Evidence Rating: Effective | More than one study
Date:
This is a behavioral treatment alternative to residential placement for adolescents with antisocial behavior, emotional disturbance, and delinquency. The program is rated Effective. Treatment group boys showed a statistically significant drop in criminal referral rates, criminal activities, and days spent in lock up, compared with comparison group boys. Treatment group girls showed a statistically significant reduction in delinquency, compared with comparison group girls.
An Effective rating implies that implementing the program is likely to result in the intended outcome(s).
This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.
This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.
Program Goals/Target Population
Multidimensional Treatment Foster Care (MTFC) is a behavioral treatment alternative to residential placement for youth 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 6), MTFC–C (for middle childhood, ages 7 to 11), and MTFC–A (for adolescents, ages 12 to 17).
Program Components
The MTFC–A 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; and psychiatric consultation and medication management, when needed.
There are three components of the intervention that work in unison to treat the youth: 1) MTFC Parents, 2) the Family, and 3) the Treatment Team.
- 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.
- 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, to reduce conflict, and to 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.
- 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, to review the daily behavioral information collected by telephone, and to adjust the child’s individualized treatment plan.
Program Theory
The program is 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 (Chamberlain and Reid 1998).
Study 1
Self-Reported Index Offenses
Treatment group boys self-reported fewer index offenses (or serious property and person offenses, such as auto theft or aggravated assault), compared with comparison group boys, at 1-year post-termination. This difference was statistically significant.
Official Criminal Referral Rates
Chamberlain and Reid (1998) found that boys in the Multidimensional Treatment Foster Care–Adolescents (MTFC–A) group had a greater reduction in official criminal referral rates (41 percent), compared with boys in the Group Care (GC) comparison group (7 percent), at 1-year post-termination. This difference was statistically significant.
Self-Reported General Delinquency
Treatment group boys self-reported fewer general delinquent and criminal activities, compared with comparison group boys, at 1-year post-termination. This difference was statistically significant.
Self-Reported Felony Assaults
Treatment group boys self-reported fewer felony assaults, compared with comparison group boys, at 1-year post-termination. This difference was statistically significant.
Days in Detention
Treatment group boys spent approximately 60 percent fewer days incarcerated in local detention facilities, compared with comparison group boys, at 1-year post-termination. This difference was statistically significant.
Youth Participation – Treatment Completion
Treatment group boys were more likely to complete their treatment program (73.0 percent), compared with comparison group boys (36.0 percent), at 1-year post-termination. This difference was statistically significant.
Youth Participation - Runaways
Treatment group boys were less likely to have run away from their placements (30.5 percent), compared with comparison group boys (57.8 percent), at 1-year post-termination. This difference was statistically significant.
Reunification With Family
There were no statistically significant differences between the boys in the treatment and comparison groups in among of time spent living with their parents or relatives, at 1-year post-termination.
Study 2
General Delinquency
Chamberlain, Leve, and DeGarmo (2007) found that girls in the MTFC–A treatment group showed lower levels of general delinquency (measured by combining criminal referral, self-reported delinquency, and days in locked settings), compared with girls in the GC comparison group, at the 2-year follow up. This difference was statistically significant.
Self-Reported Delinquency
There were no statistically significant differences between the girls in the treatment and comparison groups in self-reports of delinquency, at the 2-year follow up.
Criminal Referrals
There were no statistically significant differences between the girls in the treatment and comparison groups in criminal referrals, at the 2-year follow up.
Days in Locked Settings
Treatment group girls spent fewer days in locked settings, compared with comparison group girls, at the 2-year follow up. This difference was statistically significant.
Study 1
In the 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) comparison condition. 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 (the average age was 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 statistically significant differences between the two groups on any of the baseline variables. Treatment fidelity was assessed at 3 months through the use of an onsite interview examining practices at each placement site.
For the MTFC–A 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. The authors conducted subgroup analyses on age.
Study 2
Chamberlain, Leve, and DeGarmo (2007) conducted an evaluation that involved 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 MTFC–A condition (n = 37) or the GC comparison 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 MTFC–A 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 comparison 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’ report of total days spent in detention, correctional facilities, jail, or prison; and girls’ report of delinquency. Information regarding criminal referrals was obtained from state police records and circuit court data, and delinquency was 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. The authors conducted subgroup analyses on age.
Specific information about implementation and training/certification for Multidimensional Treatment Foster Care can be found at the website for Treatment Foster Care Oregon (TFCO).
Subgroup Analysis
Chamberlain and Reid (1998) conducted subgroup analyses on age. They did not find any statistically significant differences between younger and older boys in the treatment group on measures of delinquency. Chamberlain, Leve, and DeGarmo (2007) also conducted subgroup analyses on age. Across both treatment and comparison groups, older girls exhibited lower levels of delinquency, compared with younger girls, at the 2-year follow up. These differences were statistically significant.
