Multidimensional Family Therapy (MDFT)

1  — Well-Supported by Research Evidence
Medium
1  — Well-Supported by Research Evidence
Medium
1  — Well-Supported by Research Evidence
Medium
1  — Well-Supported by Research Evidence
Medium

About This Program

Target Population: Adolescents 11 to 18 with the following symptoms or problems: substance abuse or at risk, delinquent/conduct disorder, school and other behavioral problems, and both internalizing and externalizing symptoms

For children/adolescents ages: 11 – 18

For parents/caregivers of children ages: 11 – 18

Program Overview

MDFT is a family-based treatment for adolescent substance use, delinquency, and other behavioral and emotional problems. Therapists work simultaneously in four interdependent domains: the adolescent, parent, family, and community. Therapy sessions are held alone with the youth, alone with the parents, and with youth and parents together. Once a therapeutic alliance is established and youth and parent motivation is enhanced, the MDFT therapist focuses on facilitating behavioral and interactional change. The final stage of MDFT works to solidify behavioral and relational changes and launch the family successfully so that treatment gains are maintained.

Program Goals

The goals of Multidimensional Family Therapy (MDFT) are:

  • Improve youth emotional regulation, coping, and problem solving skills
  • Improve youth expressive and communication skills
  • Promote youth success in school/work
  • Reduce youth drug use and problem behaviors
  • Improve and stabilize youth mental health problems
  • Improve parenting skills and practices
  • Enhance parents individual functioning
  • Improve family communication and problem solving skills
  • Strengthen emotional attachments and feelings of love and connection among family members
  • Build family member capacity to actively reach out to access and actualize needed resources necessary for stress reduction or daily life needs

Essential Components

The essential components of Multidimensional Family Therapy (MDFT) include:

  • Being an integrated family therapy approach that attempts to improve:
    • Parenting practices
    • Family problem solving skills
    • Parental teamwork
    • Parent functioning by motivating them to obtain substance abuse or mental health treatment for themselves, if needed.
    • Adolescent communication, emotion regulation and coping skills
    • Adolescent functioning by reducing substance use and delinquency, and improving school bonding and performance, and family relationships
  • Emphasizing parental self-care throughout treatment to ensure that parents are maximally available to and effective with their teens
  • Following these intervention parameters:
    • Provided at different levels of care: outpatient, intensive outpatient (IOP), in-home, residential/inpatient
      • Number of sessions per week: 1-3 depending on service delivery setting and needs of the youth and family
      • Length of treatment: 3-6 months
      • A mix of individual youth, parent, and family sessions of approximately 40% youth, 20% parent, and 40% family
      • Use of telephone calls/texts with youth and family in between face-to-face sessions
      • Community sessions with school, juvenile justice, child welfare, etc.
      • MDFT has specific clinical supervision protocols; each therapist receives:
        • Case review supervision: Each case is reviewed at least every other week
          • Either video or live supervision at least 8 times per year
        • Case and supervision information entered into in the web-based MDFT Clinical Portal by MDFT therapists and supervisors which facilitates adherence to the approach. Fidelity and outcome reports provided to programs twice yearly (at the midpoint and at the end of the year.)
        • In programs serving youth and families with few resources and high need, a therapist assistant/family advocate an added benefit to the MDFT program; works to reduce barrier to treatment participation and facilitate access to community resources

Program Delivery

Child/Adolescent Services

Multidimensional Family Therapy (MDFT) directly provides services to children/adolescents and addresses the following:

  • Substance use, delinquency, conduct disorder, school problems (attendance, behavior, grades), family problems (e.g., conflict, domestic violence, disengagement), co-morbid mental health problems (e.g., depression, anxiety, ADHD), or high risk sexual behaviors (unprotected sex, sex while drunk or high)

Parent/Caregiver Services

Multidimensional Family Therapy (MDFT) directly provides services to parents/caregivers and addresses the following:

  • Parents of adolescents with substance abuse or delinquent behavior problems who may also experience substance abuse or mental health issues themselves

Recommended Intensity:

For at-risk and early intervention, therapists typically provide 1-2 sessions per week, with sessions lasting between 45 and 90 minutes. More severe cases will require sessions 1- 3 times per week (average of 2) with each session lasting 45-90 minutes. For all cases, the dose titrates down as the treatment progresses. The dose is more intense in the first third of treatment and is gradually reduced to 1 session per week during the last 4-6 weeks.

