Multidimensional Treatment Foster Care Research Articles

A Randomized Evaluation of Multidimensional Treatment Foster Care: Effects on School Attendance and Homework Completion in Juvenile Justice Girls

Despite growing evidence that child welfare youth are at increased risk for juvenile delinquency, little is known about gender-specific processes and effective treatment programs for girls. Multidimensional Treatment Foster Care (MTFC), an empirically validated intervention for child welfare and juvenile justice populations, has demonstrated efficacy in reducing arrest rates in delinquent boys and girls. In this study, the efficacy of MTFC on school attendance and homework completion was examined in juvenile justice girls who were referred to out-of-home care (N = 81). Results from this randomized intervention trial suggest that MTFC was more effective than group care in increasing girls' school attendance and homework completion while in treatment and at 12 months postbaseline. In addition, the previously reported effect of MTFC on reducing girls' days in locked settings was mediated by homework completion while girls were enrolled in the intervention setting. Implications for policy and practice are described.

Intervention Effects on Foster Preschoolers’ Attachment-Related Behaviors From a Randomized Trial

This study examined change in attachment-related behaviors among foster preschoolers participating in a randomized trial of the Multidimensional Treatment Foster Care Program for Preschoolers (MTFC-P). Measures of secure, resistant, and avoidant behaviors were collected using a caregiver-report diary at 3-month intervals during the 12 months following a new foster placement. Children randomly assigned to the MTFC-P intervention condition (n = 57) showed significant increases in secure behavior and significant decreases in avoidant behavior relative to children assigned to a regular foster care condition (n = 60). Both groups showed significant decreases in resistant behavior over time. Analyses also revealed a significant interaction between treatment condition and age at first foster placement on change in secure behavior. Results are discussed in terms of the importance of early intervention and prevention services for foster preschoolers.

Blueprints in Sweden. Symptom load in Swedish adolescents in studies of Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC)

The purpose of the present study was to compare symptom load in youth groups treated with three Swedish Blueprint programmes—Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC)—to see if symptom load matches the intensity of the treatment model as expected. These youth groups were also compared with in- and outpatients from child and adolescent psychiatry, and a normal comparison group. In addition, we compared the symptom load of their mothers. Symptom load was measured by the Achenbach System of Empirically Based Assessment (ASEBA) in the adolescents, and by the Symptom Checklist 90 in their mothers. The results showed that youth in the MST and MTFC studies had a higher symptom load than in the FFT study, and the same pattern of results was found in their mothers. It is concluded that there seems to be a reasonable correspondence between the offered resources and the symptom load among youth and parents; treatment methods with higher intensity have been offered to youth with higher symptom load. The correlation between internalized and externalized symptoms was high in all study groups. The MST and MTFC groups had an equally high total symptom load as the psychiatric inpatient sample.

Multidimensional treatment foster care for girls in the juvenile justice system: 2-year follow-up of a randomized clinical trial.

This study is a 2-year follow-up of girls with serious and chronic delinquency who were enrolled in a randomized clinical trial conducted from 1997 to 2002 comparing multidimensional treatment foster care (MTFC) and group care (N = 81). Girls were referred by juvenile court judges and had an average of over 11 criminal referrals when they entered the study. A latent variable analysis of covariance model controlling for initial status demonstrated maintenance of effects for MTFC in preventing delinquency at the 2-year assessment, as measured by days in locked settings, number of criminal referrals, and self-reported delinquency. A latent variable growth model focusing on variance in individual trajectories across the course of the study also demonstrated the efficacy of MTFC. Older girls exhibited less delinquency over time relative to younger girls in both conditions. Implications for gender-sensitive programming for youths referred from juvenile justice are discussed.

Foster parents in Multidimensional Treatment Foster Care: How do they deal with implementing standardized treatment components?

This article focuses upon 28 Swedish foster parents and their experience of working in a manual-based treatment program – Multidimensional Treatment Foster Care (MTFC) – focusing on treating troubled youth. Using interviews and questionnaires, the study addresses how foster parents perceive the components and core terms specific to MTFC. Both quantitative and qualitative analyses were conducted. Interestingly, 80% of the foster parents as a group rated all the program components the highest possible positive value. From the qualitative analysis a difference appeared between the foster parents about the view on foster parenthood and the attitudes towards the program. One group perceived themselves as professionals and accepted the program. The second group, although seeing themselves as professionals found it difficult to accept the program. The third group viewed foster parenthood as a ‘way of life’. The highlight of this study is the overwhelmingly positive attitude towards the MTFC program manual. It appears that 24-hours a day access to “treatment tools” and a treatment team, are very important inputs for the satisfaction of foster parents.

Editorial: Behaviorally oriented therapies, corrections, and public policy.

