Multidimensional Treatment Foster Care (MTFC) Family of Programs. Philip Fisher, Ph.D. Oregon Social Learning Center Eugene, Oregon USA

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1 Multidimensional Treatment Foster Care (MTFC) Family of Programs Philip Fisher, Ph.D. Oregon Social Learning Center Eugene, Oregon USA

2 Children in care are a very high risk population Surveys find that up to half of these children have symptoms of psychological disorders (e.g., Glisson, 1994, 1996; Horowitz, Simms, & Farrington, 1994; Stein, Evans, Mazumdar, & Rae-Grant, 1996; Trupin, Tarico, Benson, Jemelka, & McClellan, 1993). McIntyre and Keesler (1986): Nearly nine times the relative risk of psychopathology, and specific syndromes are between 2 and 32 times more likely. Among children under 6 in care, Klee et al. (1997) found that 80% have developmental or emotional problems; over 50% exhibit problems in both areas.

3 Once placed in out of home care, children s rates of re-entry into care are very high Figure 1. Permanent placement failures following out of home care % of children in remaining in permanent Cum Survival placements Time Months in perm following placement permanent placement Condition FCI FCI-censored FCC FCC-censored 40 (Fisher, Burraston, & Pears, 2005)

4 Risk for permanent placement failure increases as the number of out of home placements increases Figure 2. Association between # of out of home placements and probability of permanent placement failure (Fisher, Burraston, & Pears, 2005)

5 Effective strategies are needed To identify children s needs To reduce risks for poor outcomes To promote healthy development and To reduce unnecessary costs to the system

6 The Oregon MTFC Model Objective: To change the negative trajectory of antisocial behavior by improving social adjustment with family members and peers through simultaneous and well-coordinated treatments in the home, school, & community. Treatment is provided in a family setting where new skills can be practiced and reinforced. 3/21/2006

7 MTFC Family of Programs Infancy Preschool Latency Age Adolescence PREVENTIO N MTFC-P (preschoolers) Project KEEP Multidimensional Treatment Foster Care (MTFC) TREATMEN T

8 Basic Concept Foster Foster Home Home Therapy Therapy

9 MTFC & MTFC-P program goals Treatment techniques: Simple, practical, & effective Areas of emphasis: Support and encourage positive behavior Clear and consistent limits Close supervision of the child Separation from delinquent peers (adolescents) Responsiveness to child s cues and needs (preschoolers)

10 Program Structure Foster Parent Consultant Family Therapist Daily Report Caller STAFF Case Manager Child Therapist Behavioral Skills Trainer Child Psychiatrist Caregiver-Child Relationship Case Management Child Needs Contexts Home Community Preschool/school

11 4 Key Program Components Foster parent support & consultation services Child treatment services Parenting support for birth/adoptive families Daily Report telephone check-in w/caregiver

12 Foster Parent Support Central concept: Foster parents as members of the treatment team 12 hours pre-service training course Ongoing consultation with program staff Weekly support and training meetings 24-hour, 7-day on call staff member Emergency crisis intervention Respite

13 Treatment Techniques 1: Tangible Encouragement for Positive Behavior Kid bucks Star/sticker charts Point charts Level system Preschool Latency age Adolescence Immediate Daily Weekly

14 Treatment Techniques 2: Developmentally appropriate limit setting Preschool Latency age Adolescence Redirection/ Distraction Time Out Work Chore Privilege Removal

15 Resources for Children Individual therapy/skills training Psychiatric medication management School/preschool consultation Therapeutic playgroup to promote school readiness (MTFC-P) Referral for services to address special needs (e.g. developmental delays, dental, medical)

16 Parenting Support for Birth/Adoptive Families Weekly family counseling focusing on Parent Management Training Instruction in behavior management methods Home visits with crisis back-up: Start small increase over time Case management: Service coordination, access, utilization 24-hour, 7-day on call to case manager Aftercare

17 Daily Report Telephone Check-In 5-10 minute telephone call Behavior checklist format 0 = behavior did not occur 1= behavior occurred, was not stressful 2 = behavior occurred, was stressful Web-based, housed on OSLC server as WEBdr Data entry, management, and analysis all on-line Facilitates off-site consultation