Recommended Duration:

3-4 months for at-risk and early intervention youth and families. 5-6 months for youth with a substance abuse and/or conduct disorder diagnosis.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Agency
  • Day Treatment Program
  • Foster/Kinship Care
  • Hospital
  • Residential Care Facility
  • School
  • Juvenile detention/justice facility
  • Day Treatment Program/Intensive Outpatient Program (IOP)

Homework

This program does not include a homework component.

Languages

Multidimensional Family Therapy (MDFT) has materials available inlanguages other than English:

Dutch, French, German, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Clinic treatment rooms large enough to accommodate a family
  • Cell phones for therapists, case managers/therapist assistants, and supervisors to call each other and clients.
  • Equipment to record therapy session for supervision and play back sessions for supervision.
  • Capacity to conduct live supervision sessions.
  • If serving a drug-using or high-risk population, funds to pay for instant urine screen testing that is incorporated into ongoing treatment.

Education and Training

Prerequisite/Minimum Provider Qualifications

Therapists must have Master's Degree in counseling, mental health, family therapy, social work, or a related discipline.

Therapist assistants can have a Bachelor's Degree or relevant experience.

Education and Training Resources

There is a manual that describes how to implement this program , and there is training available for this program.

Training Contact:
Training is obtained:

Training is provided onsite and through phone and video conference.

Number of days/hours:

Therapist training for full certification takes approximately 5 months to complete, and it includes 3 on-site trainings, weekly consultations, access to the Online program, review of video recordings of therapist's work, competence ratings, and written examinations. Supervisor training takes an additional 4 months. MDFT also provides train-the-trainer training where trained MDFT supervisors can be trained as agency-based or regional trainers and have the capacity to train new therapists with only minimal support from MDFT International.

Additional Resources:

There currently are additional qualified resources for training:

For Europe:

  • Angela Pasma
    MDFT Academie
    email: a.pasma@mdft.nl

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Multidimensional Family Therapy (MDFT).

Formal Support for Implementation

There is formal support available for implementation of Multidimensional Family Therapy (MDFT) as listed below:

After the initial year there is ongoing coaching, booster training and support which is much less intensive than the year 1 training. MDFT also provides Train the Trainers (TTT) training to the agency (usually the certified MDFT supervisor) so they can train new therapists at their site. All the training (initial and ongoing) is provide at the providers site and via phone, video conferencing calls, and through our web-based MDFT portal.

Fidelity Measures

There are fidelity measures for Multidimensional Family Therapy (MDFT) as listed below:

MDFT assesses fidelity by examining (a) the parameters of treatment (e.g. the frequency and duration of treatment sessions and domains targeted; frequency of supervision provided, etc.), (b) the techniques of MDFT by trainer ratings of competence at each of the two Intensive Site Visits consisting of case presentation, video recordings of therapy sessions, and live supervision, and (c) clinician rating of outcome from intake to discharge. Available tools include the Multidimensional Family Therapist Competency Evaluation and the MDFT Clinical Portal, a web-based database management system. For more information, contact Gayle Dakof at gdakof@mdft.org.

Implementation Guides or Manuals

There are implementation guides or manuals for Multidimensional Family Therapy (MDFT) as listed below:

The Program Guide for MDFT Implementation and Sustainability provides implementation guidelines focusing on program essentials, training, quality assurance and fidelity, and tools and resources on a variety of topics (e.g.. how to prevent burnout, use of interpreters, booster sessions). The MDFT supervisor manual details the MDFT supervision system, including therapist evaluation scales, and tools designed to enhance therapist professional development. These guides are unpublished and currently only available to programs that contract with the nonprofit organization MDFT International for MDFT training and implementation services.

Research on How to Implement the Program

Research has been conducted on how to implement Multidimensional Family Therapy (MDFT) as listed below:

The following articles are on implementation of MDFT:

  • Liddle, H. A., Rowe, C. L., Quille, T. J., Dakof, G. A., Mills, D. S., Sakran, E., & Biaggi, H. (2002). Transporting a research-based adolescent drug treatment into practice. Journal of Substance Abuse Treatment, 22(4), 231-243.
  • Rowe, C., Rigter, H., Henderson, C., Gantner, A., Mos, K., Nielsen, P., & Phan, O. (2013). Implementation fidelity of Multidimensional Family Therapy in an international trial. Journal of Substance Abuse Treatment, 44(4), 391-399.

