Program Profile: Multidimensional Treatment Foster Care-Adolescents

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.

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, 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.
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, 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

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:

These sources were used in the development of the program profile:

Following are CrimeSolutions-rated programs that are related to this practice:

Formal System Processing for Juveniles

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

Mentoring for Youth Development

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

Family-based Treatment for Adolescent Delinquency and Problem Behaviors

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

Psychosocial Interventions for Antisocial Behavior of Juveniles

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

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?