Multidimensional Treatment Foster Care (MTFC)
This program was part of a cost-benefit analysis completed by the Washington State Institute for Public Policy on several violence prevention and reduction programs, including six Blueprints programs: Watching the Bottom Line: Cost-Effective Interventions for Reducing Crime in Washington.
Program Summary
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.
Program Targets:
MTFC targets Teenagers with histories of chronic and severe criminal behavior at risk of incarceration and those with severe mental health problems at risk for psychiatric hospitalization.
Program Content:
MTFC Training for Community Foster Families emphasizes behavior management methods to provide youth with a structured and therapeutic living environment. After completing a pre-service training and placement of the youth, MTFC parents attend a weekly group meeting run by a program supervisor where ongoing support and supervision are provided. Foster parents are contacted daily during telephone calls to check on youth progress and problems. MTFC staff are available for consultation and crisis intervention 24/7.
Services to the Youth's Family occur throughout the placement . Family therapy is provided for the biological (or adoptive) family, with the goal of returning the youth back to the home. The parents are supported and taught to use behavior management methods that are used in the MTFC foster home. Closely supervised home visits are conducted throughout the youth's placement in MTFC. Parents are encouraged to have frequent contact with the MTFC program supervisor to get information about their child's progress in the program.
Coordination and Community Liaison. Frequent contact is maintained between the MTFC program supervisor and the youth's case workers, parole/probation officer, teachers, work supervisors, and other involved adults.
Program Outcomes:
Evaluations of MTFC have demonstrated that program youth compared to control group youth:
- Spent 60% fewer days incarcerated at 12 month follow-up;
- Had significantly fewer subsequent arrests;
- Ran away from their programs, on average, three time less often;
- Had significantly less hard drug use in the follow-up period;
- Had quicker community placement from more restrictive settings (e.g., hospital, detention); and
- Had better school attendance and homework completion at 24 months follow-up.
Program Costs:
The cost per youth is from one-half to one-third less in MTFC than in residential, group or hospital placements and averages approximately $3,900 per month. The average length of stay is seven months.
The information for this fact sheet was excerpted from:
Chamberlain, P., & Mihalic, S.F. (1998). Multidimensional Treatment Foster Care: Blueprints for Violence Prevention, Book Eight. Blueprints for Violence Prevention Series (D.S. Elliott, Series Editor). Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado.
Chamberlain, P., Leve, L., & DeGarmo, D. (2007). Multidimensional Treatment Foster Care for Girls in the Juvenile Justice System: Two Year Follow-up of a Randomized Clinical Trial. Journal of Consulting and Clinical Psychology, 75(1), 187-193.
1998 (Updated 03/2007)
Program Background
Violent juvenile crime is a growing concern in most communities. Citizens are reaching for solutions. Getting youth who commit crimes off the streets has become a high priority. This is especially true for violent and sexual offenders. Increased capacity for incarceration is an option that many states have taken. However, long-term incarceration is costly and has other disadvantages. Alternatives to incarceration typically involve placement and treatment of youth in congregate care settings.
The Oregon Social Learning Center (OSLC) Multidimensional Treatment Foster Care (MTFC) Program was developed as an alternative to institutional, residential, and group care placement for teenagers with histories of chronic and severe criminal behavior. In most communities, such juveniles are placed in out-of-home care settings prior to being sent to closed custody incarceration. Typically, these settings include some type of group home or cottage on a larger institutional campus where youngsters reside with others who have similar problems and histories of offending. On a continuum of care, MTFC is a relatively non-restrictive community-based placement that can be used in lieu of residential or group care or that can be used for youth transitioning back to the community from such settings. MTFC is less expensive than placement in group, residential care, or institutional settings.
Theoretical Rationale/Conceptual Framework
Many adults, including some policy makers and treatment providers, accept the notion that adolescents are beyond adult influence. From the popular literature on adolescence and from personal experiences "we know" that the influence of peers takes on enormous proportions during the teenage years, especially in relation to the influence of parents. In the scholarly literature on the development and maintenance of delinquency, there has been consistent empirical support for the powerful role of negative (or deviant) peer relations. Therefore, it seems logical that treatment approaches must abandon or at least not rely on parental efforts to supervise and discipline youngsters in the face of the emerging power of the peer group.
