Multidimensional Family Recovery (MDFR)

3  — Promising Research Evidence
High
3  — Promising Research Evidence
High
3  — Promising Research Evidence
High

About This Program

Target Population: Parents with children from birth to 18 who have come to the attention of, or are involved with, the child welfare system and have at least one parent whose substance use is determined to be a primary child safety risk factor

For parents/caregivers of children ages: 0 – 18

Program Overview

Multidimensional Family Recovery (MDFR) is a home- and community-based family intervention that addresses parental substance misuse and child maltreatment. MDFR is designed to help parents involved in the child welfare system achieve and sustain sobriety, provide a safe and healthy family environment for their children, comply with child welfare or court requirements, and prevent further child welfare involvement. MDFR provides certain direct interventions and also facilitates engagement in substance use treatment and other needed service for parents and children. MDFR promotes change in six domains: self of the parent, parenting/co-parenting, children & child safety, family relationships, intimate relationships, and basic needs and resources. Within these domains the MDFR counselors meet (a) alone with the parents, (b) alone with spouses/partners of the parent(s), grandparents, and other family members; and (c) in conjoint sessions with the parent and spouse/partner, co-parent, grandparents, children, and other family members as needed.

Program Goals

The goals of Multidimensional Family Recovery (MDFR) are:

  • Help parents enroll into, remain in, and benefit from substance use treatment and other services required by child welfare or the court (e.g., intimate partner violence [IPV] services, parenting interventions, mental health services, employment, housing).
  • Promote emotional attachment, bonding, and connection between parents and their children.
  • Improve basic child safety knowledge and practices (e.g., safe sleeping, safe storage of mediations, water safety).
  • Improve parenting knowledge and practices (e.g., co-parenting, how to prevent and manage temper tantrums, basics of “good” parenting at any age, how to enhance development).
  • Enhance/increase family emotional and practical assistance to support parent sobriety and parenting.
  • Facilitate access to developmental, educational, and health care services for the children.
  • Facilitate parent access to health, family planning, vocational/educational, financial, and other needed services.
  • Improve parent and family communication, conflict resolution, and problem-solving skills.
  • Help parents comply with child welfare/court requirements in order to facilitate reunification, prevent child removal from the home, and otherwise have their case closed successfully.
  • Prevent further involvement in the child welfare system.

Logic Model

The program representative did not provide information about a Logic Model for Multidimensional Family Recovery (MDFR).

Essential Components

The essential components of Multidimensional Family Recovery (MDFR) include:

