Multidimensional Treatment Foster Care Research Articles

Effective family‐based program options for justice‐involved youth

AbstractFamilies play a significant role both in youth's development of criminal behavior and in their desistance of criminal behavior. Nonetheless, programming for families of justice‐involved youth is limited. This article describes two family‐based programs found in the National Institute of Justice CrimeSolutions database. Among 19 programs for families, only the Functional Family Therapy and Multidimensional Treatment Foster Care for Adolescents are documented as effective in helping justice‐involved youths and their families. The discussion proposes how these programs could be used to harness services under special education law for students with emotional and behavioral disabilities who are overrepresented in juvenile correctional facilities.

Vulnerable yet forgotten? A systematic review identifying the lack of evidence for effective suicide interventions for young people in contact with child protection systems.

Children and young people in out-of-home care are at a higher risk of suicide than young people not involved with child protection systems. Despite this, there is a lack of evidence of effective suicide prevention interventions for this vulnerable population. We reviewed the types of suicide prevention interventions that have been used and evaluated with children and young people and staff and carers in out-of-home care/child protection systems. We conducted a systematic review of existing literature using PRISMA guidelines. Only five studies met the inclusion criteria. Two evaluated youth-focused interventions: emotional intelligence therapy; and multidimensional treatment foster care, while three evaluated adult-focused "gatekeeper training." Youth-focused interventions led to reductions in suicidal thoughts (suicidal ideation), and adult-focused interventions led to increased knowledge, skills, and behaviors such as referring youth to supports. Only one study, one of the youth-focused ones, evaluated the impact of the intervention in terms of suicide attempts but found no reduction. Large numbers of children enter into care with a high risk of suicide. With the considerable overlap between the trauma characteristics and mental health needs of young people in out-of-home care and suicide risk factors in the general population of young people, we recommend developing (and evaluating) new or adapted existing suicide prevention interventions designed specifically for the out-of-home care context. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

PROTOCOL: Strategies for scaling up the implementation of interventions in social welfare: protocol for a systematic review.

PROTOCOL: Strategies for scaling up the implementation of interventions in social welfare: protocol for a systematic review.

Effects of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) for Young Foster Children with Severe Behavioral Disturbances

Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) has thus far only been tested for diminishing behavior problems in the US. This study tested relative efficacy of MTFC-P on multiple outcomes against treatment as usual in the Netherlands (TAU; Study I), and regular foster care (Study II). The sample included 55 children that received MTFC-P, 23 children received TAU and 30 children from regular foster care (RFC). Changes in behavioral and relationship functioning, trauma symptoms, hypothalamic-adrenal-pituitary (HPA-) axis functioning, and caregiving stress were assessed via questionnaires, interviews, and salivary cortisol. Outcomes of Study I were evaluated using a randomized controlled design and quasi-experimental design, outcomes of Study II according to non-equivalent group comparison. No evidence was found for relative efficacy of MTFC-P over TAU. A treatment effect was found on trauma symptoms, in favor of TAU. Outcomes of Study II revealed that whereas caregiving stress and secure base distortions were significantly more severe at baseline in MTFC-P compared to RFC, post treatment differences were no longer significant. However, percentages of symptoms of disinhibited attachment and attachment disorder were nearly equal between groups at baseline, while post treatment percentages indicated significantly more symptoms in MTFC. In addition, results revealed a significant difference in the severity of externalizing problems post treatment, in favor of RFC. The results obtained within this study indicate that children in MTFC-P and usual treatment foster care in the Dutch context improved similarly, thus not showing the same advantages that MTFC-P has demonstrated in the US. Results should be interpreted with caution due to lower than planned power. Findings underscore the challenges of testing novel treatments across contexts with highly different child welfare provisions.