Association with deviant peers has been shown to be a strong predictor of involvement in and escalation of aggressive and delinquent behavior. For example, peer support for aggressive behavior in the classroom increases aggression. Interaction with negative peers predicts substance use. Research in sociology and developmental psychology over the past 25 years has clearly shown that youngsters who have strong bonds with delinquent peers are at far greater risk for becoming delinquent in the first place and for escalating delinquency over time than those who associate with nondelinquent peers.
It is ironic then that most delinquency treatment programs put youngsters with criminal histories together in groups that can potentially facilitate further bonding and development of common social identities among group members. These treatments run the risk of actually contributing to the maintenance and enhancement of delinquent friendship cliques.
Most widely used treatments for delinquency, such as Positive Peer Culture, attempt to use the "group process" to gain a therapeutic effect. The assumption is that the peer group can best motivate and influence youth to change their behaviors and attitudes. However, it seems unreasonable to expect youngsters with histories of serious delinquent behaviors to function as a group and somehow become good influences on each other or establish prosocial norms or values. It may be that these approaches vastly underestimate the influence that adult-initiated norms and rules of conduct can have in the face of day-to-day involvement in a peer-dominated culture. A more sensible intervention would involve minimizing the influence of peers and immersing the youngster in a nondelinquent culture.
A number of studies have shown that parents play a key role in the support and socialization of their adolescents. Specifically, adolescent adjustment can be enhanced by the extent to which parents are able to effectively supervise their teenager, to follow through with consequences when necessary, and to promote positive involvement in school and other normative activities. Conversely, the development of adolescent antisocial behavior leads not only to escalating problems with delinquency and drug use, but the behavior itself wears down and neutralizes what normative socialization forces exist that could potentially guide the adolescent into more prosocial patterns of adjustment. As the conflict between parents and youth increases, parents' capacity to provide a supportive or corrective influence decreases, and the youngster becomes increasingly committed to and influenced by delinquent peers who, in turn, reinforce the teenager's alienation from adult influence. If delinquency escalates, the youngster's behavior finally begins to compromise community safety to the point where courts intervene and require that the youth be held accountable. At this point in the youth's development, where close parental supervision and guidance are absolutely critical, parents are typically distressed, demoralized, defeated, and cynical. The challenge is to come up with an intervention to provide corrective or therapeutic parenting for antisocial adolescents whose parents, for one reason or another, are unable to rise to the occasion.
Social Learning Theory underpins the MTFC model. Social Learning Theory describes the mechanisms by which individuals learn to behave in social contexts. In family settings, daily interactions between family members shape and influence both prosocial and antisocial patterns of behavior that children develop and carry with them into their interactions with others outside of the family (e.g., peers, teachers, coaches). A number of studies at the Oregon Social Learning Center and elsewhere have identified specific family processes or interaction patterns that predict the development of antisocial behavior patterns in children and adolescents. Parents in these families inadvertently reinforce their child for being negative or coercive as a means of getting their own way or avoiding tasks or minding. Typically these parents will make repeated requests and demands, the child will whine, yell, and otherwise noncomply, and the parent will respond by giving in. In this manner the child is actually reinforced for coercive behavior and has "learned" that negative coercive responses such as crying are an effective way to get parents to back off. Thousands of these interactions are embedded in family life and because they may "work" in the short term, both parents and children are gradually shaped to use more negative control strategies over time. Unfortunately, there are damaging long term effects. For example, observational studies in family homes have shown that not only do families with antisocial youngsters have more negative interactions, parents also do not notice when their child is behaving appropriately. The child is not only "taught" to be coercive, they do not develop the skills necessary to have positive behaviors that could be of use in making friends or in relating positively to teachers, coaches, or other adults.