  • Family-Based Intervention:
    • MDFR is a family-based intervention that involves various family members (e.g., co-parent, spouse/partner, grandparents, aunts/uncles, children) as needed to further case goals.
    • MDFR is based on the assumption that strengthening parents so they can provide a safe and healthy environment for their children is the best way to protect and nurture children.
    • Individual sessions are held alone with the client (parent) and alone with family members prior to convening couple or family sessions.
    • Couple and family sessions are held as needed to further case goals.
    • The number of family members involved in MDFR, and the extent of each member’s involvement, is determined on a case-by-case basis.
  • Essential Intervention Features:
    • Interact with parents in a way that is respectful and collaborative, empathic and nonjudgmental.
    • Challenge parent’s behavior, discuss discrepancies, promote change in a context of authenticity, compassion, and support.
    • Involve the family to promote change in parents.
    • Improve parenting practices and parent–child interactions.
    • Improve couple and family communication skills (i.e., enhance mutual respect and understanding).
    • Promote change in 6 domains: Self of the Parent, Parenting/Co-parenting, Children & Child Safety, Family Relationships, Intimate Relationships, Basic Need & Resources.
  • Client Eligibility:
    • Parents age 18 or over who have come to the attention of or are involved with child welfare and misuse drugs or alcohol
    • At least one child between the ages of birth and 18
    • Parent willing to involve family members (e.g., co-parent, grandparents) in the intervention
  • Parameters of the Intervention (e.g., settings, length of intervention, weekly dose, caseload):
    • Services are provided in home and community settings.
    • Length of the intervention varies depending on the service delivery context and overall goals of the program:
      • If MDFR is provided by child welfare workers or drug court workers, then the intervention will be delivered for as long as the worker is involved in the case.
      • If MDFR is provided as a companion or support to traditional child welfare or drug court services, then the intervention typically lasts from 3–6 months.
    • Counselor caseload varies between 5 and 12 families depending on the service delivery context and overall goals of the program.
    • MDFR is a mix of intervention sessions:
      • Individual sessions with parent, parent’s spouse/partner, co-parent, other family members (e.g., grandparents), children
      • Couple sessions
      • Family sessions
    • Use of telephone calls/texts in between face-to-face sessions.
    • Collaborative sessions with child welfare, court, and treatment providers as needed.
    • Number of sessions per week:
      • 1-3 depending on service delivery setting, program goals, and needs of the case
      • Typical dosage:
        • Month 1–2: 2 sessions per week until client is engaged in substance use treatment
        • Month 2–4: 1 session per week
        • Month 4–6: 1 session every other week
    • Length of sessions: 45–90 minutes
  • MDFR Staffing:
    • MDFR works as a team with a minimum of two counselors and 1 supervisor.
    • The MDFR supervisor must have a master’s degree in a clinical field such as Marriage and Family Therapy, Mental Health Counseling, or Social Work.
    • MDFR counselors must have either a bachelor’s degree and related experience or a master’s degree in a clinical field.
    • Optional staff recommended but not required:
      • Many teams also have a peer counselor, case manager, or family advocate as part of the team who can:
        • Assist the counselor in helping the family access needed services and resources.
        • Provide extra support to the parent and family.
        • Serve an “aftercare” function once the case has been closed with the MDFR counselor.
  • Supervision:
    • MDFR has specific supervision protocols:
      • Each counselor receives:
        • Weekly 90-minute individual case review supervision
        • Audio review supervision at least 6 times per year
      • Case and supervision information is entered into the web-based MDFR Portal by MDFR counselors and supervisors, which facilitates fidelity to the approach. Fidelity and outcomes reports are provided to programs twice yearly (at the midpoint and at the end of the year).

Program Delivery

Parent/Caregiver Services

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

  • Substance misuse and substance use disorders; poor mental health; neglectful and abusive parenting behaviors; lack of parenting knowledge and practices; negative family communication; poor family problem solving; poor self-care practices and general functioning; lack of social support; inadequate facilitation of children’s development
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: MDFR is a family-based intervention and the client (parent/caregiver) must be willing to allow the MDFR counselor to meet individually with family members and in family sessions with them. The number of family members involved in MDFR and the extent of each member’s involvement is determined on a case-by-case basis. Some cases might involve many family members and many sessions while others might involve only one family member and as little as three contacts with the family. Individual sessions are held alone with the client (parent/caregiver) and alone with family members prior to convening couple or family sessions. The focus of the family work is to: (a) reduce family discouragement, criticism, and general negativity toward the client, (b) increase the amount and quality of family member emotional and practical support to client to support recovery and improved parenting, (c) increase understanding and mutual respect between client and family, and, if needed, (d) begin repairing conflicted relationships and assertively refer to couples or family therapy.

Recommended Intensity:

1–3 weekly face-to-face sessions for 45–90 minutes each with telephone calls and text messages in between sessions; number of sessions depends on service delivery setting, program goals, needs of the case, and changes based on how long client has been in substance abuse treatment. See Essential Components above for more details.

Recommended Duration:

Length of the intervention varies depending on the service delivery context and overall goals of the program. See Essential Components above for more details.

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Community Daily Living Setting
  • Foster / Kinship Care
  • Community-based Agency / Organization / Provider
  • Group or Residential Care

Homework

This program does not include a homework component.

Languages

Multidimensional Family Recovery (MDFR) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, 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:

  • Cell phones
  • Equipment to record sessions (audio)
  • Funds to pay for instant urine screen testing that is incorporated into ongoing intervention sessions
  • Computers/laptops with camera, internet browsers such as Google Chrome or Firefox, and capacity to use Zoom or other videoconferencing service for supervision

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Supervisors must have a Master’s Degree in a clinical field such as marriage and family therapy, mental health counseling, or social work.

Counselors must have a minimum Bachelor’s Degree and relevant experience. On a case by case basis, exceptions can be made for counselors who have extensive relevant and/or personal experience and do not have a Bachelor’s Degree.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

  • Dakof, G. A. (2019). Multidimensional Family Recovery intervention manual. MDFT International, Inc.

