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Program Profile: Multidimensional Treatment Foster Care–Adolescents

Evidence Rating: Effective - More than one study Effective - More than one study

Date: This profile was posted on June 10, 2011

Program Summary

A behavioral treatment alternative to residential placement for adolescents who have problems with chronic antisocial behavior, emotional disturbance, and delinquency. This program is rated Effective. It was associated with a significant drop in official criminal referral rates, involvement in criminal activities, and days spent in lock up among MTFC-A boys. Similarly, the program was associated with a significant reduction in delinquency and days spent in lock up among MTFC-A girls.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals

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.


Target Population

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).


Program Components

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.

Program Theory

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.

Evaluation Outcomes

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Study 1

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).


Youth Participation

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).


Study 2

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.


Criminal Referral

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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Evaluation Methodology

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Study 1

In this evaluation of the Multidimensional Treatment Foster Care–Adolescents (MTFC–A) program conducted by Chamberlain and Reid (1998), 85 boys referred for community placement in the juvenile justice system were randomly assigned to either MTFC–A or Group Care (GC). Six boys dropped out for lack of parental consent, and five boys assessed at baseline failed to be placed and were sent home. Boys were 12–17 years old (mean=14.9 years), with histories of serious chronic delinquency averaging 14 previous criminal referrals and more than four felonies. The mean age at first criminal referral was 12.6 years. All were mandated to out-of-home care by a committee of juvenile court, and all lived in the Pacific Northwest. The large majority (85 percent) were white, 6 percent were African American, 5 percent were Hispanic, and 3 percent were Native American. There were no significant differences between the two groups on any of the baseline variables.


Treatment fidelity was assessed at 3 months through the use of an onsite interview examining practices at each placement site.


For the intervention group, daily phone contact with MTFC parents and a 2-hour weekly supervision meeting for MTFC–A parents were provided. Case managers and individual and family therapists were supervised in weekly 2-hour meetings with the project director and clinical consultants. Individual and family therapy sessions were videotaped and reviewed in these meetings. MTFC parents were taught how to implement an individualized plan for each youth. A three-level system was used in which the boy’s privileges and level of supervision were based on his compliance with program rules, adjustment in school, and general progress. Each boy attended weekly individual therapy emphasizing skill building in solving problems, social perspective-taking, and nonaggressive methods of self-expression. All boys were enrolled in public school, and 45 percent attended some special education classes. Boys carried a card to each class, and teachers had to sign off on attendance, homework completion, and attitude. Consequences were delivered for even minor rule infractions (such as being 2 minutes late to class). These included loss of points and privileges, extra chores, or in extreme cases stays in detention.


In the GC condition, the programs concentrated on establishing prosocial norms through therapeutic group work, during which youth confronted one another about negative behavior and participated in discipline and decision-making.


Outcome measures included number of days each month a youth was in care, on the run, in detention, or in State training school. Delinquent and criminal activities were assessed from official criminal referral data recorded by the Oregon Youth Authority, which included all officially reported misdemeanor and felony offenses on the youth’s record from 1 year prebaseline until 1 year postprogram, discharge, or expulsion. In addition, all boys completed the Elliott Behavior Checklist, a self-report questionnaire about criminal or delinquent behaviors during a specified time period. Three subscales were examined: general delinquency, index offenses, and felony assault.


Study 2

The subjects for this study by Chamberlain, Leve, and DeGarmo (2007) were 103 girls referred by Juvenile Court judges in Oregon between 1997 and 2002. The girls had been mandated to out-of-home care because of chronic delinquency and were randomly assigned to the experimental condition (n=37) or the control condition (n=44). The average length of stay in the randomized placement was 174 days, and the average time between baseline and intervention was 47 days. The girls were 13 to 17 years old at baseline. Seventy-four percent were white, 12 percent Native American, 9 percent Hispanic, and 2 percent African American, 1 percent Asian American, and 2 percent were designated as “other.”


Foster parents of the girls assigned to the intervention group received daily phone contact, during which the Parent Daily Report Checklist was completed. Weekly fidelity data was collected on parent implementation of an individualized, in-home daily reinforcement system for the girls. Weekly foster parent group training, supervision, and support meetings were led by experienced program supervisors. School functioning was closely monitored with a daily school card signed by teachers.