Relevant Published, Peer-Reviewed Research

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

When more than 10 research articles have been published in peer-reviewed journals, the CEBC reviews all of the articles as part of the rating process and identifies the 10 most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The 10 articles chosen for Multidimensional Family Therapy (MDFT) are summarized below:

Schmidt, S., Liddle, H., & Dakof, G. (1996). Changes in parenting practices and adolescent drug abuse during Multidimensional Family Therapy. Journal of Family Psychology, 10(1), 12-27. doi:10.1037/0893-3200.10.1.12

Type of Study: One-group pretest-posttest study
Number of Participants: 29 families

Population:

  • Age — Mean=16 years
  • Race/Ethnicity — 55% European American and 45% Ethnic minorities (primarily African American and Hispanic)
  • Gender — 72% Male and 28% Female
  • Status — Participants were families who were part of a controlled clinical trial that compared the efficacy of MDFT with adolescent group therapy and multifamily educational intervention in reducing drug abuse and behavior problems in adolescents. This sample included 29 families from the 33 in MDFT treatment condition.

Location/Institution: Philadelphia PA/Temple University

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study focused on adolescents and their families who completed a course of Multidimensional Family Therapy (MDFT) as part of a controlled clinical trial. Substance use was measured using adolescent self-report and urinalysis, and other dimensions that were measured in the study include acting out behaviors and parenting. Over half (59%) of the families demonstrated both an improvement in parenting and a reduction of adolescent drug use. In 21% of families, parenting did not improve meaningfully, but the adolescent’s drug use showed significant reduction by the end of the treatment. Limitations include lack of a comparison or control group.

Length of postintervention follow-up: Unclear (6- and 12-month follow-up reported but not specified if postintervention).

*Liddle, H. A., Dakof, G. A., Parker, K., Diamond, G. S., Barrett, K., & Tejeda, M. (2001). Multidimensional Family Therapy for adolescent drug abuse: Results of a randomized clinical trial. American Journal of Drug & Alcohol Abuse, 27(4), 651-688. doi:10.1081/ADA-100107661

Type of Study: Randomized controlled trial
Number of Participants: 182

Population:

  • Age — 13-18 years
  • Race/Ethnicity — 51% White/non-Hispanic, 18% African-American, 15% Hispanic, 6% Asian, and 10% Other
  • Gender — 80% Male and 20% Female
  • Status — Participants were youths and their families who were referred from the juvenile justice system and secondarily through schools and health and mental health agencies.

Location/Institution: San Francisco/University of California, San Francisco; University of Miami; San Francisco Bay Area/various community based clinics in the San Francisco Bay Area; Miami/University of Miami Miller School of Medicine.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This article reports outcomes from a randomized controlled trial showing a sustained effect of at least 1 year for all three topic areas in which the program is highlighted. Participants were randomized into one of three conditions: Multidimensional Family Therapy (MDFT), adolescent group therapy (AGT), and multifamily educational intervention (MEI). Measures to assess drug use included adolescent self-report, collateral report (parent report), and urinalysis. Other dimensions measured included family functioning, school performance measured through the grade point average (GPA), and problem behaviors measured using the Acting Out Behaviors (AOB) Scale. At termination, 42% of the youths who received MDFT, in comparison to 25% in AGT and 32% in MEI, reported clinically significant reduction in drug use. At the 1-year follow-up, 45% in MDFT, 32% in AGT, and 26% in MEI demonstrated clinically significant change in that their drug use was below initial treatment entry criteria. Additionally, those in the MDFT condition showed considerable improvement in school performance: With respect to GPA, at intake only 25% of the youths assigned to MDFT had GPAs of 2.0 (C average) or better; 43% of AGT youths and 36% of MEI youths had GPAs of 2.00 or better. One year after treatment, 76% of the youths in the MDFT treatment condition had a C average or better, while 60% of AGT and 40% of MEI youths had a C average or better. There were no differences between the three groups on acting out behaviors. Limitations include a predominantly male and white sample, as well as the use of self-report in assessing drug use.