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20 Notable outcomes from program evaluation studies of MTFC & MTFC-P Chamberlain & Reid (1992) found that MTFC is half the cost of psychiatric hospitalization per month Chamberlain, Moreland and Reid (1996) found that compared to regular foster care, MTFC has: Fewer placement disruptions Lower foster parent attrition Fewer child problem behaviors in follow-up Chamberlain & Reid (1998) found that compared to group care, boys in MTFC had: Fewer arrests & violent crime Less incarceration More days living with family

21 Foster placement failure and foster parent retention percentage MTFC Regular Foster Care 0 Failed placements Foster Parent Drop Outs

22 MTFC-P increases permanency Figure Figure 3. Effects 3. Survival of MTFC-P Functions reducing by Condition permanent placement failure % of children in remaining in permanent Cum Survival placements Time Months in perm following placement permanent placement Condition FCI FCI-censored FCC FCC-censored 40 (Fisher, Burraston, & Pears, 2005)

23 MTFC-P mitigates risk of failed permanent placement resulting from prior out of home placements Figure 4. For children who received MTFC-P, number of prior placements was not associated with increased risk for permanent placement failure (Fisher, Burraston, & Pears, 2005)

24 MTFC-P improves attachment 0.9 Figure 5. Secure and insecure attachment at 3 month intervals Secure behavior T1 T2 T3 T4 T5 Time Reg Foster Care MTFC-P Community Comparison 0.4 Insecure Behavior Fisher & Kim (submitted) 0.1 T1 T2 T3 T4 T5 Time Reg Foster Care MTFC-P Community Comparison

25 Cost-Effectiveness Analysis: Washington State Institute for Public Policy (May, 1999) Cost comparisons for treating youth from juvenile justice are approximately 1/3 less than group care Criminal justice costs saved/participant $27,202 Crime victim costs saved/participant $16,459 Net gain to taxpayer and victim costs avoided $43,661 TFC saved taxpayers $14.07 for every dollar spent Youth justice system AND crime victim benefits per dollar of cost $22.58

26 Implementing MTFC in Community Settings

27 Transport of MTFC into Communities 31 sites in the United States (10 California counties) 2 sites in Canada UK Child Welfare and Youth Justice Sweden 2 randomized trials underway (in New York City and Lund, Sweden) In 2001 established separate organization to conduct dissemination and quality assurance activities (TFC Inc.)

28 MTFC Training and Technical Assistance Package Completion of readiness process Presentation to key stake holders (on-site) 4 day training for treatment team and administration in Oregon One treatment team has capacity children Each team requires the specified training process

29 MTFC Training and Technical Assistance Package Foster parent training (on-site) Weekly telephone supervision for one year (PDR plus video tapes of foster parent and clinical meetings) 3 site visits tailored to sites needs Quarterly program evaluations Application for certification (emphasis on developing capacity for self-monitoring

30 Individual site implementations Site 1 Site 2 Site 3 Treatment Foster Care Consultants Inc., Eugene Oregon USA Site 5 Site 4 Etc.

31 National level implementations Site 1 Site 2 Treatment Foster Care Consultants Inc., Eugene Oregon USA National Implementation Team Site 3 Site 5 Site 4 Etc.

32 Implementation Timeline Initial Contact & Readiness Assessment Contract Executed/ Commitments in writing Initial Site Visit: Model overview Stakeholder commitments Timelines estab. 4-day Pre-service Staff Training 2-day Pre-service Foster Parent Training Web PDR Startup Program Startup: Tel. Consult Begins Follow-up Site visits& Implementation Feedback

33 What predicts successful outcomes? Eager buy-in to the model at the system, agency, and clinician levels Capacity to fund the model Ongoing staff training, supervision, & support Ability to recruit and support foster parents The bottom line is fidelity to MTFC mechanisms: PDR Quarterly program reviews Monitoring outcomes in 7 domains including coding tapes from foster parent and clinical meetings Coming soon: Studies on implementation of evidencebased practices that test how to engage and support adoption

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