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Multidimensional Family Therapy (MDFT)

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare Relevance Level:
Medium

See descriptions of 3 levels

Brief Description

The information in this program outline is provided by the program representative and edited by the CEBC staff. The Multidimensional Family Therapy (MDFT) program has been rated by the CEBC in the areas of: Substance Abuse Treatment (Adolescent) and Behavioral Management for Adolescents in Child Welfare.

  • Types of Maltreatment: Does not target any specific kind of maltreatment
  • 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.

MDFT is a family-based treatment system for adolescent substance use, delinquency, and related behavioral and emotional problems. Therapists work simultaneously in four interdependent domains: the adolescent, parent, family, and extra-familial. Once a therapeutic alliance is established and youth and parent motivation is enhanced, the MDFT therapist focuses on facilitating behavioral and interactional change. In the adolescent domain, adolescents are helped to develop coping, emotion regulation, and problem solving skills; improve social competence; and establish alternatives to substance use and delinquency. In the parent domain, the focus is on enhancing parental teamwork and improving parenting practices. Decreasing family conflict, deepening emotional attachments, and improving family communication and problem solving skills are the key goals within the family domain. In the extrafamilial domain, MDFT fosters family competency in interactions with social systems (e.g., justice, educational, social welfare). The final stage of MDFT works to solidify behavioral and relational changes and launch the family successfully so that treatment gains are maintained.

Essential Components

MDFT is 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.

Parental self-care is emphasized throughout treatment to ensure that parents are maximally available to and effective with their teens.

To follow MDFT with fidelity, these therapy parameters must be followed:

  • Number of sessions per week: 2-3
  • 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 with youth and family in between face-to-face sessions
  • Extrafamilial sessions with school, juvenile justice, child welfare, etc.

Fidelity to the MDFT interventions is rated on the Multidimensional Intervention Inventory (independent raters score therapists on their use of 16 distinct MDFT interventions in sessions).

To follow MDFT with fidelity, these supervision parameters need to be followed:

  • Each therapist receives 1 -2 hours of case review supervision weekly, 1 – 2 hours of DVD/videotape supervision each month, and 1 live supervision session each month.
  • MDFT therapists and supervisors complete MDFT paperwork (case conceptualization forms, weekly reports, supervision reports, and checklists).

There is a version of MDFT for STD/HIV Prevention that is conducted in individual and family session format. The MDFT STD/HIV prevention component is conducted in a structured, interactive multiple family group format. These are parent and youth groups. We recommend no more than 5 families because the parents and youth come together for interactive family activities in each session and sufficient attention must be given to each family.

Child Component

Multidimensional Family Therapy (MDFT) was designed with a child component that addresses the following presenting problems and symptoms:

  • 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).

Age range: 11 – 18

Developmental Delays:

This program was not developed for children with developmental delays, and has not been tested for children with developmental delays.

Parent / Caregiver Component

Multidimensional Family Therapy (MDFT) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

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

Group Format

Multidimensional Family Therapy (MDFT) was not designed to be conducted in a group setting, and has not been tested for use in a group setting.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Agency
  • Day Treatment Program
  • Foster Home
  • Hospital
  • Residential Care Facility
  • School

Homework

This program does not include a homework component.

Languages

Multidimensional Family Therapy (MDFT) has materials available in languages 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:

  • Capacity to hold treatment sessions in the clinic and in the home. This includes clinic treatment rooms large enough to accommodate a family and the ability of therapists to conduct sessions in the family home (transportation to home, reimbursement for milege, etc).
  • Cell phones for therapists, case managers/therapist assistants, and supervisors to call each other and clients.
  • Equipment to record therapy session for supervision (DVD, videotape), and equipment to 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.

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.

Number of days/hours:

Therapist training for full certification takes approximately 6 months to complete, and it includes 3 on-site trainings, weekly telephone consultations, access to the Online program, review of recordings (DVD/video) of therapist's work, fidelity ratings, and written examinations.

Additional Resources:

There currently are additional qualified resources for training:

For the State of Connecticut:

For Riverside County Mental Health, Riverside CA:

For Department of Juvenile Justice, Multnomah County Oregon:

For Europe:

Implementation Information

Since Multidimensional Family Therapy (MDFT) is highly rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Assessments

To be given to organizations or providers in order to measure organizational or individual readiness:

Pre-implementation personal consultation via telephone and e-mail is required.

Implementation Tools — for the program (e.g., implementation guides or manuals)

Numerous implementation tools are provided including manuals, protocols, guides, and forms designed to enhance implementation. These tools and documents are not publicly available, but are provided as part of the certification training.

Fidelity Measures

Two types of fidelity measures are provided. Fidelity to the parameters of MDFT treatment and supervision include, among other items: length of treatment, number and types of treatment sessions, and number and types of supervision sessions. Fidelity to MDFT treatment and supervision methods and principles are evaluated by rating recorded sessions. These procedures are not publicly available, but are provided as part of the certification training.

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 practice must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

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.

Type of Study: Non-randomized one-group pre-test/post-test design
Number of Participants: 29 families

Population:

  • Age range — Not Specified
  • Race/Ethnicity — 55% European American, 45% ethnic minorities (primarily African American and Hispanic)
  • Gender — 72% male, 28% female
  • Status — Families who participated in this study 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. The most significant limitation of the study is the lack of a comparison or control group.

Length of post-intervention follow-up: 6 and 12 month follow-up (doesn’t specify if post-treatment).

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.

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

Population:

  • Age range — 13-18 years
  • Race/Ethnicity — 51% white/non-Hispanic, 18% African-American, 15% Hispanic, 6% Asian, 10% other
  • Gender — 80% male, 20% female
  • Status — Youths and their families 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)
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, and problem behaviors. 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 and family functioning. Limitations include a predominantly male and white sample, as well as the use of self-report in assessing drug use.

Length of post-intervention 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.

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

Population:

  • Age range — 13-18 years
  • Race/Ethnicity — 61% Caucasian/White, 30% African American/Black, 4% Hispanic/Latino, 6% Other/Mixed
  • Gender — Not Specified
  • Status — Adolescents and their families 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.

Length of post-intervention follow-up: 38-46 weeks post-intervention (Treatment length 6-14 weeks, with 3, 6, 9, and 12-month follow-ups after intake).

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.

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

Population:

  • Age range — 11-15 years
  • Race/Ethnicity — 42% Hispanic, 38% African American, 11% Haitian or Jamaican, 3% non-Hispanic White, 4% Other
  • Gender — 58 males, 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. 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 post-intervention 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.

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 range — 12-17.5 years
  • Race/Ethnicity — 72% African American, 18% White (non-Hispanic), 10% Hispanic
  • Gender — 182 (81%) male, 42 (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: Phiiladelphia ,PA/Temple Teen Care (University Based Community Clinic), Temple University; Miami, FL/University of Miami Miller School of Medicine.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
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 post-treatment. 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 post-intervention 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.

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

Population:

  • Age range — 11-15 years
  • Race/Ethnicity — 42% Hispanic, 38% African American, 11% Haitian or Jamaican, 3% White (non-Hispanic), 4% Other
  • Gender — 61 (74%) male, 22 (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 post-intervention follow-up: 6 and 12 month post-intake follow-up, with 3-6 months of treatment.

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

Name: Gayle A. Dakof, PhD
Agency/Affiliation: MDFT International, Inc.
Website: www.med.miami.edu/ctrada/x14.xml
Email:
Phone: (786) 999-3158

Date Reviewed: July 2010