This document was printed from the website of the California Evidence-Based Clearinghouse for Child Welfare (CEBC), which you can access at http://www.cebc4cw.org/
This document was printed from the website of the California Evidence-Based Clearinghouse for Child Welfare (CEBC), which you can access at http://www.cebc4cw.org/
Child Welfare Outcomes: Permanency and child/family well-being.
Type of Maltreatment: Not specified
Target Population: Preschool foster children aged 3-6 years old who exhibit a high level of disruptive and anti-social behavior which cannot be maintained in regular foster care or who may be considered for residential treatment.
Brief Description:(The information in this program outline is provided by the program representative and edited by the CEBC staff.)
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) has been rated by the CEBC in the areas of Higher Level of Placement, Infant and Toddler Mental Health (0-3), Mental Health Treatment for Children, and Placement Stabilization. MTFC-P is a treatment foster care model specifically tailored to the needs of 3 to 6-year-old foster children. MTFC-P is effective at promoting secure attachments in foster care and facilitating successful permanent placements. MTFC-P is delivered through a treatment team approach in which foster parents receive training and ongoing consultation and support; children receive individual skills training and participate in a therapeutic playgroup; and birth parents (or other permanent placement caregivers) receive family therapy. MTFC-P emphasizes the use of concrete encouragement for pro-social behavior; consistent, non-abusive limit-setting to address disruptive behavior; and close supervision of the child. In addition, the MTFC-P intervention employs a developmental framework in which the challenges of foster preschoolers are viewed from the perspective of delayed maturation. Since MTFC-P is highly rated on the Scientific Rating Scale, information on available pre-implementation assessments, implementation tools, and fidelity measures was requested from the program representative. Please see the program's separate Implementation Information page for details.
THREE KEY MECHANISMS
OTHER COMPONENTS
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) was designed to be conducted in a group.
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) has not been tested for use in a group setting.
The recommended group size is: There are two main components that are conducted in group environment: Therapeutic Playgroup and Foster Parent Support Meeting. The Therapeutic Playgroup is conducted with approximately 10 children. The Foster Parent Support Meeting occurs with 10 caregivers from foster homes.
Recommended intensity: For Foster parent(s), there is typically a minimum of seven contacts per week which consist of five 10-minute contacts, one two-hour group and additional contacts based on the amount of support or consultation required. For the child in treatment, two contacts per week which consist of a two-hour therapeutic playgroup and a two-hour skills training session. For the biological family or other long-term placement resource, one contact per week in the form of a one-hour skill-building session.
Recommended duration: Designed with an overall treatment duration of 6-9 months.
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) includes a homework component.
Description: Biological (or other long-term placement resource) parents are guided in practicing parenting skills outside of the sessions during visits with the child in foster care and with other children living in the home.
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) is typically conducted in a(n): Birth Family Home, Community Agency, Foster Home, and School.
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) was designed with a Parent Component.
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) addresses the following presenting problems and symptoms: Has a child in foster care who exhibits a high level of disruptive and anti-social behavior.
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) was designed with a Child Component.
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) addresses the following presenting problems and symptoms: Disruptive, maladaptive behaviors such as aggression, anxiety, depression, hyperactivity, autism spectrum, attachment, enuresis, encopresis, defiance, tantrums and general anti-social behavior. They include a wide range of diagnoses and also include developmental delays.
Age range(s): 3-6
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) was developed for children with developmental delays.
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) has been tested for children with developmental delays.
Relevant research studies:
Fisher, P. A., Burraston, B., & Pears, K. (2005). The Early Intervention Foster Care Program: Permanent placement outcomes from a randomized trial. Child Maltreatment, 10, 61-71.
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) has materials available in a language other than English.
Language(s) available:
Dutch. For information on which materials are available in this language, please check on the program's website or contact the program representative (all contact information is listed at the bottom of this page).
There is a manual that describes how to implement this program.
There is training available for Multidimensional Treatment Foster Care for Preschoolers (MTFC-P).
Training contact: TFC Consultants, Inc., Gerard Bouwman, President, 1163 Olive Street, Eugene, OR 97401, 541-343-2388
Number of days/hours: 5 days for a total of 40 hours
Training is obtained: It is conducted in Eugene, Oregon.