Family Therapy for Adolescents: A Research‐informed Perspective

Specific research‐informed models of family therapy have been developed for a range of adolescent problems. These include Brief Strategic Family Therapy (BSFT), Functional Family Therapy (FFT), Multisystemic Therapy (MST), Multidimensional Family Therapy (MDFT), and Multidimensional Treatment Foster care (MTFC) for conduct disorder and drug misuse; family‐focused cognitive behaviour therapy for anxiety disorders and depression; Attachment‐based Family Therapy (ABFT) for depression; family‐focused therapy as an adjunct to pharmacological therapy for bipolar disorder; ABFT, youth‐nominated support team, and Dialectical Behaviour Therapy (DBT) combined with Multifamily Therapy for self‐harm; the Maudsley model of family therapy for eating disorders; and psychoeducational family theory for psychosis. All of these approaches aim to reduce individual and familial risk factors which exacerbate adolescent problems, and enhance protective factors which promote resilience and recovery from psychological difficulties.

Preliminary evidence of the impact of early childhood maltreatment and a preventive intervention on neural patterns of response inhibition in early adolescence

Maltreated youths in foster care often experience negative developmental and psychological outcomes, which have been linked with poor response inhibition. Recent evidence suggests that childhood maltreatment is also associated with alterations in the neural circuitry underlying response inhibition. However, a burgeoning line of research has begun to explore the mitigating effects of preventive interventions on neural functioning. The current study used event-related functional magnetic resonance imaging to explore the impact of early childhood maltreatment and a preventive intervention on response inhibition in early adolescence. Thirty-six demographically similar adolescents (ages 9-14years) completed a Go/NoGo task. The sample included nonmaltreated adolescents (n=14) and maltreated adolescents who were in foster care as preschoolers and randomly assigned to receive services as usual (n=11) or a preventive intervention, Multidimensional Treatment Foster Care for Preschoolers (n=11). The groups demonstrated similar behavioral performance but significantly different neural patterns. The maltreated adolescents who received services as usual demonstrated subcortical hypoactivity during successful response inhibition and subcortical hyperactivity during unsuccessful response inhibition. In contrast, the nonmaltreated adolescents and maltreated adolescents who received the intervention exhibited strikingly similar neural patterns during successful response inhibition, but the maltreated adolescents who received the intervention demonstrated prefrontal hypoactivity during unsuccessful response inhibition. These findings offer preliminary evidence that early childhood maltreatment alters the neural patterns underlying response inhibition in early adolescence and that participating in a preventive intervention could mitigate maltreatment-related effects on these neural systems.

Multi-dimensional Treatment Foster Care in England: differential effects by level of initial antisocial behaviour.

Multi-dimensional Treatment Foster Care (MTFC), recently renamed Treatment Foster Care Oregon for Adolescents (TFCO-A) is an internationally recognised intervention for troubled young people in public care. This paper seeks to explain conflicting results with MTFC by testing the hypotheses that it benefits antisocial young people more than others and does so through its effects on their behaviour. Hard-to-manage young people in English foster or residential homes were assessed at entry to a randomised and case-controlled trial of MTFC (n = 88) and usual care (TAU) (n = 83). Primary outcome was the Children’s Global Assessment Scale (CGAS) at 12 months analysed according to high (n = 112) or low (n = 59) baseline level of antisocial behaviour on the Health of the Nation Outcome Scales for Children and Adolescents. After adjusting for covariates, there was no overall treatment effect on CGAS. However, the High Antisocial Group receiving MTFC gained more on the CGAS than the Low group (mean improvement 9.36 points vs. 5.33 points). This difference remained significant (p < 0.05) after adjusting for propensity and covariates and was statistically explained by the reduced antisocial behaviour ratings in MTFC. These analyses support the use of MTFC for youth in public care but only for those with higher levels of antisocial behaviour. Further work is needed on whether such benefits persist, and on possible negative effects of this treatment for those with low antisocial behaviour.Trial Registry Name: ISRCTNRegistry identification number: ISRCTN 68038570Registry URL:www.isrctn.com

Automatic classification of communication logs into implementation stages via text analysis.