Length of postintervention follow-up: 6 and 12 months.

Dennis, M. L., Godley, S. H., Diamond, G. S., Tims, F. M., Babor, T., Donaldson, J., … Funk, R. R. (2004). The Cannabis Youth Treatment (CYT) study: Main findings from two randomized trials. Journal of Substance Abuse Treatment, 27, 197-213. doi:10.1016/j.jsat.2003.09.005

Type of Study: Randomized controlled trial
Number of Participants: 600

Population:

  • Age — 13-18 years
  • Race/Ethnicity — 61% Caucasian/White, 30% African American/Black, 4% Hispanic/Latino, and 6% Other/Mixed
  • Gender — Predominately Male
  • Status — Participants were adolescents and their families who were recruited from sequential admissions to 4 treatment sites

Location/Institution: Madison County, IL/Chestnut Health Systems, Philadelphia, PA/Children’s Hospital of Philadelphia.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article presents the main outcome findings from two inter-related randomized trials conducted at 4 sites to evaluate the effectiveness of 5 short-term outpatient interventions for adolescents with cannabis use disorders. Trial 1 compared Motivational Enhancement Therapy and Cognitive Behavioral Therapy – 5 Sessions (MET/CBT5) with a 12-session regimen of MET and CBT (MET/CBT12) and another that included family education and therapy components (Family Support Network [FSN]). Trial II compared the Motivational Enhancement Therapy and Cognitive Behavioral Therapy – 5 Sessions (MET/CBT5) with the Adolescent Community Reinforcement Approach (A-CRA) and Multidimensional Family Therapy (MDFT). All 5 Cannabis Youth Treatment (CYT) interventions demonstrated significant pre-post treatment improvements during the 12 months after random assignment to a treatment intervention in the 2 main outcomes: Days of abstinence, as measured by self-reports using Global Appraisal of Individual Needs (GAIN) (a standardized semi-structured interview), and the percent of adolescents in recovery (no use or abuse/dependence problems and living in the community). Overall, the clinical outcomes were very similar across sites and conditions. Two notable limitations of the study are its reliance on participant self-report and the lack of a no-treatment control group. This study shows outcomes for the Substance Abuse Treatment (Adolescent) topic area only.

Length of postintervention follow-up: 38-46 weeks.

Liddle, H. A., Rowe, C. L., Ungaro, R. A., Dakof, G. A., & Henderson, C. (2004). Early intervention for adolescent substance abuse: Pretreatment to posttreatment outcomes of a randomized controlled trial comparing Multidimensional Family Therapy and peer group treatment. Journal of Psychoactive Drugs, 36(1), 49-63. doi:10.1080/02791072.2004.10399723

Type of Study: Randomized controlled trial, intent-to-treat design
Number of Participants: 80

Population:

  • Age — 11-15 years
  • Race/Ethnicity — 42% Hispanic, 38% African American, 11% Haitian or Jamaican, 3% Non-Hispanic White, and 4% Other
  • Gender — 58 Males and 22 Females
  • Status — Participants were referred for substance abuse and behavioral problems from juvenile justice, the school system, or other sources such as family.

Location/Institution: Miami FL/Village, Inc. (non-profit community drug abuse treatment clinic that provides a range of outpatient services to adolescents and their families); Miami FL/University of Miami Miller School of Medicine.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated a family-based therapy – Multidimensional Family Therapy (MDFT) – and a peer group therapy with urban, low-income young adolescents. Adolescents and their parents were assessed at intake, randomly assigned to either MDFT (n=39) or group therapy (n=41), and reassessed at 6 weeks after intake and at discharge. Measures used included the Global Appraisal of Individual Needs (GAIN). In order to assess adolescent externalizing and internalizing symptoms, the Youth Self-Report (YSR) of the Child Behavior Checklist was administered; family risk and protective factors were measured with the Family Environment Scale (FES). Substance use was measured by the Timeline Follow-Back Method (TFLB) as adapted for adolescents, which obtains self-reports of daily substance use. Results showed that MDFT was significantly more effective than peer group therapy in reducing risk and promoting protective processes in the individual, family, peer, and school domains, as well as in reducing substance use over the course of treatment. Externalizing symptoms decreased more rapidily in the MDFT group than the comparison group; there was no difference on internalizing symptoms. Limitations of the study include the self-report nature of assessing the youths’ drug use and family problems, as well as the questionable generalizability of the sample, which was low-income, urban, and consisted primarily of males from ethnic minorities.