By the time an antisocial child has reached school age, three processes are well underway. Parents are responding to him/her negatively; the child uses coercive tactics as his/her main strategy for getting what s/he wants and avoiding what s/he does not want (e.g., chores, homework); and s/he has deficits in prosocial behavior, having failed to learn the skills necessary to cooperate in the classroom, on teams, or in clubs. There is substantial evidence that aggressive children are likely to be rejected by their peers and that rejected children are more likely to associate with other aggressive, rejected children who tend to reward negative behavior in their interactions with each other. Antisocial aggressive children are also at risk for school failure. The "coercive training" that they received in their families reduces their behavioral and social competencies which sets them up for social and academic failure at school.
Over time, without effective intervention, these processes continue and become amplified. The youth's experience of early failure in school, parental negativity, rejection by peers, and exclusion from clubs and sports activities all set the stage for association with delinquent peers, school drop-out, drug use, and delinquency in adolescence.
Brief Description of Intervention
In Multidimensional Treatment Foster Care, adolescents are placed, usually singly or at most in twos, in a family setting for six to nine months. Community families are recruited, trained, and supported to provide well-supervised placements and treatment. MTFC parents are part of the treatment team along with program staff. They are paid a monthly salary and a small stipend to cover extra expenses. MTFC parents implement a structured, individualized program for each youth that is designed to simultaneously build on the youngster's strengths and to set clear rules, expectations, and limits. MTFC parents are contacted daily (Monday through Friday) by telephone, and data are collected on the youth's behavior during the past 24 hours. During this call, potential problems are discussed, and plans for the coming day are reviewed. MTFC parents are supported by a case manager who coordinates all aspects of the youngsters' treatment program. Additional components of the program include weekly supervision and support meetings for MTFC parents; skill-focused individual treatment for youth; weekly family therapy for biological parents (adoptive or other aftercare resource); frequent contact between participating youth and their biological/adoptive family members, including home visits; close monitoring of the youngsters' progress in school; coordination with probation/parole officers; and psychiatric consultation/medication management, as needed.
Weekly meetings with MTFC parents are run by the case manager and attended by other involved program staff. During these meetings, telephone data collected during the prior week are reviewed and discussed, and the youths' individualized programs are adjusted as needed. Each individualized program is structured to give the youth a clear picture of what is expected of him/her throughout the day and evening. During the placement period, individualized programs are readjusted to fit youths' changing needs, to reflect progress, and to target new problem behaviors that emerge. The individualized programs help guide MTFC parents to be specific in the way they reinforce progress and to consistently set limits and consequences. Individualized programs give youth a concrete way to measure their success. The individualized programs also are used by biological/adoptive parents or relatives during home visits and when youth return home after placement.
Because youth who participate in the program have committed several delinquent acts (i.e., an average of thirteen previous arrests in our most recent sample), the level of supervision required is high. Youth are not permitted to have unsupervised free time in the community, and their peer relationships are closely monitored. Over the course of the placement, levels of supervision and discipline are adjusted, depending on the youth's level of progress or lack thereof. Close monitoring of youngsters at home and at school is a hallmark of the MTFC model. There is heavy emphasis placed on teaching interpersonal skills and on participation in positive social activities, including sports, hobbies, and other forms of recreation.
The MTFC model uses a specific and structured multi-modal treatment approach. Multi-modal treatment includes behavioral skills training across settings (e.g., home, school, with peers). The success of the program depends on the group of adults, including the MTFC parents and the MTFC program staff (i.e., case manager, family therapist, individual therapist), that work intensively with the youth and his/her parents (or other relatives) and that surround the youngsters with positive role models and mentors. The youth is taught how to do well in a family setting and at school and is intensively supervised, consistently disciplined, and isolated from other delinquent peers. Both the youth and his/her parents participate in a structured program where the rules and limits are clear, as are the consequences for failing to comply with the program rules. By the time youth return home, their parents have improved their ability to provide a successful home environment. They are practiced in keeping youth from associating with delinquent peers. They know how to set limits and follow through with discipline. They understand the importance of helping the youth succeed in school and on the job. The MTFC placement is an opportunity for youth and their families to experience a turning point towards positive and productive relationships and activities.
