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Multidimensional Treatment Foster Care

Ages 11-18

Rating: Level 1


Multidimensional Treatment Foster Care (MTFC) is a behavioral treatment alternative to residential placement for adolescents who have problems with chronic antisocial behavior, emotional disturbance, and delinquency. It 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. 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 and to reduce conflict and 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, review the daily behavioral information collected by telephone, and adjust the child’s individualized treatment plan.

There are three versions of MTFC, each serving specific age groups. Each version has been subjected to rigorous scientific evaluations. The versions are MTFC–P (for preschool children, ages 3 to 5), MFFC–L (for latency-aged children, 6–11), and MTFC–A (for adolescents, 12–17).


Eight randomized trials and numerous other studies have provided evidence of the feasibility and effectiveness of MTFC. This section reviews the four most comprehensive studies.

Study 1, a full-scale clinical trial conducted during 1990–96, was the largest and most comprehensive. Seventy-nine 12- to 17-year-old male juvenile offenders with histories of chronic and serious delinquency were randomly assigned to treatment in MTFC or group care (GC) for an average of 7 months. The sample was 85 percent white, 6 percent African-American, 6 percent Hispanic, and 3 percent Native American. In GC the boys lived with 6–15 others who had similar delinquency histories. In MTFC, boys were placed individually in homes with families recruited from the community. The MTFC parents were trained in behavior management skills and were closely supervised. Data was collected on official arrests and confidential reports of criminal activity. The number of days each boy was incarcerated was tracked, as was information on school attendance, academic advancement, and mental health. Data was collected every 2 months for a year.

Study 2 compared the effectiveness of MTFC with typical community treatment for youths ages 9–18 leaving State mental hospitals. Cases were referred by the hospital community outreach team and randomly assigned to the treatment (n=10: 5 males, 5 females) or control group (n=10: 3 males, 7 females). The treatment group received MTFC, while control group members were placed in community settings such as a group home, a juvenile corrections training school, a secure residential treatment center, or remained in the State hospital. The control group received milieu, individual, or group therapy—or some combination of these three—depending on their placement. Measures included the PDR Checklist, which examined rates of problem behaviors; the Behavior Symptom Inventory, which examined the presence or absence of psychiatric symptoms; and the tracking of rehospitalizations.

To gauge the effectiveness of enhanced services and stipends for foster care parents, Study 3 followed 72 foster children from three Oregon counties for 2 years. The sample was 61 percent female, 86 percent white, 6 percent African-American, 4 percent Hispanic, and 4 percent other or mixed ethnicities. Their foster parents were randomly assigned to three groups: 1) assessment only, in which parents were neither paid for their participation nor given enhanced training and support; 2) payment only, in which parents were paid for their participation but did not receive enhanced training or support; and 3) enhanced training and support, in which parents did not receive payment but did receive enhanced training and support (ETS). Foster parents and children were assessed before placement, shortly after placement, 3 months afterward, and 2 years afterward.

Study 4 was a 2-year follow-up of girls with serious and chronic delinquency. Eighty-one chronic female offenders were randomly assigned to MTFC (n=37) or to community-based group care (n=44). Each participant was mandated by the juvenile court to receive out-of-home care owing to her chronic delinquency with an average of 11 lifetime criminal referrals. Participants were 13–17 years old with an average age of 15 at baseline. The sample was 74 percent white, 68 percent were from single-parent families, and 32 percent were from families with an annual income of less than $10,000. There were no differences on the rates or types of baseline offenses or other demographic characteristics. The intervention group received MTFC 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).


Overall, the evaluation results showed that MTFC was not only feasible but also, compared with alternative residential treatment models, more cost-effective and led to better outcomes for children and families.

Specifically, Study 1 found that, compared with the control group (GC), MTFC youths spent 60 percent fewer days in incarceration during the 12-month follow-up, had significantly fewer subsequent arrests, and had significantly less hard-drug use. A significantly greater proportion of boys in MTFC completed their programs successfully (73 percent versus 36 percent). 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 happier, compared with boys in GC.

Study 2 results showed that juveniles in the MTFC group were placed out of the hospital at a significantly higher rate. In fact, during the 7-month follow-up period, 33 percent of the control participants remained in the hospital the entire time because no appropriate aftercare resource could be identified. More MTFC youth were placed in family settings, while control youth tended to be placed in institutional settings. There were no differences found in rehospitalization rates or in rates of child reports of psychiatric symptoms. Significant differences favoring MTFC participants were found in adult reports of child problem behaviors.

Study 3 found that fewer foster parents in MTFC ETS groups dropped out; that is, there was a significantly higher retention rate for foster parents in ETS. In terms of adolescent outcomes, youth whose foster parents participated in the ETS group had significantly fewer disruptions in their placements. In addition, 3 months after the study, children in the ETS group showed the largest drop in the rate of problem behaviors. However, the ETS group initially showed a significantly higher rate of problem behaviors at baseline.

Study 4 showed that more participation in MTFC resulted in better outcomes (in terms of days in locked settings, number of criminal referrals, and self-reported delinquency) than placement in GC at 12- and 24-month follow-ups. Findings showed effects at the 1-year follow-up were maintained at the 2-year assessment with a slightly larger effect size and that trajectories of reductions across the course of the study were significantly larger for MTFC. The number of days in locked facilities displayed the largest effect size in this study. MTFC girls spent more than 100 fewer days in locked settings at the 2-year assessment than GC girls (mean difference=104.82 days).

Risk Factors


  • Anti-social behavior and alienation/Delinquent beliefs/General delinquency involvement/Drug dealing
  • Cognitive and neurological deficits/Low intelligence quotient/Hyperactivity
  • Early onset of aggression and/or violence
  • Favorable attitudes toward drug use/Early onset of AOD use/Alcohol and/or drug use
  • Mental disorder/Mental health problem/Conduct disorder


  • Family history of the problem behavior/Parent criminality
  • Family management problems/Poor parental supervision and/or monitoring
  • Pattern of high family conflict

Protective Factors


  • Healthy / Conventional beliefs and clear standards
  • High expectations
  • Perception of social support from adults and peers
  • Positive / Resilient temperament
  • Social competencies and problem-solving skills


  • Effective parenting
  • Good relationships with parents / Bonding or attachment to family
  • Having a stable family


  • Clear social norms / Policies with sanctions for violations and rewards for compliance
  • Presence and involvement of caring, supportive adults
  • Safe environment / Low neighborhood crime


  • Involvement with positive peer group activities


  • OJJDP: Blueprints
  • SAMHSA: Model Programs
  • OJJDP/CSAP: Strengthen Families
  • HHS: Surgeon General
  • Department of Education


Chamberlain, Patricia. 1998. “Treatment Foster Care.” Juvenile Justice Bulletin. Washington, DC: 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, and J. 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.

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

Curtis, P.A.; G. Alexander; and L.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.

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.


Patricia Chamberlain, Ph.D., Director
Oregon Social Learning Center
160 East Fourth Street
Eugene, OR 97401
Phone: (541) 485-2711
Fax: (541) 485-7087
Web site:

Technical Assistance Provider

Gerard J. Bouwman, President
TFC Consultants, Inc.
1163 Olive Street
Eugene, OR 97401
Phone: (541) 343-2388
Web site: