Multidimensional Treatment Foster Care – an alternative to institutional placement Euromet Symposium 2013 Annika W Jonsson, psychologist Sara Lindstein, psychologist SiS ungdomshem Hässleholm

Background Information  OSLC, where MTFC was developed, was started in the 1970’s by Gerald Patterson and John Reid in Eugene, Oregon, USA  The MTFC program is based on Social Learning Theory and Coercion Theory  MTFC is evidence- and manualbased

How is MTFC different?  MTFC places one child with a family at a time  Placement in MTFC is approx. one year  MTFC uses a team approach to treatment  Foster Parents are members of the team  For one of the foster parents, MTFC is a full-time job  Programs are individualized for each youth  Support for foster parents is available 24 hours a day, 7 days a week  Foster parents meet regularly with their supervisor and other foster parents in the program to learn from and support each other

Main purpose of MTFC Youth returning to a permanent living with his/her family. For all treatment components of MTFC, this is focus from day one.

MTFC Key stones  Reinforcement of pro-social behaviors  Close supervision  Fair, consistent and predictable limits and consequences  Supportive relationships  Minimize association with peers who may be a bad influence

Who is served by MTFC?  Children and youth in need of out-of-home placement due to serious behavioral and emotional problems and their families  MTFC-P serves children 3 – 6 years old  MTFC-C serves children 7 – 11 years old  MTFC-A serves youth 12 – 17 years old  Those who may have failed in prior placements or treatments  Can be used as step-down from institutional placements  Can be used as diversion from institutional placements

Exclusionary criteria  Absence of serious behavior problems  Substance abuse is the only problem behavior  Sex offending/acting out is the only problem behavior  Active suicidal/homicidal  Psychosis  Schizophrenia  Bi-polar disorder with psychotic features

The MTFC Universe School Foster parents Social services Youth therapist Biological family Family therapist Youth Program supervisor Skills coach

Core Components for MTFC Parents  Conducts daily behavior management point and level system  Daily telephone contact and data collection  Weekly support and training meetings  24-hour, 7-day on-call program supervisor

Core Components for Youth  Daily mentoring by MTFC parents  Daily structure and support via a point and level system  Daily school card  Weekly contact with parents and frequent home visits  Weekly individual therapy  Weekly skill building and advocacy  Close supervision of whereabouts and associations  Psychiatric consultation

Point chart Name Date Points Things to Do to Earned Points Earned Bonus Total  5 UP ON TIME  5 READY IN MORNING  5MORNING CLEANUP  5GO TO SCHOOL, CARRY SCHOOL CARD  10ON TIME FOR CLASS  10BEHAVIOR IN CLASS  10 READ AND STUDY  5 ATTEND THERAPIES & SKILLS TRAINING  5ATTEND LEISURE ACTIVITY  10BEING ON TIME  5 CHORE  5 DINNER WITH FOSTER FAMILY  5 ENGAGE IN FAMILY ACTIVITIES  0-10 PRO-SOCIAL PEER CONTACT  5ATTITUDE  5 BED ON TIME  5CELL PHONE TO FOSTER PARENTS DAILY TOTAL (115)

Point and Level System  Three levels  Opportunities to earn points for compliance, prosocial behavior  Points are lost for rule violations, misbehavior  Provides a framework within which interaction can occur without engagement in conflict

Level 1 During Level 1, the youth settles into the MTFC family home and begins to build relationships. In Level 1, there is very close supervision and immediate reinforcement.  The youth earns points for routine daily activities.  The youth is supervised at all times.  No homevisits, no time with friends, no cell phone  The youth should be able to earn approx. 100 points a day.  It takes 2,100 points or about 3 weeks to move out of Level 1.

Level 2 Level 2 will be individualized according to what was learned during level 1.  Youths can earn 805 points a week.  Bonuspoints earned in one week are used to buy privileges for the next week.  They learn to delay gratification, plan ahead, and work toward a goal.  The amount and quality of privileges increases.  They can be demoted to level 1 for low point days.  It takes 110 days to earn enough points to move to level 3.

Level 3 Level 3 is a maintenance phase. The youth is allowed more free time and a higher quality of privileges in level 3.  The youth must earn 90 points a day.  Youth and foster parents/family are more independent in relation to the program supervisor  Activities must be approved in advance.  Serious violations can result in a demotion to level 1.

Core Components for Families  Weekly family counseling focusing on Parent Management Training: teaching parents to use clear and consistent discipline, be warm and supportive and to supervise their children closely  Instruction in behavior management methods  Home visits with crisis back-up  24-hour, 7-day on call to program supervisor

Research results – Swedish 2-year-follow-up Comparison MTFC-group (n = 20) and TAU-group (treatment as usual)(n = 20)  MTFC had significantly reduced all self-reported problem symptoms (internalized and externalized) for youths and mothers.  TAU had significantly reduced some self-reported problem symtoms  MTFC had reduced all self-reported problem symtoms with at least 30% Pia Kyhle Westermark, 2009, IMS & Socialhögskolan, Lunds universitet

Swedish 3-year-follow-up Comparison SiS assessment + MTFC-treatment (n = 19) vs SiS assessment +TAU (n = 27)  Violent crime during the three-year follow-up period 0 % in the MTFC-group vs 41 % in the TAU group  Days in locked wards during the follow up period: MTFC average 23 days vs TAU average 87 days  Third year – significantly lower frequency of criminality in the MTFC-group On going study, Bergström & Höjman, Lund university/SiS

Aftercare  Aftercare helps to prevent old patterns of problem behavior to return. Without it, problem behaviors most often reoccur. Support is needed for a long time.  The youth level of functioning after the termination of the MTFC-program is more dependent on the situation at home then it is on the level of functioning during the MTFC-placement.  Multidimensional work is necessary also in the phase of aftercare; family, school, friends and leisure activities.