Length of postintervention follow-up: None.

*Liddle, H., Dakof, G., Turner, R., Henderson, C. , & Greenbaum, P. (2008). Treating adolescent drug abuse: A randomized trial comparing multidimensional family therapy and cognitive behavior therapy. Addiction, 103(10), 1660-1670. doi:10.1111/j.1360-0443.2008.02274.x

Type of Study: Randomized controlled trial; 2 (treatment condition) x 4 (time) repeated-measures intent-to-treat randomized design
Number of Participants: 224

Population:

  • Age — 12-17.5 years
  • Race/Ethnicity — 72% African American, 18% White (non-Hispanic), and 10% Hispanic
  • Gender — 81% Male and 19% Female
  • Status — Participants were referred to the study from a variety of sources, including the juvenile justice system, child welfare service agencies, schools, and other sources.

Location/Institution: Philadelphia, PA/Temple Teen Care (University Based Community Clinic), Temple University

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This article reports outcomes from an RCT showing a sustained effect of at least 1 year for only the Substance Abuse Treatment (Adolescent) topic area. This study compared Multidimensional Family Therapy (MDFT) with an individual Cognitive-Behavioral Therapy (CBT) approach. Measures to assess substance use included the Personal Experience Inventory (PEI) and the Timeline Followback (TLFB) method. Results showed that both MDFT and CBT were efficacious treatment methods, but MDFT was superior to CBT in decreasing drug abuse problem severity. Additionally, when looking at a measure that assessed functional impairment due to drug use, youth receiving MDFT had better results than those who received CBT. Twelve months following intake, participants who received MDFT decreased their frequency of other drug use by 77%, while CBT recipients increased their frequency of using these substances. MDFT was able to maintain symptomatic reductions at 6 and 12 months posttreatment. Limitations of the study include the questionable generalizability of the data, given that the sample was comprised of mostly African-American males, as well as the reliance of self-report and lack of urinalysis in assessing drug use.

Length of postintervention follow-up: 6 and 12 months.

Liddle, H., Rowe, C., Dakof, G., Henderson, C., & Greenbaum, P. (2009). Multidimensional Family Therapy for young adolescent substance abuse: Twelve-month outcomes of a randomized controlled trial. Journal of Consulting & Clinical Psychology, 77(1), 12-25. doi:10.1037/a0014160

Type of Study: Randomized controlled trial intent-to-treat repeated measures design
Number of Participants: 83

Population:

  • Age — 11-15 years
  • Race/Ethnicity — 42% Hispanic, 38% African American, 11% Haitian or Jamaican, 3% White (non-Hispanic), and 4% Other
  • Gender — 74% Male and 26% Female
  • Status — Participants were referred primarily from juvenile justice and school for outpatient treatment for high risk behaviors including substance use.

Location/Institution: Miami, FL/The Village South, Inc.; Miami, FL/University of Miami Miller School of Medicine.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were randomly assigned to either peer-group therapy (n = 43) or Multidimensional Family Therapy (MDFT, n = 40). Adolescents’ substance use was measured with the Timeline Followback (TFLB) method, as well as with the Problem-Oriented Screening Instrument for Teenagers (POSIT), which relies on self-report to assess substance use and other problems. Both treatments demonstrated higher than average treatment retention rates (97% for MDFT and 72% for group treatment). From intake to 12 months later, youths in MDFT demonstrated more improvement than those in peer group therapy in substance use, delinquency, internalized distress, affiliation with delinquent peers, and family and school functioning. Participants in the MDFT condition reported fewer days of substance use as well as a tendency to report increased abstinence from drugs and alcohol. Limitations of the study include the sample being predominantly comprised of African American and Hispanic youths, as well as the overall small sample size. Also, the use of self-report in measuring substance abuse may be a limiting factor.

Length of postintervention follow-up: 6-9 months.

