Multidimensional treatment foster care an alternative to institutional placement
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Multidimensional Treatment Foster Care – an alternative to institutional placement. Euromet Symposium 2013 Annika W Jonsson, psychologist Sara Lindstein, psychologist SiS ungdomshem Hässleholm. Background Information .

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Multidimensional Treatment Foster Care – an alternative to institutional placement

Euromet Symposium 2013

Annika W Jonsson, psychologist

Sara Lindstein, psychologist

SiS ungdomshem Hässleholm


Background Information

  • OSLC, where MTFC was developed, was started in the 1970’s by Gerald Patterson and John Reid in Eugene, Oregon, USA

  • The MTFC program is based on Social Learning Theory and Coercion Theory

  • MTFC is evidence- and manualbased


How is MTFC different?

  • MTFC places one child with a family at a time

  • Placement in MTFC is approx. one year

  • MTFC uses a team approach to treatment

  • Foster Parents are members of the team

  • For one of the foster parents, MTFC is a full-time job

  • Programs are individualized for each youth

  • Support for foster parents is available 24 hours a day, 7 days a week

  • Foster parents meet regularly with their supervisor and other foster parents in the program to learn from and support each other


Main purposeof MTFC

Youthreturningto a permanent livingwithhis/herfamily. For all treatmentcomponentsof MTFC, this is focus from dayone.


MTFC Keystones

  • Reinforcement of pro-social behaviors

  • Close supervision

  • Fair, consistent and predictable limits and consequences

  • Supportive relationships

  • Minimize association with peers who may be a bad influence


Who is served by MTFC?

  • Children and youth in need of out-of-home placement due to serious behavioral and emotional problems and their families

  • MTFC-P serves children 3 – 6 years old

  • MTFC-C serves children 7 – 11 years old

  • MTFC-A serves youth 12 – 17 years old

  • Those who may have failed in prior placements or treatments

  • Can be used as step-down from institutional placements

  • Can be used as diversion from institutional placements


Exclusionarycriteria

  • Absence of serious behavior problems

  • Substance abuse is the only problem behavior

  • Sex offending/acting out is the only problem behavior

  • Active suicidal/homicidal

  • Psychosis

  • Schizophrenia

  • Bi-polar disorder with psychotic features


The MTFC Universe

Program supervisor

Social

services

School

Foster

parents

Youth

Skills coach

Family

therapist

Youth

therapist

Biological

family


Core Components for MTFC Parents

  • Conducts daily behavior management point and level system

  • Daily telephone contact and data collection

  • Weekly support and training meetings

  • 24-hour, 7-day on-call program supervisor


Core Components for Youth

  • Daily mentoring by MTFC parents

  • Daily structure and support via a point and level system

  • Daily schoolcard

  • Weekly contact with parents and frequent home visits

  • Weeklyindividualtherapy

  • Weekly skill building and advocacy

  • Close supervision of whereabouts and associations

  • Psychiatricconsultation


Point chart

Name Date

Points Things to Do to Earned Points Earned Bonus Total

  • 5 UP ON TIME

  • 5READY IN MORNING

  • 5MORNING CLEANUP

  • 5GO TO SCHOOL , CARRY SCHOOL CARD

  • 10ON TIME FOR CLASS

  • 10BEHAVIOR IN CLASS

  • 10 READ AND STUDY

  • 5ATTEND THERAPIES & SKILLS TRAINING

  • 5ATTEND LEISURE ACTIVITY

  • 10BEING ON TIME

  • 5CHORE

  • 5DINNER WITH FOSTER FAMILY

  • 5ENGAGE IN FAMILY ACTIVITIES

  • 0-10 PRO-SOCIAL PEER CONTACT

  • 5ATTITUDE

  • 5BED ON TIME

  • 5CELL PHONE TO FOSTER PARENTS

    DAILY TOTAL (115)


Point and Level System

  • Three levels

  • Opportunities to earn points for compliance, prosocial behavior

  • Points are lost for rule violations, misbehavior

  • Provides a framework within which interaction can occur without engagement in conflict


Level 1

During Level 1, the youth settles into the MTFC family home and begins to build relationships. In Level 1, there is very close supervision and immediate reinforcement.

  • The youth earns points for routine daily activities.

  • The youth is supervised at all times.

  • No homevisits, no time with friends, no cell phone

  • The youth should be able to earn approx. 100 points a day.

  • It takes 2,100 points or about 3 weeks to move out of Level 1.


Level 2

Level 2 will be individualized according to what was learned during level 1.

  • Youths can earn 805 points a week.

  • Bonuspointsearned in one week are used to buy privileges for the next week.

  • They learn to delay gratification, plan ahead, and work toward a goal.

  • The amount and quality of privileges increases.

  • They can be demoted to level 1 for low point days.

  • It takes 110 days to earn enough points to move to level 3.


Level 3

Level 3 is a maintenance phase. The youth is allowed more free time and a higher quality of privileges in level 3.

  • The youth must earn 90 points a day.

  • Youth and foster parents/family are more independent in relation to the program supervisor

  • Activities must be approved in advance.

  • Serious violations can result in a demotion to level 1.


Core Components for Families

  • Weeklyfamily counseling focusing on Parent Management Training: teaching parents to use clear and consistent discipline, be warm and supportive and to supervise their children closely

  • Instruction in behavior management methods

  • Home visits with crisis back-up

  • 24-hour, 7-day on call to program supervisor


Research results – Swedish 2-year-follow-up

Comparison MTFC-group (n = 20) and TAU-group (treatment as usual)(n = 20)

  • MTFC hadsignificantlyreduced all self-reported problem symptoms (internalized and externalized) for youths and mothers.

  • TAU hadsignificantlyreducedsomeself-reported problem symtoms

  • MTFC hadreduced all self-reported problem symtoms with at least 30%

    Pia Kyhle Westermark, 2009, IMS & Socialhögskolan, Lunds universitet


Swedish 3-year-follow-up

ComparisonSiSassessment + MTFC-treatment (n = 19) vs SiSassessment+TAU (n = 27)

  • Violentcrimeduring the three-yearfollow-up period 0 % in the MTFC-group vs 41 % in the TAU group

  • Days in lockedwardsduring the followup period: MTFC average 23 days vs TAU average 87 days

  • Thirdyear – significantlylowerfrequencyofcriminality in the MTFC-group

    On going study, Bergström & Höjman, Lund university/SiS


Aftercare

  • Aftercarehelpstoprevent old patternsof problem behaviortoreturn. Withoutit, problem behaviorsmostoftenreoccur. Support is neededfor a long time.

  • The youthleveloffunctioningafter the termination ofthe MTFC-program is moredependenton the situation at homethen it is on the leveloffunctioningduring the MTFC-placement.

  • Multidimensionalwork is necessaryalso in the phaseofaftercare; family, school, friendsand leisureactivities.


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