The manual and resource material are only available to programs that contract with MDFT International for MDFR training and quality assurance services. Contact Training Contact below for more information.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Training is provided onsite and through videoconference, and only available to staff who will be implementing MDFR in a licensed program.

Number of days/hours:

Specialized training is provided to MDFR counselors and supervisors. Initial certification training for an entire team takes approximately 12 months to complete (6 months to certify counselors and an additional 6 months to train supervisors). Training begins with a 3-day Introduction to MDFR. After the Introduction, training continues through weekly videoconference calls and quarterly boosters with expert MDFR trainers. Counselors submit audio recordings of their sessions and receive feedback. Supervision training typically begins 4–5 months after the Introduction to MDFR.

Implementation Information

Pre-Implementation Materials

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

Formal Support for Implementation

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

Formal support is required. After the initial year of training and implementation coaching, ongoing formal support is provided through site visits/boosters, tele-conferencing, review of audio recordings, and through a web-based system (MDFR Portal).

In Year 2 of the program, the following services are provided:

  • Monthly coaching video conference calls
  • Twice yearly onsite boosters
  • Review of 2 intervention audio recordings from each counselor
  • Review of 2 supervision audio recordings from supervisors

After Year 2, ongoing coaching, booster training and support is less intensive consisting of:

  • Quarterly coaching video conference calls
  • Yearly onsite booster
  • Review of 1 intervention audio recording from each counselor
  • Review of 2 supervision audio recordings from each supervisor

Formal support is ongoing. The formal support includes fidelity monitoring, coaching to support fidelity and improve clinical competence, and outcome evaluation.

Fidelity Measures

There are fidelity measures for Multidimensional Family Recovery (MDFR) as listed below:

  • MDFR Fidelity Measure: At the close of each case, the counselor and supervisor jointly complete this measure indicating the extent to which each of 25 MDFR interventions were delivered during the course of the program.
  • Through data entered in the MDFR Portal, fidelity is assessed by examining (a) parameters of the intervention (e.g., frequency and duration of sessions, session composition), and (b) ratings of outcomes from intake to discharge on key variables (e.g., retention in substance use treatment, child abuse potential, substance use).
  • Review and rating of audio recordings of MDFR sessions, and MDFR Supervision sessions.

Implementation Guides or Manuals

There are no implementation guides or manuals for Multidimensional Family Recovery (MDFR).

Implementation Cost

There are no studies of the costs of Multidimensional Family Recovery (MDFR).

Research on How to Implement the Program

Research has not been conducted on how to implement Multidimensional Family Recovery (MDFR).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Dakof, G. A., Quille, T. J., Tejeda, M. J., Alberga, L. R., Bandstra, E., & Szapocznik, J. (2003). Enrolling and retaining mothers of substance-exposed infants into drug abuse treatment. Journal of Consulting and Clinical Psychology, 71(4), 764–772. https://doi.org/10.1037/0022-006X.71.4.764

Type of Study: Randomized controlled trial
Number of Participants: 103

Population:

  • Age — Mean=30.7 years
  • Race/Ethnicity — 100% Black (93 African American, 3 Haitian, 1 Jamaican, and 1 Bahamian)
  • Gender — 100% Female
  • Status — Participants were mothers referred from either the University of Miami/Jackson Memorial Hospital or from the Department of Children and Families.

Location/Institution: Miami–Dade County, Florida

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to provide an experimental test of the Engaging Moms (EM) Program [now called Multidimensional Family Recovery (MDFR)] in a sample of mothers of substance-exposed infants. Participants were randomly assigned to either the EM Program (n=51) or community services as usual (n=52). Measures utilized include the Addiction Severity Index (ASI), the Circumstances, Motivation, Readiness and Suitability Scales (CMRS), and the Structured Clinical Interview for DSM–IV. Results indicate that significantly more women assigned to the EM Program enrolled into drug abuse treatment than did women assigned to t community services as usual. Sixty-seven percent of participants in the EM Program received at least 4 weeks of drug abuse treatment compared with 38% of the community services women. However, 90 days following treatment entry, there were no differences between the groups. Logistic regressions revealed that readiness for treatment predicted both short-term and long-term treatment retention. Limitations include generalizability to women from other racial/ethnic groups, that the study was conducted in a university setting so transportability to practice settings is unknown, and lack of follow-up. 