Rigter, H., Henderson, C. E., Pelc, I., Tossmann, P., Phan, O., Hendriks, V., ... Rowe, C. L. (2013). Multidimensional Family Therapy lowers the rate of cannabis dependence in adolescents: A randomised controlled trial in Western European outpatient settings. Drug and Alcohol Dependence, 130(1–3), 85-93. doi:10.1016/j.drugalcdep.2012.10.013

Type of Study: Randomized controlled trial
Number of Participants: 450

Population:

  • Age — 13-18 years
  • Race/Ethnicity — Not specified though 40% were of first- or second-generation foreign descent
  • Gender — 85% Male
  • Status — Participants were youth with a cannabis use disorder.

Location/Institution: The Outpatient Cannabis Clinic of The Department of Psychiatry of Brugmann University Hospital in Brussels, Therapieladen in Berlin, Centre Emergence in Paris with suburban CEDAT (Conseils Aide et Action contre le Toximanie) sub-sites in Mantes la Jolie and St. Germain en Laye, the twinning sites of Parnassia Brijder (addiction care) and De Jutters (forensic care) in The Hague, and Phénix in Geneva

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study reports on Multidimensional Family Therapy (MDFT) tested in several countries as part of a trans-national study. Study participants were randomly assigned to MDFT or to Individual Psychotherapy (IP). Measure utilized was the Adolescent Diagnostic Interview-Light (ADI-Light for cannabis). Results indicate positive outcomes were found in both the MDFT and IP conditions. MDFT outperformed IP on the measures of treatment retention and prevalence of cannabis dependence. MDFT reduced the number of cannabis consumption days more than IP in a subgroup of adolescents reporting more frequent cannabis use at baseline. MDFT exceeded IP in decreasing the prevalence of cannabis dependence. Limitations include the lack of long-term follow-up and generalizability to other ethnic group. This study shows outcomes for the Substance Abuse Treatment (Adolescent) topic area only.

Length of postintervention follow-up: Unclear (3, 6, 9 and 12 months after baseline results reported, but length of treatment is not clear).

Schaub, M. P., Henderson, C. E., Pelc, I., Tossman, P., Phan, O., Hendriks, V., … Rigter, H. (2014). Multidimensional Family Therapy decreases the rate of externalising behavioural disorder symptoms in cannabis abusing adolescents: outcomes of the INCANT trial. BMC Psychiatry, 14(1), 26-33. doi:10.1186/1471-244X-14-26

Type of Study: Randomized controlled trial
Number of Participants: 450 cases/families

Population:

  • Age — 13-18 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were youth involved in the INCANT project with a cannabis use disorder.

Location/Institution: Berlin, Brussels, Geneva, The Hauge, and Paris

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study utilized data from the INCANT project to compared MDFT with individual therapy (IP). Measures utilized include the Timeline Follow-Back (TLFB), the Youth Self Report (YSR), the Child Behaviour Checklist (CBCL), and the Family Environment Scale (FES). Results indicate that MDFT and IP groups improved on all outcome measures. Models including treatment, site, and referral source showed that MDFT outperformed IP in reducing externalizing symptoms. Both MDFT and IP reduced the rate of externalizing and internalizing symptoms and improved family functioning among adolescents with a cannabis use disorder. MDFT outperformed IP in decreasing the rate of externalizing symptom. Limitations include reliance on self-reported measures and generalizability to other substance disorders.

Length of postintervention follow-up: Approximately 6 months.

*Dakof, G. A., Henderson, C. E., Rowe, C. L., Boustani, M., Greenbaum, P. E., Wang, W., ... Liddle, H. A. (2015). A randomized clinical trial of family therapy in juvenile drug court. Journal of Family Psychology, 29(2), 232-241. doi:10.1037/fam0000053

Type of Study: Randomized controlled trial
Number of Participants: 112

Population:

  • Age — 13-18 years
  • Race/Ethnicity — 59% Hispanic, 35% African American
  • Gender — 88% Male
  • Status — Participants were youth involved in the Juvenile District Court.