There currently are not additional qualified resources for training.
The typical resources for implementing Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) are: Office space for a team of approximately 6-8 people: Program Supervisor, Recruiter/Trainer/Parent Daily Report Checklist Caller, Family Therapist, 2-3 Skills Trainers/Playgroup Assistants/Playgroup Leader and FP (Foster Parent) Consultant; 1-2 treatment rooms with video recording; Conference room with video recording; and Internet access for Program Supervisor.
Program supervisor: In addition to a Master's level education in a clinical field and considerable relevant experience in behavior management approaches, this person should possess supervisory skills, considerable organizational abilities, and a thorough understanding of and enthusiastic attitude toward the treatment model. The program supervisor must be available to the foster parents and treatment team members 24 hours a day, 7 days a week.
Foster parent consultant/recruiter/trainer: While a formal post-secondary education is not necessary for this position, this person must have knowledge of foster parents and a clear understanding of the model. Prior experience as a foster parent or as an adoptive parent of older children is strongly desirable.
Family therapist: Master’s level education in a clinical field. Knowledge of Parent Management Training or related behaviorally based parenting techniques is highly desirable.
Playgroup leader: Bachelor’s level education in a relevant field. The playgroup leader is responsible for organizing, preparing, and executing the playgroup curriculum. This person is also responsible for leading the assistants for playgroup. The playgroup leader is also an individual skills trainer for children in the program.
Skills trainer: Bachelor’s level education in a relevant field. Since skills training activities take place outside of the office, mileage reimbursements and reimbursements for modest entertainment, food, and beverage expenses are typically associated with these activities. Two skills trainers will also hold the position of playgroup assistants.
PDR-caller: This important position should be filled by someone with a thorough understanding of the treatment model and experience in foster parent activities. The specific education level for this position is less important. It may be filled by an experienced (ex-) foster parent.
Foster family: No formal education is required for foster parents. However, foster parents trained in the program should have a basic understanding of child development with reasonable expectations for this population of foster children. It is especially helpful when foster parents have a good sense of humor and do not take behaviors personally.
Consulting psychiatrist: Adequately serve children in the program who need medication prescribed and managed.
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) is rated a "2 - Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one rigorous randomized controlled trial with a sustained effect of at least 6 months. For more information on the rating of a "2 - Supported by Research Evidence," please see the Scientific Rating Scale.
Fisher, P. A., Gunnar, M. R., Chamberlain, P., & Reid, J. B. (2000). Preventive intervention for maltreated preschoolers: Impact on child’s behavior, neuroendocrine activity, and foster parent functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1356-1364.
Type of Study: Non-randomized comparison groups.
Number of participants: 30
Population:
Location/Institution: Oregon
Summary: (To include comparison groups, outcomes, measures, notable limitations) This study compares a group of children receiving intensive Early Intervention Foster Care (EIFC) treatment to those receiving regular foster care services (RFC) and to a community sample of children living with their biological families. The authors note that due to lack of random assignment, the EIFC group generally had more severe maltreatment histories than did the RFC group. Outcome measures included the Child Caregiver Interviewer Impressions Form, which examines parenting strategies, the Parent Daily Report, to measure parenting stress, and the Early Childhood Inventory to measure child behavioral adjustment. Child stress response was also measured by sampling salivary cortisol levels. Baseline levels showed the foster children were developmentally delayed relative to the community sample. At follow-up, the EIFC group did not differ from the community sample in parenting strategies, while the RFC group was significantly lower. The EIFC group also showed improvement in behavioral adjustment and salivary cortisol levels more similar to normal. Limitations include small group sizes and lack or random assignment to groups.
Length of post-intervention follow-up: 12 weeks.
Fisher, P. A., Burraston, B., & Pears, K. (2005). The Early Intervention Foster Care program: Permanent placement from a randomized trial. Child Maltreatment, 10(1), 61-71.
Type of Study: Randomized controlled trial.