Throughout the MTFC placement, the youth's biological family (or adoptive family or other aftercare resource) participates in the treatment. Parents attend weekly treatment sessions and have on-call access to MTFC staff. During weekly sessions, effective methods for supervising, disciplining, and encouraging the youth are discussed. Biological parents and youth have a number of opportunities to practice these skills during home visits that are scheduled throughout the youth's placement. During home visits, parents run the youth's individualized program which is similar to the one used in the MTFC home. Home visits start out being short, one to two hours in length, and as the youth and his/her parents progress through the program, eventually overnight visits are scheduled. Following each home visit, the family therapist debriefs the biological parents and the youth regarding problems and progress.
Evidence of Program Effectiveness
Researchers and policy makers agree that development of effective interventions for youngsters with severe conduct problems should take advantage of the substantial body of basic research that addresses the life course development of aggression and antisocial behaviors. Further, to be most useful, expensive intervention trials need to provide experimental tests of their underlying theoretical model of change. Thus, an efficient intervention study should ideally serve two purposes: evaluate the effectiveness of the intervention and provide specific information that can guide the development of better interventions in the future. Therefore, the goals of our program of research have been:
- to systematically evaluate the immediate and longer-term outcomes of the interventions, and
- to evaluate the contribution of the intervention's key variables to changes in outcomes.
The MTFC model has been tested in two studies where the feasibility of using this model in lieu of incarceration for adolescents referred for delinquency was explored. The first study of 32 youth used a matched control group. Results from this study showed that MTFC was not only feasible but, compared to alternative residential treatment models, it was cost effective and the outcomes for children and families were better. For example, during a two-year follow-up period, the number of days delinquent youngsters were incarcerated in the state training school were lower for participants in MTFC than for a comparison group of youngsters placed in group care programs. The savings in incarceration costs alone were $122,000 (see Study 2, in Evaluation chapter, for more information). The boys and girls in this study had all been committed to the state training school and due to overcrowding were being diverted to placement in community-based programs. All youngsters came into the program from juvenile detention. Three-quarters of the youth in both the MTFC and the matched groups had previously spent some time during the last year in the state training school (an average of 23 days for MTFC youth and 15 days for youth in the comparison group).
These initial findings encouraged us to apply for federal funding to conduct a full-scale clinical trial on the efficacy of MTFC for adolescents with serious and chronic delinquency. When designing the study, in addition to looking at the relative effectiveness of the treatment models, we were interested in the broader issue of understanding the factors or key treatment components which led to success or failure for individual participants.
In 1991, a study to compare the effectiveness of two treatment models for male adolescents who had histories of chronic delinquency was initiated (see Study 1, in Evaluation chapter). The two models used very different approaches to exposure to delinquent peersone attempted to use peer group interactions therapeutically, and the other attempted to maximize the influence of mentoring adults and prosocial peers and to isolate boys from their delinquent peers. Seventy-nine boys, who were mandated into out-of-home care by the juvenile court, were randomly assigned to placement in Group Care (GC) or Multidimensional Treatment Foster Care (MTFC). In GC, boys lived with six to fifteen others who had similar histories of delinquency. In MTFC, a boy was placed in a home with a family who had been recruited from the community. MTFC parents were trained in the use of behavior management skills and were closely supervised throughout the boy's placement. In both conditions, treatment lasted for an average of seven months.
Boys who participated were from 12 to 17 years old (average age, 14.3), had an average of thirteen previous arrests and 4.6 prior felonies, and half had committed at least one crime against a person. All participants had extensive previous contacts with the juvenile justice system, had been supervised by parole or probation officers, and were labeled by the Department of Youth Services as chronic offenders. On average, study boys had spent 76 days during the previous year in juvenile detention. Their offenses included both misdemeanors and felonies; parole violations and status offenses were not included in the boy's offense counts. All boys were on parole or probation, depending on whether they had previously been committed to the state training school (in which case they were on parole), and were supervised by a parole/probation officer throughout the course of their placement and in aftercare. The period of time that parole/probation supervision lasted after treatment varied depending on the length of the jurisdiction, the boy's age, and whether he had completed restitution. There was no difference in parole/probation supervision for the two groups.
