Multidimensional Treatment Foster Care (MTFC)« Back to list
|Category||Type||Target Age Group||Setting||Outcomes||Source of Rating|
|Proven Programs||Delinquency & Recidivism||
||17.9% reduction in recidivism||
MTFC is a cost-effective alternative to regular foster care, group or residential treatment, and incarceration for youth who have problems with chronic disruptive behavior. The evidence of positive outcomes from this unique multi-modal treatment approach is compelling. The MTFC treatment model can be implemented by any agency or organization providing services to children with serious behavior problems and their families.
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and prosocial behavior in children and adolescents who are in need of out-of-home placement. Youth come to MTFC via referrals from the juvenile justice, foster care, and mental health systems.
MTFC treatment goals are accomplished by providing:
- close supervision
- fair and consistent limits
- predictable consequences for rule breaking
- a supportive relationship with at least one mentoring adult
- reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings. The intervention components 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
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, review the daily behavioral information collected by telephone, and adjust the child's individualized treatment plan. The MTFC-P treatment team varies, see the MTFC-P Information page.
Teenagers with histories of chronic and severe criminal behavior at risk of incarceration and those with severe mental health problems
For more Information or to find Technical Assistance, visit:
TFC Consultants, Inc.
California Institute for Mental Health
References and/or Published Evaluations
Randomized clinical trials are widely recognized as the "gold standard" for evaluating whether social science programs produce positive outcomes for the youth and families who participate in them.
Eight randomized trials and numerous other studies have provided evidence of the feasibility and effectiveness of MTFC. The first studies explored the feasibility and cost effectiveness of using the model for adolescents referred for delinquency and for children and adolescents leaving the state mental hospital. Results showed that MTFC was not only feasible, but that compared to alternative residential treatment models, the cost of MTFC was substantially lower resulting in savings for both systems and taxpayers (see www.wa.gov/wsipp). Later studies examined immediate and long-term outcomes in several areas including:
- Youth criminal behavior and incarceration rates
- Youth violent offending
- Youth behavioral and mental health problems
- Disruption of placements and running away
- Placement recidivism
- Attachment to caregivers
- Gender differences
- Foster parent retention and satisfaction
Specifically, we have found that both boys and girls referred from juvenile justice show greater benefits from participation in MTFC than in group care. Youth in MTFC have about half the number of arrests as those in group care at follow-up and MTFC youth have a higher rate of desistance from arrest than those in group care. In addition, there are significant and meaningful differences between MTFC and group care youth on participation in violent criminal activity. Across studies, we have also found that fewer adolescents run away from MTFC than from group care. Once youth leave placements, those in MTFC spend significantly fewer days in locked settings (detention, training schools, hospitals, etc.) at follow-up.
The effectiveness of the MTFC-P program for preschoolers in the foster care system has also been examined in a randomized trial. Children entering new foster placements were randomly assigned to either the MTFC-P program or to foster care "as usual." Results indicate that children in the MTFC-P program experienced fewer permanent placement failures over time. In addition, in contrast with children in regular foster care, permanent placement failures for MTFC-P children were no higher for children with multiple prior foster placements than for children with no prior placements.
Adaptations of MTFC for use in the "regular" state-supported foster care system are underway. In a large randomized trial, in collaboration with the Child and Adolescent Services Research Center (CASRC) in San Diego County, California, over 700 foster and kinship families receiving a new placement were randomly assigned to enhanced services using a version of the MTFC model or to case work services "as usual." Foster and kinship homes in the MTFC condition had fewer placement disruptions, more frequent reunifications with birth families, and lower rates of child behavior problems.
For additional information, see the following:
Westermark, P. K., Hansson, K., Olsson, M. Multidimensional treatment foster care (MTFC): results from an independent replication. Journal of Family Therapy (2010) 1-23, doi: 10.1111/j.1467-6427.2010.00515.x
Fisher, P., Tininenko, J., Bruce, J., Pears, K. (In Press). Sleep Disruption in Young Foster Children. Child Psychiatry and Human Development.
Leve, L., Fisher, P., Chamberlain, P. Multidimensional Treatment Foster Care as a Preventive Intervention to Promote Resiliency Among Youth in the Child Welfare System. Journal of Personality 77:6, December 2009
Fisher, P., Chamberlain, P., Leve, L. Improving the lives of foster children through evidenced-based interventions. Vulnerable Children and Youth Studies, Vol. 4, No. 2, June 2009, 122-127
Kerr, D., Leve, L. D., Chamberlain, P. (2009) Pregnancy rates among Juvenile Justice Girls in two randomized controlled trials of MTFC. Journal of Consulting and Clinical Psychology, 2009, Vol. 77. No. 3, 588-593.
Fisher, P., Kim, H., Pears, K. (2009) Effects of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) on reducing permanent placement failures among children with placement instability. 0190-7409/ - see front matter. Published by Elsevier Ltd. doi:10.1016/j.childyouth.2008.10.012
Westermark, P., Hannsson, K., Vinnerljung, B. (2008) Does MTFC reduce placement breakdown in foster care? International Journal of Child & Family Welfare, 2008/4, page 155-171.
Chamberlain, P., Brown, C. H., Saldana, L., Reid, J., Wang, W., Marsenich, L., Sosna, T., Padgett, C., & Bouwman, G. (2008). Engaging and recruiting counties in an experiment on implementing evidence-based practice in California. Administration and Policy in Mental Health and Mental Health Research, 35(4), 250-260.
