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Multidimensional Treatment Foster Care (MTFC)

Model Program

Program Outcomes

  • Delinquency and Criminal Behavior
  • Illicit Drug Use
  • Teen Pregnancy
  • Tobacco
  • Violence

Program Type

  • Community Supervision and Aftercare
  • Foster Care and Family Prevention
  • Juvenile Justice, Other

Program Setting

  • Community (e.g., religious, recreation)
  • Home
  • Transitional Between Contexts

Continuum of Intervention

  • Indicated Prevention (Early Symptoms of Problem)

Age

  • Early Adolescence (12-14) - Middle School
  • Late Adolescence (15-18) - High School

Gender

  • Male and Female

Race/Ethnicity

  • All Race/Ethnicity

Endorsements

  • Coalition for Evidence-Based Policy: Top Tier
  • Crime Solutions: Effective
  • Blueprints: Model
  • OJJDP Model Programs: Effective
  • SAMHSA: 2.8-3.1

Program Information Contact

TFC Consultants, Inc.
Gerard Bouwman, President
1163 Olive St.
Eugene, Oregon 97401
Telephone: 541-343-2388 ext. 204
gerardb@mtfc.com
Website: www.mtfc.com

Program Developer/Owner

  • Patricia Chamberlain, Ph.D.
  • Oregon Social Learning Center

Brief Description of the Program

Multidimensional Treatment Foster Care (MTFC) is a cost effective alternative to group or residential treatment, incarceration, and hospitalization for adolescents who have problems with chronic antisocial behavior, emotional disturbance, and delinquency. Community families are recruited, trained, and closely supervised to provide MTFC-placed adolescents with treatment and intensive supervision at home, in school, and in the community; clear and consistent limits with follow-through on consequences; positive reinforcement for appropriate behavior; a relationship with a mentoring adult; and separation from delinquent peers. MTFC utilizes a behavior modification program based on a three-level point system by which the youth are provided with structured daily feedback. As youth accumulate points, they are given more freedom from adult supervision. Individual and family therapy is provided, and case managers closely supervise and support the youths and their foster families through daily phone calls and weekly foster parent group meetings. There is a learning emphasis on teaching interpersonal skills and on participation in positive social activities including sports, hobbies, and other forms of recreation. Placement in foster parent homes typically last for about six months. Aftercare services remain in place for as long as the parents want, but typically last about one year.

See: Full Description

Outcomes

When implemented with delinquent boys, significant program effects, relative to a comparison group, included:

  • Incarcerated 60% fewer days 12 months after baseline
  • Fewer subsequent arrests 12 months after baseline
  • Less self-reported other drug use at 12 and 18 months, and tobacco and marijuana use at 18 months post-program
  • Fewer violent offense referrals (21% in MTFC vs. 38% of Controls) two years after enrollment
  • Fewer self-reported violent offenses (10.5 incidents for MTFC group vs. 32.6 incidents for control group) two years after enrollment
  • Ran away from their programs, on average, three times less often

When implemented with delinquent girls, significant program effects, relative to a comparison group, included:

  • Fewer days in locked settings, fewer criminal referrals, lower caregiver-reported delinquency, and more time on homework at 12-months post-baseline
  • Reductions on a combined measure of days spent in locked settings, criminal referrals, and self-reported delinquency at 24-months post-baseline
  • Odds of becoming pregnant in group care 2.44 times higher than that of girls in MTFC 24 months post-baseline (Kerr et al. 2009)

Significant Risk and Protective Factors:

  • Family management skills and deviant peer association functioned as mediators of the effect of treatment condition on subsequent youth antisocial behavior.

Race/Ethnicity/Gender Details

The program is suitable for all ethnic groups. The program has been demonstrated effective for both boys and girls.

Risk and Protective Factors

Risk Factors
  • Individual: Antisocial/aggressive behavior, Early initiation of antisocial behavior, Favorable attitudes towards antisocial behavior, Physical violence
  • Peer: Interaction with antisocial peers
  • Family: Poor family management
  • School: Poor academic performance
Protective Factors
  • Individual: Clear standards for behavior, Problem solving skills, Prosocial behavior, Prosocial involvement, Rewards for prosocial involvement, Skills for social interaction
  • Peer: Interaction with prosocial peers
  • Family: Attachment to parents, Opportunities for prosocial involvement with parents, Parent social support, Rewards for prosocial involvement with parents
  • School: Rewards for prosocial involvement in school
  • Neighborhood/Community: Opportunities for prosocial involvement, Rewards for prosocial involvement

See also: Multidimensional Treatment Foster Care (MTFC) Logic Model (PDF)

Training and Technical Assistance

Potential foster parents undergo a more intensive screening process prior to training than families interested in "regular" foster care. Once eligibility is determined, an application is completed and home visit is conducted, where parents learn about the program in detail, and the expectations and training certification requirements are explained. TFC parents must be willing to work with a more difficult population of adolescents, and take a more active treatment perspective, including a program that is more intensely structured for day-to-day activities. Parents are part of a therapeutic team, with ongoing monitoring and assistance. Foster parents receive 20 hours of preservice training, where they are indoctrinated with an overview of the program model. They learn to analyze behavior, implement the individualized daily program, methods for working with the biological family, and understand MTFC policies and procedures. During training, an emphasis on learning techniques for reinforcing and encouraging are stressed. During screening and training, MTFC personnel learn more about the family and make assessments about matching them with a program youth. Demographics are considered (i.e., youth with histories of sexual acting out or problems getting along with other children are carefully placed).