These sources were used in the development of the program profile:
Study 1
Chamberlain, Patricia, and John B. Reid. 1998. “Comparison of Two Community Alternatives to Incarceration for Chronic Juvenile Offenders.” Journal of Consulting and Clinical Psychology 66(4):624–33
Study 2
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.
These sources were used in the development of the program profile:
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.
http://www.wsipp.wa.gov/rptfiles/11-07-1201.pdfChamberlain, Patricia. 1998. “Treatment Foster Care.” Juvenile Justice Bulletin. Washington, D.C.: Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice.
http://www.ncjrs.gov/pdffiles1/ojjdp/173421.pdfChamberlain, 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.
http://www.ncjrs.gov/pdffiles1/Digitization/174201NCJRS.pdfChamberlain, Patricia, Sandra Moreland, and Kathleen 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 John B. 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.
Curtis, Patrick A., Gina Alexander, and Lisa 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.
Chamberlain, Patricia, Joe Price, Leslie D. Leve, Heidemarie Laurent, John A. Landsverk, and John B. Reid. 2008. “Prevention of Behavior Problems for Children in Foster Care: Outcomes and Mediation Effects.” Prevention Science 9(1):17–27.
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.
Harold, Gordon T., David C.R. Kerr, Mark Van Ryzin, David S. DeGarmo, Kimberly A. Rhoades, and Leslie D. Leve. 2013. “Depressive Symptom Trajectories Among Girls in the Juvenile Justice System: 24-Month Outcomes of an RCT of Multidimensional Treatment Foster Care.” Prevention Science 14:437–46.
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.
Leve, Leslie D., David C.R. Kerr, and Gordon T. Harold. 2013. “Young Adult Outcomes Associated With Teen Pregnancy Among High-Risk Girls in a Randomized Controlled Trial of Multidimensional Treatment Foster Care.” Journal of Child & Adolescent Substance Abuse 22:421–34.
Rhoades, Kimberly A., Patricia Chamberlain, Rosemarie Roberts, and Leslie D. Leve. 2013. “MTFC for High-Risk Adolescent Girls: A Comparison of Outcomes in England and the United States.” Journal of Child & Adolescent Substance Abuse 22:435–49.
Following are CrimeSolutions-rated programs that are related to this practice:
The practice of using traditional juvenile justice system processing in lieu of alternative sanctions to deal with juvenile criminal cases. The practice is rated No Effects for reducing recidivism compared to the youth that were diverted from the system. Test
Evidence Ratings for Outcomes
Crime & Delinquency - Multiple crime/offense types |
This practice provides youth with a positive and consistent adult or older youth relationship to promote healthy youth development and social functioning and to reduce risk factors. The practice is rated Effective in reducing delinquency and improving educational outcomes; Promising in improving psychological outcomes and cognitive functioning; and No Effects in reducing substance use.
Evidence Ratings for Outcomes
Crime & Delinquency - Multiple crime/offense types | |
Education - Multiple education outcomes | |
Mental Health & Behavioral Health - Psychological functioning | |
Mental Health & Behavioral Health - Cognitive functioning | |
Mental Health & Behavioral Health - Social functioning | |
Drugs & Substance Abuse - Multiple substances |
In general family-based treatment practices consist of a wide range of interventions that are designed to change dysfunctional family patterns that contribute to the onset and maintenance of adolescent delinquency and other problem behaviors. This practice is rated Effective for reducing recidivism, and Promising for reducing antisocial behavior and substance use, and improving psychological functioning and school performance.
Evidence Ratings for Outcomes
Crime & Delinquency - Multiple crime/offense types | |
Mental Health & Behavioral Health - Externalizing behavior | |
Drugs & Substance Abuse - Multiple substances | |
Mental Health & Behavioral Health - Psychological functioning | |
Education - Academic achievement/school performance |
This practice involves the use of psychosocial interventions to reduce antisocial behavior in juveniles. Psychosocial interventions consist of both preventive and therapeutic interventions but share the common goal of improving psychosocial functioning. The practice is rated Effective for the reduction of antisocial behavior.
Evidence Ratings for Outcomes
Juvenile Problem & At-Risk Behaviors - Antisocial behaviors |
Age: 12 - 17
Gender: Male, Female
Race/Ethnicity: White, Black, Hispanic, American Indians/Alaska Native, Asian/Pacific Islander, Other
Geography: Suburban Rural
Setting (Delivery): Residential (group home, shelter care, nonsecure)
Program Type: Alternatives to Detention, Alternatives to Incarceration, Children Exposed to Violence, Cognitive Behavioral Treatment, Family Therapy, Group Home, Individual Therapy, Mentoring, Parent Training, Residential Treatment Center, Wraparound/Case Management
Targeted Population: Children Exposed to Violence, Families, Young Offenders
Current Program Status: Active
10 Shelton McMurphey Boulevard 1163 Olive Street
Patricia Chamberlain
Oregon Social Learning Center
Eugene, OR 97401
United States
Website
Email
Gerard J. Bouwann
President
TFC Consultants
Eugene, OR 97401
United States
Email