Chamberlain, P., Price, J., Leve, L. D., Laurent, H., Landsverk, J. A., & Reid, J. B. (2008). Prevention of behavior problems for children in foster care: Outcomes and mediation effects. Prevention Science, 9, 17-27.
Magellan Health Services Children's Services Task Force.(2008). Perspectives on Residential and Community-Based Treatment for Youth and Families.
Price, J. M., Chamberlain, P., Landsverk, J., Reid, J., Leve, L., & Laurent, H. (2008). Effects of a foster parent training intervention on placement changes of children in foster care. Child Maltreatment, 13, 64-75.
Fisher, P. A., & Stoolmiller, M. (2008). Intervention effects on foster parent stress: Associations with child cortisol levels. Development and Psychopathology, 20, 1003-1021._ Back to Top
Provided by www.mtfc.com, October 2010
- Has this program been replicated at other sites? If so, how many and where are they?
The program has been replicated at hundreds of sites all over the world. In California, the program has been or is being implemented at sites in Orange, Fresno, San Diego, Sacramento, San Jose, Long Beach, Riverside, Bakersfield, Lancaster, North Hills, Ukiah, Paradise, El Centro, Ventura and La Verne. Check the web site for a complete list of current sites.
- What kind of training and technical assistance is available for this program?
TFC Consultants, Inc. specializes in providing complete implementation services for MTFC sites. In order to realize positive treatment outcomes similar to those attained in the evaluation studies, implementation efforts focus on promoting program fidelity. To facilitate adherence to the treatment model, TFC Consultants, Inc., works with communities to identify issues that are likely to affect their ability to successfully implement the MTFC model.
- First Year Schedule of Implementation Activities (Adjustments to this schedule are occasionally made to accommodate specific circumstances):
TFC Consultants, Inc., visits your site. The focus of this visit is to bring all of the stakeholders to a common understanding about the model and implementation procedures. Program success depends on the participation in and commitment to the model of all relevant agencies and officials, so it is important to include all of the stakeholders at this initial step. The model is presented to administrators, program staff, any foster parents who may have already been identified for participation, and representatives from relevant outside entities, such as the local juvenile justice community, mental health community, and/or foster care certification agency. Finally, an implementation plan and timelines are developed for training program staff; recruiting, training, and certifying foster parents; and placements in the foster homes.
- Your agency staff attends a four-day training session at the model site in Eugene, Oregon (five days for Program Supervisors). Clinical training sessions are scheduled quarterly for replacement staff and new implementation teams.
- Consultation is provided regarding foster parent recruitment with your agency staff, as needed.
- The first group of foster parents are trained at your site during a two-day training.
- WebPDR procedures are initiated and training is provided for staff.
- Ongoing weekly telephone consultation is conducted with your program supervisors regarding treatment plans, progress, issues, and problems for each placement.
- Periodic reports are prepared for your program director or administrator on implementation progress, staff performance, model adherence and other relevant issues. As part of the quarterly review, videotapes of your site's weekly foster parent and clinical meetings are coded for adherence to MTFC principles and procedures.
- Additional in-person training, problem solving, and consultation can be provided when needed. Up to six days of on-site consultation is provided.
- In most cases, new sites can be fully operational within a year from start-up of the implementation.
- First Year Schedule of Implementation Activities (Adjustments to this schedule are occasionally made to accommodate specific circumstances):
- Once the program has been implemented, can an organization obtain assistance with fidelity monitoring or quality assurance?
To develop MTFC program certification standards, OSLC Community Programs (the founding MTFC program), TFC Consultants, Inc., and the Center for Research to Practice (an independent research organization specializing in dissemination issues) have collaborated to specify a program certification protocol that provides standardized measurement of all important MTFC model components and sets consistent standards that must be met for programs to be considered certified. As part of the process, detailed feedback is provided to applicant programs regarding program strengths and areas in need of improvement. Applications can be submitted by any organization that believes their MTFC program meets certification criteria, regardless of whether they receive previous training or technical assistance from TFC Consultants, Inc.
Program staff can self-assess the degree to which they think their program meets certification standards by reviewing the certification packet available on the web site (www.mtfc.com). Because the certification process involves a thorough evaluation of several components of your MTFC program, including coding videotapes of foster parent and clinical staff meetings, a fee is charged for this process. The application fee is non-refundable, regardless of whether or not certification standards are met and certification is obtained, therefore it is important to carefully review the specific measures that will be used to determine whether the program meets the standards before your organization makes an application for certification.
TFC Consultants, Inc., is available to provide technical assistance to help identify areas in need of improvement prior to application for certification, or to address adherence issues either prior to application or as they emerge in the certification process. This certification model, in tandem with the availability of consultation and technical assistance tailored to the specific needs of each applicant, is intended to provide a cost-effective, individualized mechanism for ongoing assurance of model fidelity and outcomes. Once a program is certified, the certification is valid for two years, and re-certifications are valid for three years. Application materials and information regarding the standards for certification are provided in the next section.
The Center for Research to Practice conducts the certification procedure independently and without consultation with TFC Consultants, Inc., or OSLC Community Programs staff. The Center for Research to Practice trains program certification evaluators and videotape coders to reliability standards so that sites can be assured that they are receiving an objective, independent evaluation of their MTFC program's level of functioning.
- Can an organization obtain assistance with data collection or measurement of outcomes?
As stated above, additional in-person training, problem solving, and consultation can be provided when needed. Up to six days of on-site consultation is provided through the standard technical assistance package. Contact TFC Consultants, Inc. for more information.