Length of postintervention follow-up: None.

Dakof, G. A., Cohen, J. B., & Duarte, E. (2009). Increasing family reunification for substance-abusing mothers and their children: Comparing two drug court interventions in Miami. Juvenile and Family Court Journal, 60(4), 11–23. https://doi.org/10.1111/j.1755-6988.2009.01033.x

Type of Study: Pretest-posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 80

Population:

  • Age — Not specified
  • Race/Ethnicity — 46 Black, 22 Hispanic, 9 White/Non-Hispanic, and 3 Other
  • Gender — 100% Female
  • Status — Participants were mothers involved with the child welfare system (CWS) for child neglect and severe substance use.

Location/Institution: Miami-Dade (Florida) Dependency Drug Court

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to examine the impact of Engaging Moms Program (EMP) [now called Multidimensional Family Recovery (MDFR)] on drug court graduation and family reunification. Participants were assigned to either a standard case management model (N=37) or to the EMP model (N=43). Measures utilized include administrative court records. Results indicate that 72% of mothers in the EMP graduated from drug court, and 70% were reunified with their children. In contrast, 38% of mothers receiving case management services (CMS) graduated from drug court and 40% were reunited with their children. Limitations include lack of randomization, small sample size, data limited to information contained in the court records, and lack of follow-up.

Length of postintervention follow-up: None.

Dakof, G. A., Cohen, J. B., Henderson, C. E., Duarte, E., Boustani, M., Blackburn, A., Venzer, S. E., & Hawes, S. (2010). A randomized pilot study of the Engaging Moms Program for family drug court. Journal of Substance Abuse Treatment, 38(2), 263–274. https://doi.org/10.1016/j.jsat.2010.01.002

Type of Study: Randomized controlled trial
Number of Participants: 62

Population:

  • Age — Mean=30.2 years
  • Race/Ethnicity — 26 Black, 22 Hispanic, and 14 White
  • Gender — 100% Female
  • Status — Participants were mothers involved with the child welfare system (CWS) for child neglect and severe substance use.

Location/Institution: State of Florida 11th Circuit Judicial Juvenile Court in Miami, FL

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to examine the effectiveness of the Engaging Moms Program (EMP) [now called Multidimensional Family Recovery (MDFR)] versus Intensive Case Management Services (ICMS) on multiple outcomes for mothers enrolled in family drug court. Participants were randomly assigned to either usual drug court care or the EMP. Measures utilized included the Revised Conflict Tactics Scale (R-CTS), the Addiction Severity Index (ASI), the Brief Symptom Inventory (BSI), the Brief Child Abuse Potential (B-CAP), the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), the Working Alliance Inventory (WAI), the Service Satisfaction Scale-16 (SSS-16), and administrative court records. Results indicate that at 18 months after drug court enrollment, 77% of mothers assigned to EMP versus 55% of mothers assigned to ICMS had positive child welfare dispositions. There were statistically significant time effects for both intervention groups on multiple outcomes including substance use, mental health, parenting practices, and family functioning. EMP showed equal or better improvement than ICMS on all outcomes. Limitations include small sample size, generalizability due to participants, and no comparison of mothers in a non-drug-court setting.

Length of postintervention follow-up: Approximately 3 months.

Additional References

Cohen, J. B., Dakof, G. A., & Duarte, E. (2011). Dependency drug court: An intensive intervention for traumatized mothers and their young children. In J. D. Osofosky (Ed.). Clinical work with traumatized young children (pp. 252–268). The Guilford Press.

Multidimensional Family Therapy. (2018, April). MDFT Family Recovery. Multidimensional Family Therapy newsletter, 7, 3–6. http://mdft.org/mdft/media/files/Newsletter/MDFT-Newsletter_April-2018_2.pdf

Contact Information

Gayle A. Dakof, PhD
Agency/Affiliation: MDFT International, Inc
Website: www.mdft.org
Email:
Phone: (786) 999-3158

Date Research Evidence Last Reviewed by CEBC: December 2019

Date Program Content Last Reviewed by Program Staff: March 2021

Date Program Originally Loaded onto CEBC: March 2021