Data was collected on official arrests, including each boy's arrest history prior to entering the study. In addition, confidential self-reports of criminal activity were collected from each boy. The number of days each boy was incarcerated and/or "on the run" was tracked, as was information on school attendance and academic advancement. Mental health outcomes were also assessed. To measure outcomes, boys were assessed at baseline, three months after placement, and then every six months throughout a two-year follow-up period. To assess the contribution of key treatment components, variables were identified that were thought likely to influence a boy's success or failure in treatment. This was done by reviewing the research literature on the development of aggression and delinquency. Problems with adult supervision and discipline practices, as well as adult attachment and involvement with the child, were indicated as powerful predictors of child conduct problems. As discussed, the influence of negative peers appeared to play a key role, especially in escalation of delinquency, and especially if problems already existed. To examine the relative contribution of these variables to individual outcomes, the boy and his caretaker (i.e., line staff in GC, MTFC parent in MTFC) were assessed in the placement setting after he had been there for three months. The relationship between scores on these in-program variables and case outcomes were then examined.
Summary of Results
At one-year after treatment exit, boys in MTFC had less than half the number of arrests as boys in GC (i.e., an average of 2.6 offenses for MTFC boys and 5.4 offenses for GC boys; see Figure 1). Boys in MTFC had an 83 percent higher rate of desistance from arrest than did boys in GC. Nearly three times as many boys ran away or were expelled from their programs in GC than in MTFC (5 out of 36 MTFC boys, and 15 out of 38 GC boys). Boys in MTFC spent about twice as many days living with parents or relatives in follow-up than did boys in GC.
A series of analyses were conducted to control for factors that commonly effect rates of delinquency. These included boy's age, age of first offense, and number of previous arrests. In a multiple regression analysis we found that where the boys were placed (in MTFC or GC) was the only factor that reliably predicted further arrests even given consideration of the control variables (i.e., age, age at first offense, number of previous offenses); placement in MTFC predicted significantly fewer arrests than placement in GC.
In addition to looking at official arrest rates, rates of boy's self-reported delinquency was examined. Boys were asked in a confidential self-report interview to tell how many criminal acts they had committed during the past six months. Boys in MTFC reported committing significantly fewer criminal acts than GC boys at 6, 12 and 18 months post-enrollment in the study.
Next, we looked at whether the variables that we thought would mediate the effectiveness of treatment related to arrest rates during the time that boys were in the program and in follow-up. It was found that regardless of placement setting (i.e., MTFC or GC), the mediating variables examined (i.e., supervision, discipline, deviant peers) predicted arrests one year after boys had completed treatment. In other words, boys in either MTFC or GC who got good supervision; consistent, predictable discipline; and had less association with delinquent peers had fewer arrests in follow-up that those who did not. However, the structure of the GC programs (i.e., boys lived with other delinquent youth) promoted association with delinquent peers. Because of this, for GC boys, scores on the association with delinquent peers measure were higher (more negative), but the scores for effective supervision and discipline were lower than the scores for boys in MTFC. The evidence supports the theoretical rationaleto the extent that the risk factors are impacted, the behavioral outcome (i.e., arrests) will be impacted. This set of findings has implications for all programs which aim to reduce rates of criminal offending in juveniles.
The information for this fact sheet was excerpted from:
Chamberlain, P., & Mihalic, S.F. (1998). Blueprints for Violence Prevention, Book Eight: Multidimensional Treatment Foster Care. Boulder, CO: Center for the Study and Prevention of Violence.
Video Segment
Contact MTFC
MULTIDIMENSIONAL TREATMENT FOSTER CARE (MTFC) |
| For general program information and information about training and dissemination, contact: |
| Gerard Bouwman TFC Consultants, Inc. 1163 Olive Street Eugene, OR 97401 Phone: (541) 343-2388 Fax: (541) 343-2764 Email: gerardb@mtfc.com Website: www.mtfc.com |
| For information about program research, contact:: |
| Patricia Chamberlain, Ph. D. Clinic Director, Oregon Social Learning Center 10 Shelton McMurphey Boulevard Eugene, OR 97401 Phone: (541) 485-2711 Fax: (541) 485-7087 Email: pattic@oslc.org Website: www.oslc.org |