BackgroundTo improve the quality, quantity, and speed of implementation, careful monitoring of the implementation process is required. However, some health organizations have such limited capacity to collect, organize, and synthesize information relevant to its decision to implement an evidence-based program, the preparation steps necessary for successful program adoption, the fidelity of program delivery, and the sustainment of this program over time. When a large health system implements an evidence-based program across multiple sites, a trained intermediary or broker may provide such monitoring and feedback, but this task is labor intensive and not easily scaled up for large numbers of sites.We present a novel approach to producing an automated system of monitoring implementation stage entrances and exits based on a computational analysis of communication log notes generated by implementation brokers. Potentially discriminating keywords are identified using the definitions of the stages and experts’ coding of a portion of the log notes. A machine learning algorithm produces a decision rule to classify remaining, unclassified log notes.ResultsWe applied this procedure to log notes in the implementation trial of multidimensional treatment foster care in the California 40-county implementation trial (CAL-40) project, using the stages of implementation completion (SIC) measure. We found that a semi-supervised non-negative matrix factorization method accurately identified most stage transitions. Another computational model was built for determining the start and the end of each stage.ConclusionsThis automated system demonstrated feasibility in this proof of concept challenge. We provide suggestions on how such a system can be used to improve the speed, quality, quantity, and sustainment of implementation. The innovative methods presented here are not intended to replace the expertise and judgement of an expert rater already in place. Rather, these can be used when human monitoring and feedback is too expensive to use or maintain. These methods rely on digitized text that already exists or can be collected with minimal to no intrusiveness and can signal when additional attention or remediation is required during implementation. Thus, resources can be allocated according to need rather than universally applied, or worse, not applied at all due to their cost.

Family Care Treatment for dispersed populations of children with behavioral challenges: The design, implementation, and initial outcomes of an evidence-informed treatment

Children and adolescents in rural settings have behavioral needs similar to those living in urban areas, but often have less access to services. The nature of a dispersed population makes factors such as transportation and the availability of trained personnel barriers to the needed services. Multidimensional Treatment Foster Care (MTFC) is an especially effective example of an evidence-based, community-integrated service delivery option that advances positive child outcomes. Although aspects of Multidimensional Treatment Foster Care are not functional for many rural settings the principles of MTFC such as, consistently applied contingencies and parent-as-interventionist are applicable. This manuscript describes the principles-based application of MTFC in a rural area and discusses how principles-based treatment can produce outcomes predicted by more systematic replications. These outcomes include enhancing the stability of residential placement for children and youths, increasing pro-social child behavior and use of the least restrictive strategies and settings.

Risks, Outcomes, and Evidence-Based Interventions for Girls in the US Juvenile Justice System.

The proportion of the juvenile justice population that comprises females is increasing, yet few evidence-based models have been evaluated and implemented with girls in the juvenile justice system. Although much is known about the risk and protective factors for girls who participate in serious delinquency, significant gaps in the research base hamper the development and implementation of theoretically based intervention approaches. In this review, we first summarize the extant empirical work about the predictors and sequelae of juvenile justice involvement for girls. Identified risk and protective factors that correspond to girls' involvement in the juvenile justice system have been shown to largely parallel those of boys, although exposure rates and magnitudes of association sometimes differ by sex. Second, we summarize findings from empirically validated, evidence-based interventions for juvenile justice-involved youths that have been tested with girls. The interventions include Functional Family Therapy, Multisystemic Therapy, Multidimensional Family Therapy, and Treatment Foster Care Oregon (formerly known as Multidimensional Treatment Foster Care). We conclude that existing evidence-based practices appear to be effective for girls. However, few studies have been sufficiently designed to permit conclusions about whether sex-specific interventions would yield any better outcomes for girls than would interventions that already exist for both sexes and that have a strong base of evidence to support them. Third, we propose recommendations for feasible, cost-efficient next steps to advance the research and intervention agendas for this under-researched and underserved population of highly vulnerable youths.

Development and piloting of a treatment foster care program for older youth with psychiatric problems.

