Multidimensional Treatment Foster Care for Adolescents (MTFC-A)

Multidimensional Treatment Foster Care was developed in the early 1980’s as an alternative to institutional, residential, and group care placements for boys with severe and chronic criminal behavior. Subsequently, the MTFC model has been adapted for and tested with children and adolescents with severe emotional and behavioral disorders, girls referred from juvenile justice for severe delinquency, and with youth in regular state-supported foster care. Three additional randomized trials are currently underway that test:

1. The effectiveness of MTFC in treating substance use and health-risking behavior for girls referred from juvenile justice,
2. The effectiveness of applying an adaptation of MTFC to prevent placement disruption and promote family reunification in a large urban child welfare system, and
3. The preventative effects of a version of MTFC on the development of delinquency and substance use problems for foster girls entering middle school.

Program Objectives

There are two major aims of MTFC-A; to create opportunities so that youth are able to successfully live in families rather than in group or institutional settings, and to simultaneously prepare their parents, relatives, or other aftercare resources to provide youth with effective parenting so that the positive changes made while the youth are placed in MTFC-A can be sustained over the long-run. Four key elements of treatment are targeted during placement and aftercare: (1) providing youth with a consistent reinforcing environment where he or she is mentored and encouraged to develop academic and positive living skills, (2) providing daily structure with clear expectations and limits, with well-specified consequences delivered in a teaching-oriented manner, (3) providing close supervision of youth’ whereabouts, and (4) helping youth to avoid deviant peer associations while providing them with the support and assistance needed to establish pro-social peer relationships.

Program Strategies

Placements in MTFC-A are typically 6-9 months in length and rely on intensive, well-coordinated, multi-method interventions conducted in the MTFC-A foster home, with the youth’s aftercare family, and with the youth through individual therapy, skill training, and academic support. A program supervisor (with a caseload of 10) oversees the interventions that are implemented across multiple settings (e.g., home, school, community). Involvement of each youth’s family or aftercare resource is emphasized from the outset of treatment in an effort to maximize training and preparation for post-treatment care for youth and their families. Progress is tracked through daily phone calls with treatment foster parents where data is collected on youth behavior.

Youth in MTFC-A

Referrals are received from juvenile courts, probation officers, mental health and child welfare caseworkers. Youth referred to MTFC-A are between the ages of 12 and 17 and are in need of an out of home placement due to severe delinquency or antisocial behavior. Referred youth may have been involved in serious criminal offending behavior and may have complex co-morbid conditions. Most of these youth have been involved in numerous treatment efforts prior to their referral to MTFC-A, and most have experienced at least one, if not multiple, failed out-of-home placements prior to referral. Referred youth should have an IQ no less than 70 and participate exclusively in MTFC-A as the sole comprehensive treatment service. Referrals to MTFC-A programs are most appropriate after in-home family preservation programs have been tried or when youth are returning from highly restrictive institutional or group care placements. Families of the MTFC-A youth participate in the family therapy component of treatment and should be engaged in services immediately upon placement in the program. Referral information should identify the family to which the youth will reside long-term or identify independent living as the living situation upon discharge. Youth exhibiting acutely suicidal, homicidal or psychotic behavior will not be placed in the MTFC-A program. In addition, youth in need of treatment for sex offenses or substance abuse exclusively are not appropriate for MTFC-A.

Staffing

Program Supervisors are trained in the social learning treatment model and developmental psychopathology, and are responsible for coordinating all aspects of the treatment program. They serve as consultants to the foster parents, provide support and supervision in the form of weekly meetings and daily telephone contact, and are available for support, consultation, and backup 24 hours a day. Foster parents are screened, selected, and trained before they receive a placement then are supervised and supported throughout treatment through daily telephone calls and weekly foster parent groups conducted by the Program Supervisor. Family and individual therapists, skills trainers, a foster parent recruiter/trainer and a daily telephone data collector are also employed by the program and supervised by the Program Supervisor.

Special Characteristics

Involvement of the biological family or aftercare family is emphasized throughout treatment. Families are taught parenting skills that are practiced during home visits and are provided with 24-hour backup and consultation by the family therapist and Program Supervisor.

Comments on Implementation/Replication

TFC Consultants, Inc. was founded in 2002 and is the organization that is dedicated to the implementation of model-adherent MTFC-A programs. TFC Consultants provides consultation, training, and technical assistance to new and existing MTFC-A programs and helps service providers, policy makers and community leaders resolve issues related to the implementation of evidence-based practices. Through TFC Consultants, MTFC-A is being implemented in over 35 locations throughout the U.S. and in Canada, Sweden, Norway, the United Kingdom and the Netherlands.

Research Conclusions

MTFC-A has been shown to be an effective and viable method of preventing the placement of youth in institutional or residential settings. Studies have found that placement in MTFC-A can prevent escalation of delinquency and other problem behaviors such as youth violence and that placement in MTFC-A is more economical and more effective than placement in group care at decreasing offense and incarceration rates in follow-up. Overall, MTFC-A has been shown to be effective in the treatment of boys with severe delinquency and conduct disorders (Chamberlain, & Reid, 1998), in the treatment of children and adolescents leaving a state mental hospital (Chamberlain & Reid, 1991), in the prevention of placement disruptions in regular state supported foster care (Chamberlain, Moreland & Reid, 1996), and in the treatment of girls with chronic problems with delinquency (Leve & Chamberlain, in press). In addition, specific treatment components (i.e., close supervision, fair and consistent limit setting, decreased association with delinquent peers, positive adult-youth relationship) have been shown to be factors that account for the treatment effect of MTFC-A placements (Eddy & Chamberlain, 2000).