Number of participants: 90
Population:
Location/Institution: Oregon
Summary: (To include comparison groups, outcomes, measures, notable limitations) Children were randomly assigned to be placed in Early Intervention Foster Care (EIFC) or in regular foster care (RFC). Those in EIFC received parent training, supervision, and support, and children received behavioral therapy as needed. Outcome measures included type and number of placements, time in foster care before permanent placement, and failure of a permanent placement. Children in EIFC had significantly fewer failed permanent placements than children in regular foster care. The number of prior placements was positively associated with the risk of failed permanent placements for children in the comparison condition but not in the EIFC condition. The authors note that the small sample size did not allow for more detailed analysis of placement type and factors affecting placements.
Length of post-intervention follow-up: 24 months after new placement
Fisher, P., Gunnar, M., Dozier, M., Bruce, J., & Pears, K. (2006). Effects of therapeutic interventions for foster children on behavioral problems, caregiver attachment, and stress regulatory neural systems. Annals of the New York Academy of Sciences,1094, 215-225.
Type of Study: Randomized controlled trial.
Number of participants: 177
Population:
Location/Institution: Oregon
Summary: (To include comparison groups, outcomes, measures, notable limitations) This report includes data from Fisher, Burraston, & Pears, 2005. In the Fisher et al. sample, foster children were randomly assigned to receive MTFC-P or to a regular foster care condition. The present analysis shows that children in the MTFC-P group showed significantly better morning cortisol levels (associated with stress adaptation) than did those in regular foster care at a measurement period of 8-9 months after entering care.
Length of post-intervention follow-up: 8-9 months.
Fisher, P. A., & Kim, H. K. (2007). Intervention effects on foster preschoolers’ attachment-related behaviors from a randomized trial. Prevention Science, 8, 161-170.
Type of Study: Randomized controlled trial.
Number of participants: 117
Population:
Location/Institution: Oregon
Summary: (To include comparison groups, outcomes, measures, notable limitations) Children were randomly assigned to receive MTFC-P or to a regular foster care (RFC) comparison condition. Assessments were taken at 3-month intervals using a measure of attachment-related behavior, the Parent Attachment Diary. Researchers also obtained records of age at first foster placement. Over the course of the assessments, children in the MTFC-P condition showed significant increases in secure behavior and decreases in avoidant behavior relative to comparison group children. MTFC-P also resulted in more secure behavior for children who were older at first placement, while the opposite patter was true for the RFC group. A limitation to the study is the exclusive reliance on parent reports of attachment behaviors.
Length of post-intervention follow-up: 12 months following placement
Fisher, P. A., Kim, H. K., & Pears, K. C. (2009). Effects of multidimentional treatment foster care for preschoolers (MTFC-P) on reducing permanent failures among children with placement instability. Child and Youth Services Review, 31, 541-546.
Type of Study: Randomized controlled trial.
Number of participants: 52
Population:
Location/Institution: Not given.
Summary: (To include comparison groups, outcomes, measures, notable limitations) The sample for this study was taken from a larger randomized controlled trial. Children in the present sample were those who had experienced 4 or more placements prior to entry into the study. Foster children were randomly assigned to receive MTFC-P or to a regular foster care RFC condition. Measures included records of the child’s history of permanent placement attempts during the 24 months of the study, and severity of maltreatment history. The results showed that the groups did not differ on permanency attempt rates, but that the MTFC-P group had more than twice as many successful permanency attempts, defined as no subsequent changes during the first 24 months of the study. No effects of maltreatment history were found. The major limitation of the study was the small size of the subsample.
Length of post-intervention follow-up: 24 months.
Chamberlain, P., & Fisher, P. A. (2003). An application of MTFC for early intervention. In P. Chamberlain (Ed.), Treating chronic juvenile offenders: Advances made through the Oregon MTFC model (pp. 129-140). Washington, DC: American Psychological Association.
Fisher, P. A., Ellis, B. H., & Chamberlain, P. (1999). Early intervention foster care: A model for preventing risk in young children who have been maltreated. Children's Services: Social Policy, Research, and Practice, 2, 159-182.
Contact name: Rena Gold, MS
Affiliation/Agency: TFC Consultants, Inc.
Email: renag@mtfc.com
Phone: 541-343-2388
Fax: 541-343-2764
Website: http://www.mtfc.com