As we release another issue of the Behavior Analyst Today, the first author was struck by the brightness of the future of the field of behavior analysis. Advances in basic research appear to demonstrate that many of the higher processes of the brain are automatized, such as social interaction, evaluations, and judgments, as well as goal setting suggesting these processes can be studied purely behaviorally without reference to conscious, will or internal guidance (Bargh & Ferguson, 2000). This places behavioral research as central in the discussion of public policy in issues such as socialization and social judgments. Readers of this journal of course will not be surprised by this for we have presented data and theoretical work for years on the role of reinforced function in establishing social behavior (see Patterson, 2002; Snyder, Stoolmiller, Patterson, Schrepferman, Oeser, Johnson, & Soetaert, 2003). In addition, a recent review by Dunst (2003) of 29 studies of infants including 862 infants found that response-contingent learning opportunities, in which the behavior of the child is clearly related to the consequences, produced the greatest amount of social responding and greatly attenuated both negative affect and negative social responding. This offers behaviorists with a clear explanation of positive social development in children and a method to help parents avoid emotional disturbances. ********** In studies with delinquents, while the effect size overall was moderate (Effect size .40) the long-term appropriateness of behavioral treatments for juvenile offenders was found by Gottschalk, Davidson, Mayer, and Gensheimer (1987)(1) and for social learning programs a larger moderate effect size (.77) (Mayer, Gensheimer, Davidson & Gottschalk, 1986) was found. Behavioral programs are well established according to APA criteria and should serve as the cornerstone to correctional practices. Indeed, with the growth in the prison population, it is far past the time for prisons (2), half way houses and diversionary programs to incorporate a resident behavior analyst to ensure that behavioral treatments are readily available for offender remediation in an effort to reduce recidivism. In addition, in a recent meta-analysis, French and Gendreau (2006) found that behaviorally oriented programs have a large effect size when reducing prison misbehavior and this correlates with post release recidivism. A recent survey found that we asked about theoretical orientation 69% of correctional psychologists reported adhering to behavioral model (Boothby & Clements, 2000). Outside of the residential environment behavioral treatments have also been effective. Behavioral parent training has not only received empirical validation (see Chambless, Baker, Baucom, et al. 1998) but has received support as the treatment of choice for children with disruptive disorders (e.g., Brestan & Eyberg, 1998). Behavioral parent training has support for both immediate and long-term outcomes (Bank, Marlowe, Reid, Patterson, & Weinrott, 1991; Barkley, 1997; Gallagher, 2003; McMahon & Wells, 1998; Webster-Stratton, 1996; Webster-Stratton, Kolpacoff, & Hollingsworth, 1988; Webster Stratton, Hollinsworth, & Kolpacoff, 1989). Conservative estimates show between of 50-66% of children with disruptive behavior patterns function in the normal range at the termination of treatment consisting of training parents in use of operant procedures (Dishion & Patterson, 1992)3. For a particular form of behavioral parent training, parent-child interaction therapy current research suggest that it not only reduces behavioral problems but also improves emotional adjustment (see Gallagher, 2003 for review). Behavioral parent training based on social learning principles has recently moved into the foster care environment. Both specialized foster care (Chamberlain & Reid, 1991; Bryant & Snodgrass, 1992) and multidimensional treatment foster care (Chamberlain & Moore, 1998; Fischer, Ellis, & Chamberlain, 1999) represent two program models built on the parent-training model. …

Association with Delinquent Peers: Intervention Effects for Youth in the Juvenile Justice System

Although association with delinquent peers is a recognized precursor to ongoing delinquency problems, youth in the juvenile justice system are commonly prescribed intervention services that aggregate delinquent youth. However, little is known about the process variables that mediate the relationship between aggregating youth in intervention settings and poor subsequent outcomes. We examined data from two randomized intervention trials (one male sample and one female sample) with delinquent adolescents placed either in Multidimensional Treatment Foster Care (MTFC) or in group care. Path analyses suggested that the MTFC youth had fewer associations with delinquent peers at 12 months than did the group care youth. Further, associating with delinquent peers during the course of the intervention mediated the relationship between group condition and 12-month delinquent peer association. Implications for the development of interventions with delinquent youth are discussed.

Intervention outcomes for girls referred from juvenile justice: Effects on delinquency.

An increasing number of girls are entering the juvenile justice system. However, intervention programs for delinquent girls have not been examined empirically. The authors examined the 12-month outcomes of a randomized intervention trial for girls with chronic delinquency (N = 81). Girls were randomly assigned into an experimental condition (Multidimensional Treatment Foster Care; MTFC) or a control condition (group care; GC). Analyses of covariance indicated that MTFC youth had a significantly greater reduction in the number of days spent in locked settings and in caregiver-reported delinquency and had 42% fewer criminal referrals than GC youth (a trend) at the 12-month follow-up. Implications for reducing girls' chronic delinquency are discussed.

Risk, Reinforcement, Retention in Treatment, and Reoffending for Boys and Girls in Multidimensional Treatment Foster Care

In this study, the author examined the impact of youth and family preplacement risk factors on multidimensional treatment foster care (MTFC) parent—youth interactions,youth treatment completion, and outcomes for boy and girl adolescents who have problems with chronic delinquency. In particular, she looked at (a) how levels of preplacement youth and family risk factors for chronically delinquent boys and girls who were treated with MTFC affect parent—youth interactions during treatment, (b) how these interactions and preplacement youth and family risk factors relate to treatment completion for boys and girls, and (c) how treatment completion for girls and boys affects reoffending behavior during the 12 months postplacement. As hypothesized, results indicated higher levels of preplacement youth and family risk for girls compared with boys; however, contrary to the author's hypothesis, levels of preplacement youth and family risk were not found to have a significant impact on MTFC parent—youth interactions.As expected, MTFC parent—youth interactions were significantly related to treatment completion, and treatment completion was significantly related to lower rates of reoffending behavior for both boys and girls.Treatment components specific to MTFC are reviewed and directions for future research are suggested.

Multidimensional Treatment Foster Care: A Conceptually Based, Empirically Validated Approach to Treating Antisocial Behavior in Youth

Originally published in Contemporary Psychology: APA Review of Books, 2004, Vol 49(6), 788–790. Review of book Treating Chronic Juvenile Offenders: Advances Made Through the Oregon Multidimensional Treatment Foster Care Model by Patricia Chamberlain (see record 2003-02952-000). Chamberlain makes a convincing case for her adolescent treatment program in this book. This timely volume highlights the need for reform in today's treatment systems for youth demonstrating severe behavior problems, a growing concern among clinicians and policy makers as well as the community at large. As concerns mount regarding the potential iatrogenic effects and prohibitive expense of residential treatment, Chamberlain's program demonstrates a timely alternative that will be of interest to many in its target audience, which includes “clinicians, community program administrators, researchers, policymakers, judges, and attorneys.” The main takeaway message appears to be that, in spite of a reputation for failing to respond to treatment, youth who engage in antisocial behaviors and their families can make improvements when the appropriate structure and assistance are provided. Chamberlain's book can provoke discussion, as there are some components of Multidimensional Treatment Foster Care (MTFC) that threaten the status quo and may not be popular with some readers. Chamberlain makes a strong case against grouping antisocial adolescents in treatment settings, and advocates for the integration of youth with criminal records in regular neighborhoods and public schools. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

The Prevention of Violent Behavior by Chronic and Serious Male Juvenile Offenders

Over the past several decades, an increasing number of youth have been incarcerated for violent offenses. Existing interventions for serious offenders target the prevention of subsequent delinquent behavior in general, rather than the prevention of violent behavior in particular. Within the context of a randomized clinical trial of 79 adolescent males involved in the juvenile justice system, we examine the ability of multidimensional treatment foster care (MTFC) to prevent subsequent violent offending relative to services-as-usual group home care (GC). Data on offending were collected every 6 months for a 2-year period following entry into the study. The method of generalized estimating equations was used to analyze the data. Results indicate that MTFC youth were significantly less likely to commit violent offenses than youth placed in services-as-usual group care. The group effect held even after control variables, including age at placement, age at first arrest, official and self-reported prior offenses, and time since baseline,were introduced into the model. Twenty-four percent of GC youth had two or more criminal referrals for violent offenses in the 2 years following baseline versus only 5% of MTFC youth. The rates of self-reported violent offending for MTFC youth were in the normative range following baseline, whereas rates for GC youth were 4 to 9 times higher. MTFC youth were also significantly less likely to report incidents of common violence, such as hitting.

The oregon multidimensional treatment foster care model: Features, outcomes, and progress in dissemination

The practice of placing children and adolescents with severe antisocial behavior and delinquency in residential and group home settings is commonplace in most communities in the United States, yet little research exists on the short- or long-term effectiveness of such placements. Furthermore, recent evidence suggests that there are potentially damaging effects from placement in congregate care settings that relate to negative influences that problem youth who are placed together tend to have on each other. The Oregon Multidimensional Treatment Foster Care (MTFC) model was developed as an alternative to group and residential care for youth with delinquency and severe emotional and behavioral problems. The central features of the Oregon MTFC model are described, evidence on the efficacy of the model is reviewed, and practical aspects relating to dissemination are discussed along with conditions that act to facilitate or create barriers to implementation.