All program staff attend a three-day orientation on the program model, which includes a combination of didactic instruction, role plays, and case examples. Therapists and program supervisors receive an additional day of training in the MTFC therapy approach, and program supervisors receive a fifth day of training specific to their role. All clinical staff also attend the next scheduled MTFC parent training session. For new clinical staff (therapists and case managers), instruction on the point and level system and how to implement it is completed, case examples are used to explain how the program can be individualized for each case and to address specific types of problems. New staff also receive an orientation on the roles and duties of each member of the MTFC team and how these roles coordinate with each other in the treatment process. New staff also attend relevant clinical supervision and the weekly MTFC parent meetings to get practical information on how the program is implemented. They then sit in on ongoing cases or watch videotapes of treatment sessions (both individual and family).

Training Certification Process

There is no training of trainers model.

Brief Evaluation Methodology

Multidimensional Treatment Foster Care is a cost effective alternative to residential placement for chronic delinquents who have a long history with the juvenile court system and are also exhibiting chronic antisocial behavior and emotional disturbance. The initial evaluation randomized 85 serious juvenile male offenders determined by the juvenile court as eligible for out-of-home placement to either MTFC or residential group care. After six months, the goal of the treatment was to return the boys, when possible, back to their family of origin. Other randomized-controlled evaluations have proven the program to be effective for girls, younger populations, and children and adolescents leaving state mental hospital settings. The most recent evaluation reports on a version of the program adapted for use with preschoolers and finds effects on attachment-related behaviors.

References

Chamberlain, P. (1990). Comparative evaluation of specialized foster care for seriously delinquent youths: a first step. Community Alternatives: International Journal of Family Care, 2, 21-36.

Chamberlain, P. (1997). The effectiveness of group versus family treatment settings for adolescent juvenile offenders. Paper presented at the Society for Research on Child Development Symposium, Washington, D.C., April 3.

Chamberlain, P., Leve, L.D., & DeGarmo, D.S. (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(1), 187-193.

Chamberlain, P., Moreland, S., & Reid, K. (1992). Enhanced services and stipends for foster parents: effects on retention rates and outcomes for children. Child Welfare League of America, Vol. LXXI(5),387-401.

Chamberlain, P., Ray, J., & Moore, K. (1996). Characteristics of residential care for adolescent offenders: A comparison of assumptions and practices in two models. Journal of Child and Family Studies, 5, 285-297.

Chamberlain, P., & Reid, J.B. (1991). Using a Specialized Foster Care treatment model for children and adolescents leaving the state mental hospital. Oregon Social Learning Center. Draft.

Chamberlain, P., & Reid, J.B. (1994). Differences in risk factors and adjustment for male and female delinquents in Treatment Foster Care. Journal of Child and Family Studies, 3, 23-39.

Chamberlain, P., & Reid, J. (1998). Comparison of two community alternatives to incarceration for chronic juvenile offenders. Journal of Consulting and Clinical Psychology, 5, 857-863.

Eddy, J., Whaley, R., & 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.

Eddy, J.M., & Chamberlain, P. (2000). Family management and deviant peer association as mediators of the impact of treatment condition on youth antisocial behavior. Journal of Consulting and Clinical Psychology, 68, 857-863.

Fisher, P.A. & Kim, H.K. (2007). Intervention effects on foster preschoolers' attachment-related behaviors from a randomized trial. Prevention Science, 8, 161-170.

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 Counseling and Clinical Psychology, 77(3), 588-593.

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(3), 339-347.

Leve, L.D., & Chamberlain, P. (2007). A randomized evaluation of Multidimensional Treatment Foster Care: Effects on school attendance and homework completion in juvenile justice girls. Research on Social Work Practice, 17(6), 657-663.

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(6), 1181-1185.

Leve, L. D., Kerr, D. C. R., & Harold, G. T. (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(5), 421-434.

Rhoades, K. A., Chamberlain, P., Roberts, R., & Leve, L. D. (2013). MTFC for high-risk adolescent girls: A comparison of outcomes in England and the United States. Journal of Child & Adolescent Substance Use, 22(5), 435-449.

Smith, D.K., Chamberlain, P., & Eddy, J.M. (2010). Preliminary support for Multidimensional Treatment Foster Care in reducing substance use in delinquent boys. Journal of Child & Adolescent Substance Abuse, 19(4), 343-358.

Van Ryzin, M. J., & Leve, L. D. (2012). Affiliation with delinquent peers as a mediator of the effects of Multidimensional Treatment Foster Care for delinquent girls. Journal of Consulting and Clinical Psychology, 80(4), 588-596.

Westermark, P.K., Hansson, K. & Olsson, M. (2011). Multidimensional Treatment Foster Care (MFTC): Results from an independent replication. Journal of Family Therapy, 33, 20-41.