In the control condition, most programs reported endorsing a specific treatment model, with the primary philosophy being behavioral (70 percent), eclectic (26 percent), or family style (4 percent) Seventy percent of the programs reported delivering therapeutic services at least weekly.


Outcomes included the number of criminal referrals; girls’ self report of total days spent in detention, correctional facilities, jail, or prison; and girls’ self report of delinquency measured by the Elliott General Delinquency Scale. Delinquency was based on a composite of the three measured variables. Structural equation modeling and latent growth curve models were used to analyze the data.

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A recent publication from the Washington State Institute of Public Policy (Aos et al. 2011) found that the Multidimensional Treatment Foster Care had a benefit-to-cost ratio of 5.28:1.00, meaning that for every $1 invested in the program, $5.28 in benefits (including a reduction in juvenile crime) were accrued.
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Implementation Information

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Specific information about implementation and training/certification for Multidimensional Treatment Foster Care can be found at the Web site for TFC Consultants, Inc. (please see Additional References for a link).

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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Chamberlain, Patricia, and John B. Reid. 1998. “Comparison of Two Community Alternatives to Incarceration for Chronic Juvenile Offenders.” Journal of Consulting and Clinical Psychology 66(4):624–33

Study 2

Chamberlain, Patricia, Leslie D. Leve, and David S. DeGarmo. 2007. “Multidimensional Treatment Foster Care for Girls in the Juvenile Justice System: 2-Year Follow-Up of a Randomized Clinical Trial.” Journal of Consulting and Clinical Psychology 75:187–93.

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Additional References

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These sources were used in the development of the program profile:

Aos, Steve, Stephanie Lee, Elizabeth Drake, Annie Pennucci, Tali Klima, Marna Miller, Laurie Anderson, Jim Mayfield, and Mason Burley. 2011. Return on Investment: Evidence-Based Options to Improve Statewide Outcomes. Document No. 11–07–1201. Olympia, Wash.: Washington State Institute for Public Policy.

Chamberlain, Patricia. 1998. “Treatment Foster Care.” Juvenile Justice Bulletin. Washington, D.C.: Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice.

Chamberlain, Patricia, and Sharon F. Mihalic. 1998. Blueprints for Violence Prevention, Book 8: Multidimensional Treatment Foster Care. Boulder, Colo.: Center for the Study and Prevention of Violence.

Chamberlain, Patricia, Sandra Moreland, and Kathleen Reid. 1992. “Enhanced Services and Stipends for Foster Parents: Effects on Retention Rates and Outcomes for Children.” Child Welfare 71(5):387–401.

Chamberlain, Patricia, and John B. Reid. 1991. “Using a Specialized Foster Care Community Treatment Model for Children and Adolescents Leaving the State Mental Hospital.” Journal of Community Psychology 19(3):266–76.

Curtis, Patrick A., Gina Alexander, and Lisa A. Lunghofer. 2001. “A Literature Review Comparing the Outcomes of Residential Group Care and Therapeutic Foster Care.” Child and Adolescent Social Work Journal 18(5):377–92.

Chamberlain, Patricia, Joe Price, Leslie D. Leve, Heidemarie Laurent, John A. Landsverk, and John B. Reid. 2008. “Prevention of Behavior Problems for Children in Foster Care: Outcomes and Mediation Effects.” Prevention Science 9(1):17–27.

Hahn, Robert A., Jessica Lowy, Oleg Bilukha, Susan Snyder, Peter Briss, Alex Crosby, Mindy T. Fullilove, Farris Tuma, Eve K. Moscicki, Akiva Liberman, Amanda Schofield, and Phaedra S. Corso. 2004. “Therapeutic Foster Care for the Prevention of Violence: A Report on Recommendations of the Task Force on Community Preventive Services.” Morbidity and Mortality Weekly Report 53(RR–10):1–8.