Community-Based Treatment for Adjudicated Delinquents: The Oregon Social Learning Center's “Monitor” Multidimensional Treatment Foster Care Program

SUMMARY The following article outlines an empirically-validated treatment approach for addressing chronic, delinquent behavior in adolescents and their families: Multidimensional Treatment Foster Care (MTFC). MTFC grew out of evidence for the effectiveness of behavioral parent training approaches and a clinical need for programs to address the behavior of delinquent adolescents who have been found to be beyond parental control. MTFC starts with a focus on the need to return the adolescent to the family and community, and, thus, the program stresses the generalization of treatment effects. Recent replication studies are reviewed that demonstrate the effectiveness, utility, and cost-effectiveness of the MTFC program.

Multidimensional Treatment Foster Care

The goals, objectives, and philosophy of Multidimensional Treatment Foster Care (MTFC) are outlined in this article. Three specific mechanisms of the MTFC approach known to reduce conflict in the therapeutic milieu and to contribute to successful outcomes for youth and their families are described: a proactive approach to reducing problem behavior, the creation and maintenance of a consistent and reinforcing environment for the participating youth, and the separation and stratification of staff roles. Controlled outcome research comparing MTFC to other community treatment alternatives with similar populations of troubled youth are also described.Additionally, the results of preliminary research evaluating the impact of an MTFC model adapted to meet the needs of maltreated preschool-age children at entry to foster care are presented.

Multidimensional treatment foster care was more effective than group care for chronic juvenile offenders

Multidimensional treatment foster care was more effective than group care for chronic juvenile offenders

Interpersonal skills training to reduce aggressive and delinquent behavior: limited evidence and the need for an evidence-based system of care.

The prevention of aggressive and delinquent behavior during childhood and adolescence is one of the highest priorities for public health and crime prevention. The most common approach to preventing or treating these conduct problems has been to provide interpersonal skills training to the affected youth. This paper reviews all randomized controlled trials evaluating interpersonal skills training programs as an intervention to reduce conduct problems. Research shows that such programs have weak empirical support as isolated interventions. An alternative evidence-based system of care is described. Such a system would include behavioral parent training and behavioral classroom-based interventions for young children at risk of developing problems, as well as multisystemic family therapy or multidimensional treatment foster care for chronic delinquents. Within such a network of services, interpersonal skills training could play an important supportive role. Such a system holds the greatest promise for reducing the prevalence of aggressive and delinquent behavior in communities.

Comparison of two community alternatives to incarceration for chronic juvenile offenders.

The relative effectiveness of group care (GC) and multidimensional treatment foster care (MTFC) was compared in terms of their impact on criminal offending, incarceration rates, and program completion outcomes for 79 male adolescents who had histories of chronic and serious juvenile delinquency. Results show that boys who participated in MTFC had significantly fewer criminal referrals and returned to live with relatives more often. Multiple regression analyses showed that assignment to a treatment condition (i.e., GC or MTFC) predicted official and self-reported criminality in follow-up beyond other well-known predictors of chronic juvenile offending (i.e., age at 1st offense, number of previous offenses, age at referral).

Psychopathology among children placed in family foster care

The literature on psychopathology among children in family foster care published in the last 20 years was reviewed to estimate prevalence and types of psychopathology in this population. A comprehensive computerized database was searched for the period 1974 through 1994, with emphasis on recent literature. Available evidence suggests that the prevalence of psychopathology among children in family foster care is higher than would be expected from normative data, even when this population is compared with children who have backgrounds of similar deprivation. As for the types of psychopathology in this population, the only apparent trend is the predominance of externalizing disorders, such as disruptive behavior disorders. A combination of social, psychological, and biological factors may render children in family foster care highly vulnerable to psychopathology.

The lessons of Marion: The failure of a maximum security prison : American Friends Service Committee (Criminal Justice Program, 1501 Cherry Street, Philadelphia, Pennsylvania, 19102), 1985, 37pp., softcover—$2.00.

This paper presents the results of an independent evaluation of the Multi-dimensional Treatment Foster Care (MTFC) programme for young offenders in England, where it is known as Intensive Fostering (IF).A quasi-experimental, mixed methods study was carried out at the three pilot sites, with a total sample of 47 at follow up. Young people sentenced to IF were compared to a similar group, matched on the eligibility criteria for IF, the majority of whom were sentenced to custody. The groups were well-matched in terms of their characteristics and criminal histories. Official data on reconviction were collected at baseline and one year after entry to the IF placement or release from custody (Stage 1), and further data on programme completion and secondary outcomes were collected via interviews with young people and parents and questionnaires to professionals at baseline and follow up. Official data on reconviction were also collected one year after exit from the IF placements (Stage 2).At Stage 1 the IF group were less likely to be reconvicted, had committed fewer and less serious recorded offences, on average, and took longer to commit their first recorded offence. At this point the IF group were more likely to be living with their families and less likely to be in custody than the comparison group. However by Stage 2 no significant differences in patterns of reconviction remained.IF successfully contained a high-risk group in the community, but the effects of the intervention washed out once they left their foster placements. Environmental effects on entry to and exit from the IF placements may help to explain the results at both stages.