Multidimensional Treatment Foster Care (MTFC) is a behavioral treatment alternative to residential placement for youth who have problems with chronic antisocial behavior, emotional disturbance, and delinquency.
There are three versions of MTFC, each serving specific age groups. The versions are MTFC–P (for preschool children, ages 3 to 6), MTFC–C (for middle childhood, ages 7 to 11), and MTFC–A (for adolescents, ages 12 to 17).
The intervention is multifaceted and occurs in multiple settings. The intervention activities include:
- Behavioral parent training and support for MTFC foster parents
- Family therapy for biological parents (or other aftercare resources)
- Skills training for youth
- Supportive therapy for youth
- School-based behavioral interventions and academic support
- Psychiatric consultation and medication management, when needed
There are three components of the intervention that work in unison to treat the youth: MTFC Parents, the Family, and the Treatment Team.
1. MTFC Parents. The program places a youth in a family setting with specially trained foster parents for 6 to 9 months. The foster parents are recruited, trained, and supported to become part of the treatment team. They provide close supervision and implement a structured, individualized program for each child. MTFC parents are supported by a case manager who coordinates all aspects of their youngster’s treatment program. In addition, MTFC parents are contacted daily (Monday through Friday) by telephone to provide the Parent Daily Report (PDR) information, which is used to relay information about the child’s behavior over the last 24 hours to the treatment team and to provide quality assurance on program implementation. MTFC parents are paid a monthly salary and a small stipend to cover extra expenses.
2. The Family. The birth family receives family therapy and parent training. Families learn to provide consistent discipline, to supervise and provide encouragement, and to use a modified version of the behavior management system used in the MTFC home. Therapy is provided to prepare parents for their child’s return home, to reduce conflict, and to increase positive relationships in the family. Family sessions and home visits during the child’s placement in MTFC provide opportunities for the parents to practice skills and receive feedback.
3. The Treatment Team. The MTFC treatment team is led by a program supervisor who also provides intensive support and consultation to the foster parents. The treatment team also includes a family therapist, an individual therapist, a child skills trainer, and a daily telephone contact person (PDR caller). The team meets weekly to review progress on each case, to review the daily behavioral information collected by telephone, and to adjust the child’s individualized treatment plan.
The program is based on the Social Learning Theory model that describes the mechanisms by which individuals learn to behave in social contexts and the daily interactions that influence both prosocial and antisocial patterns of behavior.
12 to 17
Official Criminal Referral
In the Chamberlain and Reid (1998) study, Multidimensional Treatment Foster Care–Adolescents (MTFC–A) boys showed a larger drop in official criminal referral rates than Group Care (GC) boys did at 1 year posttermination. Forty-one percent of MTFC–A boys had no criminal referrals, compared with 7 percent of GC boys.
Self-Reported Criminal and Delinquent Behavior
Using the Elliot Behavior Checklist, MTFC–A boys reported significantly fewer criminal activities than GC boys at 1 year postbaseline on general delinquency (12.8, compared with 28.9), index offenses (3.2, compared with 8.6), and felony assaults (1.2, compared with 2.7).
Fewer MTFC–A youths than GC boys ran away from their placement (30.5 percent versus 57.8 percent), and more MTFC–A boys completed their treatment program (73 percent versus 36 percent).
Days in Detention and Reunification With Family
MTFC–A boys spent significantly fewer days than GC boys spent in lockup. Overall, MTFC–A boys spent approximately 60 percent fewer days incarcerated than GC boys did, including fewer days in local detention facilities (32 days, compared with 70 days) and fewer days in the State training schools (21 days, compared to 59 days). MTFC–A boys also spent nearly twice as much time living with their parents as GC boys spent (59 days, compared with 31 days).
Reduction in Delinquency
Overall, Chamberlain, Leve, and DeGarmo (2007) found that the effects that had been found at 1 year were maintained at the 2-year follow-up assessment, with a slightly larger effect size for Multidimensional Treatment Foster Care–Adolescents (MTFC–A) girls. MTFC–A was associated with a significantly greater reduction in delinquency, as measured by the delinquency construct and controlling for age (older girls exhibited lower levels of 2-year delinquency). However, there were no significant differences between the groups on self-reports of delinquency as measured by the Elliott Delinquency Scale.
At 2 years posttreatment, GC girls had an average of 0.22 criminal referrals, compared with 0.13 for MTFC–A girls. However, this difference was not significant, though it did approach significance (p<0.06).
Days in Locked Settings
MTFC–A girls spent significantly fewer days than GC girls did in locked settings during the 2 years posttreatment. MTFC–A girls spent 100 fewer days than GC girls in locked settings (the average difference was 104.82 days).
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