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TFC (also known as Multidimensional Treatment Foster Care, MTFC; Chamberlain, 1994)
is a treatment program for youths who have problems with delinquency and their families. MTFC is a
6-9 month program that was designed as an alternative to incarceration or group-home care for youths
who are referred by the juvenile justice system and are court-mandated to out-of-home care.
Intensive parent training is provided to the biological parents (or other guardian) during the placement period,
as well as for 12 months following treatment with MTFC. Treatment goals for youths are focused on reducing
criminal behavior and substance use, improving school attendance and grades, reducing association with
delinquent peers and establishing pro-social peer relationships, and improving youths' ability to live
successfully in a family setting. Treatment goals for the family are focused on improving parenting skills
through the use of effective discipline strategies and increasing parental involvement with their youth.
After referral and consent, youths are placed one per foster home with MTFC parents who are
recruited, trained and supervised by clinicians at the Oregon Social Learning Center (OSLC). MTFC parents complete
20 hours of pre-service training based on social learning theory and are taught to implement a daily behavior
management program in their home. Each day, youths earn points for adaptive and prosocial behaviors across home,
school, and community settings; points are lost for negative or undesirable behaviors. Daily points are then used
to "purchase" short- and long-term privileges. As youths progress through the program, the level of
responsibility and privilege increase. Youths participate in weekly individual therapy sessions that are focused
on developing effective problem-solving, social, and emotion regulation skills. Parents or guardians attend weekly
family therapy sessions, during which they are taught effective parenting and family management techniques. Youths
in MTFC attend public schools and their attendance and performance is monitored daily. Support is provided to MTFC
parents and biological parents/guardians on a twenty-four hour, seven-day-a-week basis.
The effectiveness of MTFC has been evaluated in three studies - one comparing MTFC to a
matched comparison group, one comparing the relative effectiveness of MTFC for boys and girls, and a clinical
trial comparing MTFC to group care for boys. Findings from these studies suggest that MTFC is a viable treatment
option for youths who have problems with delinquency and serious behavioral and emotional problems. For example,
in the clinical trial, where assessments were completed at baseline, at 3 months post-placement
and at 6-month intervals throughout a two-year follow-up period, results
showed that significantly more MTFC boys completed treatment compared to boys in group care. MTFC boys were also
institutionalized significantly less and had significantly fewer arrests (less than half the rate of group care)
during follow-up. In addition, MTFC boys reported significantly fewer psychiatric symptoms, had
better school adjustment, returned to their family homes after treatment more often, and rated their lives as
being happier compared to boys in group care. Since this study, the MTFC model has been adapted to treat
delinquent adolescent females referred from the juvenile justice system, and a clinical trial evaluating its
effectiveness in this regard is currently underway.
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Implementation Costs:
Staffing needs are as follows: A program director is needed to oversee the program.
For every 10 youth who are treated with MTFC, you will also need one full-time case manager,
one ½ time individual therapist, one ½ time family therapist, a full-time foster parent
recruiter/trainer/PDR caller, a consulting psychiatrist and foster parents. Other costs are accrued for
advertising for foster parents, reinforcers and incidentals for youths, and cell phones and/or pagers
for program staff. MTFC program costs (all inclusive) are $120/day.
Training Costs:
Training, consultation and clinical supervision is $40,000 for the first year.
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