Multidimensional Treatment Foster Care (A foster care intervention for severely delinquent youths) 

Randomized controlled trials show sizable reductions in youths' criminal activity. 

Description of the intervention:  The Multidimensional Treatment Foster Care program provides severely delinquent youths with foster care in families trained in behavior management, and emphasizes preventing contact with delinquent peers.  Typical community treatment for such youth, by contrast, often involves referral to a group care facility with other troubled youth. 

As an example of the program's behavior management techniques, foster parents track and regulate the youths' behaviors using a point system, with youths receiving points for positive behaviors (e.g., completing chores, attending school regularly), and losing points for negative behaviors (e.g., not completing homework, or not listening to an adult).  As youths accumulate more points, they are afforded more freedom from adult supervision.

The program provides the youths and their families with individual and family therapy during their participation in the program, and program case managers closely supervise the youths/families through daily phone calls and weekly foster parent group meetings.  The average length of stay in the program is 6-7 months.  The average cost is about $3,600 per month (2008 dollars), which is 30 to 50 percent lower than the cost of residential group care (the typical alternative treatment, in which youths are placed in group homes with other offenders, and often provided family therapy.)  Click here to go to the program's web site.

EVIDENCE OF EFFECTIVENESS

Study 1

Randomized controlled trial of 85 chronic and serious juvenile male offenders who had been mandated by juvenile courts to receive out-of-home care due to chronic delinquency.  The sample averaged 15 years of age, and had an average of 14 lifetime criminal referrals and more than 4 felony referrals.  85% of the sample was Caucasian, and 57% came from single-parent families.  Sample members were randomly assigned to Multidimensional Treatment Foster Care or to a control group that received residential group care.

Effects on the Multidimensional Treatment Foster Care group 2 years after random assignment (versus the control group):

• Much lower percentage with one or more official criminal referrals for violent offenses (21% of the Multidimensional Treatment Foster Care group had a criminal referral vs. 38% of the control group)
• Much lower percentage with two or more official criminal referrals for violent offenses-- 5% vs. 24%  (However, the study does not report whether this difference in violent offenses is statistically significant.) 
• The percentage of youth with self-reported violent offenses declined by 62% in the Multidimensional Treatment Foster Care group over the two years, compared to a 28% decline for the control group.

Discussion of study quality (click here for a glossary of terms)

• The study had low attrition:  At the two-year follow-up, outcome data on official criminal referrals were obtained for 93 percent of the original sample, and survey data (on self-reported offenses) were obtained for 79 percent of the sample.
• The study measured the intervention's effects using outcome data for all youths assigned to the Multidimensional Treatment Foster Care group, regardless of whether they completed the program (i.e., the study used an “intention-to-treat“ analysis).
• The study measured outcomes using both official records of criminal referrals and self-reported criminal offenses.
• Prior to the intervention, there were no significant differences between the Multidimensional Treatment Foster Care and control groups in their demographic characteristics or measures of their past delinquent behavior.
• Study limitation:  This was a very well-designed but small randomized controlled trial.  The study's design and implementation provide confidence that the results are valid; however, such confidence would be strengthened by corroboration in larger studies.  Also, longer-term follow-up is needed to determine if the sizable effects at two years are sustained over time.

Sources (click on linked authors' names for their contact information)

Eddy, J Mark, Rachel Bridges Whaley, and Patricia Chamberlain. “The Prevention of Violent Behavior by Chronic and Serious Male Juvenile Offenders: A 2-Year Follow-up of a Randomized Clinical Trial.”  Journal of Emotional and Behavioral Disorders, vol. 12, no. 1, spring 2004, pp. 2-8.

Fisher, Philip A., and Patricia Chamberlain.  “Multidimensional Treatment Foster Care:  A Program for Intensive Parenting, Family Support, and Skill Building.”  Journal of Emotional and Behavioral Disorders, vol. 8, no. 3, fall 2000, pp. 155-164. 

Chamberlain, Patricia and Kevin Moore.  “Models of Community Treatment for Serious Juvenile Offenders” in Social Programs That Work, edited by Jonathan Crane (Russell Sage Foundation, 1998), pp. 258-276. 

Chamberlain, Patricia and John B. Reid.  “Comparison of Two Community Alternatives to Incarceration for Chronic Juvenile Offenders.“  Journal of Consulting and Clinical Psychology, vol. 66, no. 4, 1998, pp. 624-633.

^UPDATEDStudy 2

Randomized controlled trial of 81 chronic female juvenile offenders -- averaging 15-years old and 12 lifetime criminal referrals -- who had been mandated by juvenile courts to receive out-of-home care due to chronic delinquency.  These girls were randomly assigned to Multidimensional Treatment Foster Care or to a control group that received community-based group care.

74% of the sample was Caucasian, 68% came from single-parent families, and 32% came from families with an income of less than $10,000.

The intervention group received Multidimensional Treatment Foster Care with a few adaptations for female offenders, such as an added emphasis on teaching them how to avoid aggression in social relationships (e.g., by talking to friends about distressing situations) and how to regulate their emotions (e.g., with coping and problem-solving strategies).

Effects on the Multidimensional Treatment Foster Care group 2 years after random assignment (versus the control group)