Harold, Gordon T., David C.R. Kerr, Mark Van Ryzin, David S. DeGarmo, Kimberly A. Rhoades, and Leslie D. Leve. 2013. “Depressive Symptom Trajectories Among Girls in the Juvenile Justice System: 24-Month Outcomes of an RCT of Multidimensional Treatment Foster Care.” Prevention Science 14:437–46.

Leve, Leslie D., Patricia Chamberlain, and John B. Reid. 2005. “Intervention Outcomes for Girls Referred From Juvenile Justice: Effects on Delinquency.” Journal of Consulting and Clinical Psychology 73:1181–85.

Leve, Leslie D., David C.R. Kerr, and Gordon T. Harold. 2013. “Young Adult Outcomes Associated With Teen Pregnancy Among High-Risk Girls in a Randomized Controlled Trial of Multidimensional Treatment Foster Care.” Journal of Child & Adolescent Substance Abuse 22:421–34.

Rhoades, Kimberly A., Patricia Chamberlain, Rosemarie Roberts, and Leslie D. Leve. 2013. “MTFC for High-Risk Adolescent Girls: A Comparison of Outcomes in England and the United States.” Journal of Child & Adolescent Substance Abuse 22:435–49.

TFC Consultants, Inc. 2012. “Multidimensional Treatment Foster Care.” Accessed January 3, 2012.
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Related Practices

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Following are practices that are related to this program:

Formal System Processing for Juveniles
The practice of using traditional juvenile justice system processing in lieu of alternative sanctions to deal with juvenile criminal cases. The practice is rated No Effects for reducing recidivism compared to the youth that were diverted from the system.

Evidence Ratings for Outcomes:
No Effects - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types

This practice provides at-risk youth with positive and consistent adult or older peer contact to promote healthy development and functioning by reducing risk factors. The practice is rated Effective in reducing delinquency outcomes; and Promising in reducing the use of alcohol and drugs; improving school attendance, grades, academic achievement test scores, social skills and peer relationships.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Promising - More than one Meta-Analysis Drugs & Substance Abuse - Multiple substances
Promising - One Meta-Analysis Education - Multiple education outcomes
Promising - One Meta-Analysis Mental Health & Behavioral Health - Psychological functioning

Family-based Treatment for Adolescent Delinquency and Problem Behaviors
In general family-based treatment practices consist of a wide range of interventions that are designed to change dysfunctional family patterns that contribute to the onset and maintenance of adolescent delinquency and other problem behaviors. This practice is rated Effective for reducing recidivism, and Promising for reducing antisocial behavior and substance use, and improving psychological functioning and school performance.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Promising - One Meta-Analysis Mental Health & Behavioral Health - Externalizing behavior
Promising - One Meta-Analysis Drugs & Substance Abuse - Multiple substances
Promising - One Meta-Analysis Mental Health & Behavioral Health - Psychological functioning
Promising - One Meta-Analysis Education - Academic achievement/school performance
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Program Snapshot

Age: 12 - 17

Gender: Both

Race/Ethnicity: Black, American Indians/Alaska Native, Asian/Pacific Islander, Hispanic, White, Other

Geography: Rural, Suburban

Setting (Delivery): Residential (group home, shelter care, nonsecure)

Program Type: Alternatives to Detention, Alternatives to Incarceration, Cognitive Behavioral Treatment, Family Therapy, Group Home, Individual Therapy, Mentoring, Parent Training, Residential Treatment Center, Wraparound/Case Management, Children Exposed to Violence

Targeted Population: Young Offenders, Children Exposed to Violence, Families

Current Program Status: Active

Listed by Other Directories: Child Exposure to Violence Evidence Based Guide, Model Programs Guide, National Registry of Evidence-based Programs and Practices, What Works Clearinghouse, Blueprints for Healthy Youth Development (formerly Blueprints for Violence Prevention)

Program Developer:
Patricia Chamberlain
Oregon Social Learning Center
10 Shelton McMurphey Blvd.
Eugene OR 97401
Phone: 541.485.2711
Fax: 541.485.7087

Training and TA Provider:
Gerard J. Bouwann
TFC Consultants
1163 Olive Street
Eugene OR 97401
Phone: 541.343.2388
Fax: 541.343.2764