BackgroundOlder youth in out-of-home care often live in restrictive settings and face psychiatric issues without sufficient family support. This paper reports on the development and piloting of a manualized treatment foster care program designed to step down older youth with high psychiatric needs from residential programs to treatment foster care homes.MethodsA team of researchers and agency partners set out to develop a treatment foster care model for older youth based on Multi-dimensional Treatment Foster Care (MTFC). After matching youth by mental health condition and determining for whom randomization would be allowed, 14 youth were randomized to treatment as usual or a treatment foster home intervention. Stakeholders were interviewed qualitatively at multiple time points. Quantitative measures assessed mental health symptoms, days in locked facilities, employment and educational outcomes.ResultsDevelopment efforts led to substantial variations from the MTFC model and a new model, Treatment Foster Care for Older Youth was piloted. Feasibility monitoring suggested that it was difficult, but possible to recruit and randomize youth from and out of residential homes and that foster parents could be recruited to serve them. Qualitative data pointed to some qualified clinical successes. Stakeholders viewed two team roles – that of psychiatric nurse and skills coaches – very highly. However, results also suggested that foster parents and some staff did not tolerate the intervention well and struggled to address the emotion dysregulation issues of the young people they served. Quantitative data demonstrated that the intervention was not keeping youth out of locked facilities.ConclusionsThe intervention needed further refinement prior to a broader trial. Intervention development work continued until components were developed to help address emotion regulation problems among fostered youth. Psychiatric nurses and skills coaches who work with youth in community settings hold promise as important supports for older youth with psychiatric needs.

Predicting the transition from juvenile delinquency to adult criminality: Gender-specific influences in two high-risk samples.

Most juvenile offenders desist from offending as they become adults, but many continue and ultimately enter the adult corrections system. There has been little prospective examination of which variables may predict the latter transition, particularly for women. Our aim was to find out, for men and women separately, what variables identifiable in adolescent offenders predict their continuation of offending into adult life. Participants were 61 male and 81 female youths who had been referred from the juvenile justice system for chronic delinquency and recruited into randomised controlled trials comparing Multidimensional Treatment Foster Care with group care ('treatment as usual'). All participants had attained adulthood by the time of our study. We first examined gender differences in childhood risk factors and then used Cox proportional-hazards models to estimate the relationship of potential risk factors to first adult arrest. Results indicated that, for men, juvenile justice referrals alone predicted risk of any first adult arrest as well as arrest for felony arrest specifically. Each additional juvenile referral increased the risk of any adult arrest by 9% and of adult felony arrest by 8%. For women, family violence, parental divorce and cumulative childhood risk factors, but not juvenile justice referrals, were significant predictors of adult arrest. Each additional childhood risk factor increased the risk of adult arrest by 21%. Women who experienced parental divorce were nearly three times more likely to be arrested as an adult, and those who experienced family violence 2.5 times more so than those without such experiences. We found preliminary evidence of gender differences in childhood risk factors for adult offending, and, thus potentially, for the development and use of interventions tailored differently for girls and boys and young men and young women to reduce their risk of becoming adult recidivists. Copyright © 2015 John Wiley & Sons, Ltd.

Is multidimensional treatment foster care (MTFC) more effective than treatment as usual in a three-year follow-up? Results from MTFC in a Swedish setting

This study examines three-year post-baseline outcomes for a randomized controlled trial of Swedish antisocial youths who received either multidimensional treatment foster care (MTFC) or treatment as usual (TAU). Several studies in our literature review indicated that MTFC intervention is preferred to the alternative (TAU) in the USA during follow-up. Two studies (one conducted in the UK and one in Sweden) have shown indications of a washout effect between the intervention alternatives during follow-up. However, this study showed few but positive significant outcomes at follow-up for the MTFC programme in comparison to TAU. Juveniles who participated in MTFC spent fewer days in locked settings and had committed fewer violent crimes, according to the social case records. Two key features of the MTFC programme certainly merit use in general social service—namely, reducing exposure to deviant peers and increasing school participation.

Evaluation of two implementation strategies in 51 child county public service systems in two states: results of a cluster randomized head-to-head implementation trial.

