K. Moscicki, Akiva Liberman, Amanda Schofield, and Phaedra S. Corso. 2004. “Therapeutic Foster Care for the Prevention of Violence: A Report on Recommendations of the Task Force on Community Preventive Services.”Morbidity and Mortality Weekly Report. 53(RR–10):1–8.

Leve, Leslie D., Patricia Chamberlain, and John B. Reid. 2005. “Intervention Outcomes for Girls Referred From Juvenile Justice: Effects on Delinquency.” Journal of Consulting and Clinical Psychology 73:1181–85.

Program Specification:

New Rating:

Effective

Re-reviewed Date:

June 2011

Program Type:

Alcohol and Drug Therapy / Education

Cognitive Behavioral Treatment

Family Therapy

Group Home

Mentoring

Parent Training

Wraparound / Case Management

Ethnicity:

American Indian or Alaska Native

Asian

African American

Hispanic or Latino (of any race)

White

Gender:

Both

Age:

11 - 18

Special Populations:

Mentally Ill Offenders

Serious Offenders

Young Offender

Problem Behaviors:

Aggression/Violence

Family Functioning

Risk & Protective Factors:

Risk

Protective

Additional Information:

OJJDP: Blueprints

SAMHSA: NREPP

OJJDP/CSAP: Strengthen Families

HHS: Surgeon General

Department of Education

Status:

Program is in operation at this time.

Performance Measures:

Suggested OJJDP Performance Measures for the Program Types(s):

Mental Health Services
Cognitive Behavioral Treatment
Logic Model: PDF
Performance Matrix:PDF
Delinquency Prevention
Family Therapy
Logic Model: PDF
Performance Matrix:PDF
Mental Health Services
Family Therapy
Logic Model: PDF
Performance Matrix:PDF
Serious Crime
Group Home
Logic Model: PDF
Performance Matrix:PDF
Mentoring
Mentoring
Logic Model: PDF
Performance Matrix:PDF
Delinquency Prevention
Parent Training
Logic Model: PDF
Performance Matrix:PDF
Mental Health Services
Parent Training
Logic Model: PDF
Performance Matrix:PDF

Contact Information:

Program Developer:
Patricia Chamberlain, Ph.D., Director
Oregon Social Learning Center
10 Shelton McMurphey Blvd.
Eugene, OR 97401
Phone: 541.485.2711
Fax: 541.485.7087
Email: Click Here
Website: Click Here

Training & TA Provider:
Gerard J. Bouwman, President
TFC Consultants, Inc.
1163 Olive Street
Eugene, OR 97401
Phone: 541.343.2388
Fax: 541.343.2764
Email: Click Here
Website: Click Here

Program Locations:
Gerald Bouwman
Oregon Social Learning Center
160 E. Fourth Street
Eugene, OR 97401