Location/Institution: State of Florida 11th Judicial Circuit Juvenile Court in Miami-Dade County

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This article reports outcomes from randomized controlled trial showing a sustained effect of at least 1 year for only the Behavioral Management Programs for Adolescents in Child Welfare and Disruptive Behaviors Treatment (Child & Adolescent) topic areas. The objective of this article is to examine the effectiveness of 2 theoretically different treatments delivered in juvenile drug court—Multidimensional Family Therapy (MDFT) and adolescent group therapy (AGT)—on offending and substance use. Youth were randomly assigned to either MDFT or AGT group. Measures utilized include the Diagnostic Interview Schedule for Children, Second Edition (DISC-2) and the National Youth Survey (NYS), Self-Report Delinquency Scale (SRD). Results indicate that youth in both treatments showed significant reduction in delinquency, externalizing symptoms, rearrests, and substance use. At 24-month follow-up, MDFT showed greater maintenance of treatment gains than AGT for externalizing symptoms, commission of serious crimes, and felony arrests. There was no significant difference between the treatments with respect to substance use or misdemeanor arrests. Limitations include no comparison with youth in a non-drug court setting, concerns about generalizability to other jurisdictions given variability between drug courts, and small sample size.

Length of postintervention follow-up: 6, 12, 18, and 24 months.

Liddle , H. A., Dakof, G. A., Rowe, C. L., Henderson, C., Greenbaum, P., Wang, W., & Alberga, L. (2018). Multidimensional Family Therapy as a community-based alternative to residential treatment for adolescents with substance use and co-occurring mental health disorders. Journal of Substance Abuse Treatment, 90, 47-56. doi:10.1016/j.jsat.2018.04.011

Type of Study: Randomized controlled trial, intent-to-treat design
Number of Participants: 113

Population:

  • Age — 13-18 years (Mean=15.4 years)
  • Race/Ethnicity — 68% Hispanic, 18% African American, and 13% White, Non-Hispanic
  • Gender — 75% Male and 25% Female
  • Status — Participants were youth referred to a residential treatment center diagnosed with a substance use disorder and at least one comorbid psychiatric disorder.

Location/Institution: Florida

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This purpose of this study was to compare Multidimensional Family Therapy (MDFT) with residential treatment (RT) for adolescents with co-occurring substance use and mental health disorders on substance use, delinquency, and mental health symptoms. Using an intent-to-treat design, adolescents were randomly assigned to either RT or MDFT in the home/community. Measures utilized include the Personal Experience Inventory (PEI), the Timeline Follow-Back Method (TLFB), the National Youth Survey (NYS) Self Report Delinquency Scale (SRD) and the Youth Self-Report (YSR). Results indicate that during the early phase of treatment (baseline to 2 months), youth in both treatments showed significant reductions in substance use [substance use problems, frequency of use, delinquent behaviors and externalizing symptoms, and youth receiving MDFT reported significantly greater reductions in internalizing symptoms than youth receiving RT. In phase 2, from 2 to 18 months after baseline, youth in MDFT maintained their early treatment decreases in substance use problems, frequency of use, and delinquent behaviors more effectively than youth in RT. During this period, there were no significant treatment differences in maintenance of gains for externalizing and internalizing symptoms. Limitations include limited generalizability to other treatment programs and samples due to the sample being primarily male and Hispanic, youth who met eligibility criteria for the study may not have been as severe as all youth referred for residential treatment nationwideas well as to other treatment programs, and small sample size.

Length of postintervention follow-up: 11.5 months on average.

Additional References

Liddle, H. A. (2009). Adolescent Drug Abuse Curriculum with DVD: The Clinical Innovator Series. Minneapolis, MN: Hazelden Press.

Liddle, H. A., Dakof, G. A., & Diamond, G. (1991). Adolescent substance abuse: Multidimensional Family Therapy in action. In E. Kaufman & P. Kaufmann (Eds.), Family therapy approaches with drug and alcohol problems (2nd ed., pp. 120-171). Boston: Allyn & Bacon.

Liddle, H. A., Rodriguez, R. A., Dakof, G. A., Kanzki, E., & Marvel, F. A. (2005). Multidimensional Family Therapy: A science-based treatment for adolescent drug abuse. In J. Lebow (Ed.), Handbook of clinical family therapy (pp.128-163). New York: John Wiley and Sons.

Contact Information

Gayle A. Dakof, PhD
Agency/Affiliation: MDFT International, Inc.
Website: www.mdft.org
Email:
Phone: (305) 749-9332

Date Research Evidence Last Reviewed by CEBC: June 2018

Date Program Content Last Reviewed by Program Staff: August 2018

Date Program Originally Loaded onto CEBC: July 2010