BackgroundMuch is to be learned about what implementation strategies are the most beneficial to communities attempting to adopt evidence-based practices. This paper presents outcomes from a randomized implementation trial of Multidimensional Treatment Foster Care (MTFC) in child public service systems in California and Ohio, including child welfare, juvenile justice, and mental health.MethodsFifty-one counties were assigned randomly to one of two different implementation strategies (Community Development Teams (CDT) or independent county implementation strategy (IND)) across four cohorts after being matched on county characteristics. We compared these two strategies on implementation process, quality, and milestone achievements using the Stages of Implementation Completion (SIC) (Implement Sci 6(1):1–8, 2011).ResultsA composite score for each county, combining the final implementation stage attained, the number of families served, and quality of implementation, was used as the primary outcome. No significant difference between CDT and IND was found for the composite measure. Additional analyses showed that there was no evidence that CDT increased the proportion of counties that started-up programs (i.e., placed at least one family in MTFC). For counties that did implement MTFC, those in the CDT condition served over twice as many youth during the study period as did IND. Of the counties that successfully achieved program start-up, those in the CDT condition completed the implementation process more thoroughly, as measured by the SIC. We found no significant differences by implementation condition on the time it took for first placement, achieving competency, or number of stages completed.ConclusionsThis trial did not lead to higher rates of implementation or faster implementation but did provide evidence for more robust implementation in the CDT condition compared to IND implementation once the first family received MTFC services. This trial was successful from a design perspective in that no counties dropped out, even though this study took place during an economic recession. We believe that this methodologic approach of measurement utilizing the SIC, which is comprised of the three dimensions of quality, quantity, and timing, is appropriate for a wide range of implementation and translational studies.Trial registrationTrial ID: NCT00880126 (ClinicalTrials.gov).Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0134-8) contains supplementary material, which is available to authorized users.

Effects of Multidimensional Treatment Foster Care on Psychotic Symptoms in Girls

Neurodevelopmental theories of psychosis highlight the potential benefits of early intervention, prevention, and/or preemption. How early intervention should take place has not been established, nor whether interventions based on social learning principles can have preemptive effects. The objective was to test whether a comprehensive psychosocial intervention can significantly alter psychotic symptom trajectories during adolescence-a period of heightened risk for a wide range of psychopathology. This study was a randomized controlled trial (RCT) of Multidimensional Treatment Foster Care (MTFC) for delinquent adolescent girls. Assessment of psychotic symptoms took place at baseline and then 6, 12, 18, and 24 months post-baseline using a standardized self-report instrument (Brief Symptom Inventory). A second source of information about psychotic symptoms was obtained at baseline or 12 months, and again at 24 months using a structured diagnostic interview (the Diagnostic Interview Schedule for Children [DISC]). Significant benefits for MTFC over treatment as usual for psychosis symptoms were observed over a 24-month period. Findings were replicated across both measures. Effects were independent of substance use and initial symptom severity and persisted beyond the initial intervention period. Ameliorating nonclinical psychotic symptoms trajectories beginning in mid-adolescence via a multifaceted psychosocial intervention is possible. Developmental research on nonclinical psychotic symptoms and their prognostic value should be complemented by more psychosocial intervention research aimed at modifying these symptom trajectories early in their natural history. Clinical trial registration information-Juvenile Justice Girls Randomized Control Trial: Young Adult Follow-up; http://clinicaltrials.gov; NCT01341626.

Making It Happen

This article explores the progress that state governments across the country are making in implementing the three most widely used evidence-based programs (EBPs) for delinquent youth: multisystemic therapy (MST), functional family therapy (FFT), and multidimensional treatment foster care (MTFC). Rather than rank states, this study was designed to help state policy makers and practitioners identify strategies and techniques that can help expand the quality and availability of EBPs in their jurisdictions. Its explicit focus on implementation was purposeful. Most states are not yet in a position to begin to assess if their expenditures on these programs are having an impact (or at least an impact statewide) on juvenile recidivism, placements in residential facilities, or other key outcomes. We found that there are five states that are making substantially greater progress in implementing these EBPs: New Mexico, Louisiana, Maine, Connecticut, and Hawaii. In addition to the highest availability of these programs, ranging from 9.4 to 13.0 therapist teams per million population, these states share a number of key features that demonstrate that direct and purposeful state action is behind the expansion of these programs. Some of these features include structured involvement of all key stakeholders, effective leaders who championed not just the programs but a culture of using research to improve practice, pilot testing of new EBPs, special funding for designated EBPs, and technical assistance to counties to help get programs off the ground. Gaps in knowledge are identified and implications for policy are discussed.

Multidimensional Treatment Foster Care for Adolescents in English care: randomised trial and observational cohort evaluation

Children in care often have poor outcomes. There is a lack of evaluative research into intervention options. To examine the efficacy of Multidimensional Treatment Foster Care for Adolescents (MTFC-A) compared with usual care for young people at risk in foster care in England. A two-arm single (assessor) blinded randomised controlled trial (RCT) embedded within an observational quasi-experimental case-control study involving 219 young people aged 11-16 years (trial registration: ISRCTN 68038570). The primary outcome was the Child Global Assessment Scale (CGAS). Secondary outcomes were ratings of educational attendance, achievement and rate of offending. The MTFC-A group showed a non-significant improvement in CGAS outcome in both the randomised cohort (n = 34, adjusted mean difference 1.3, 95% CI -7.1 to 9.7, P = 0.75) and in the trimmed observational cohort (n = 185, adjusted mean difference 0.95, 95% CI -2.38 to 4.29, P = 0.57). No significant effects were seen in secondary outcomes. There was a possible differential effect of the intervention according to antisocial behaviour. There was no evidence that the use of MTFC-A resulted in better outcomes than usual care. The intervention may be more beneficial for young people with antisocial behaviour but less beneficial than usual treatment for those without.

Drug Use Trajectories After a Randomized Controlled Trial of MTFC: Associations with Partner Drug Use.

Trajectories of drug use were examined in a sample of women with prior juvenile-justice system involvement. One hundred fifty-three young women who participated in a randomized controlled trial of Multidimensional Treatment Foster Care (MTFC) in adolescence were assessed on five occasions over a 24-month period in young adulthood (mean age = 22.29 years at T1). Participants assigned to the MTFC condition during adolescence reported greater decreases in drug use than girls assigned to the treatment as usual (TAU) condition. Partner drug use was significantly associated with women's concurrent drug use, although participants in the MTFC condition were more resilient to partner drug use than in the TAU condition. Implications for drug use prevention and intervention programs during adolescence are discussed.

Juvenile justice girls' depressive symptoms and suicidal ideation 9 years after Multidimensional Treatment Foster Care.

Multidimensional Treatment Foster Care (MTFC) has been found to reduce delinquency among girls in juvenile justice through 2-year follow-up. Given that such girls are at elevated risk for suicide and depression into adulthood, we tested MTFC effects on long-term trajectories of suicidal ideation and depressive symptoms. Girls (N = 166; mean [SD] age = 15.3 [1.2] years; 68% White) with a recent criminal referral who were mandated to out-of-home care were enrolled in 2 sequential cohorts. Girls were randomized to receive MTFC (n = 81) or group care (GC) treatment as usual (TAU; n = 85); the second MTFC cohort also received modules targeting substance use and risky sexual behavior. Depressive symptoms and suicidal ideation were assessed repeatedly through early adulthood (mean [SD] follow-up = 8.8 [2.9] years). Suicide attempt history was assessed in early adulthood. Girls assigned to MTFC showed significantly greater decreases in depressive symptoms across the long-term follow-up than GC girls (π = -.86, p < .05). Decreases in suicidal ideation rates were slightly stronger in MTFC than in GC as indicated by a marginal main effect (odds ratio [OR] = .92, p < .10) and a significant interaction that favored MTFC in the second cohort relative to the first (OR = .88, p < .01). There were no significant MTFC effects on suicide attempt. MTFC decreased depressive symptoms and suicidal thinking beyond the decreases attributable to time and TAU. Thus, MTFC has further impact on girls' lives than originally anticipated.

Supplemental Material for Juvenile Justice Girls’ Depressive Symptoms and Suicidal Ideation 9 Years After Multidimensional Treatment Foster Care

Supplemental Material for Juvenile Justice Girls’ Depressive Symptoms and Suicidal Ideation 9 Years After Multidimensional Treatment Foster Care