MTFC Outcomes MTFC – A (Boys) MTFC – A (Girls) MTFC -P

1. MTFC OutcomesMTFC – A (Boys)MTFC – A (Girls)MTFC -P

2. The History of MTFC MTFC is based on almost threedecades of longitudinal research on the predictors of conduct problems and antisocial behavior • In 1983, the MTFC model was developed for adolescents referred from Juvenile Justice as an alternative to group care & training school placement • In 1986 the model was adapted for use with children and teens referred from the State Mental hospital • In 1990 components of MTFC were adapted for use with “regular” state-supported foster care • To date, 6 randomized trials have been conducted on the efficacy of MTFC

3. Daily structure and support via the Level System Daily school card Weekly skill building & advocacy Close supervision of whereabouts and associations Recreational skill building Psychiatric consultation/ medication management Daily mentoring & counseling by TFC parents Core Components for Youth

4. Daily telephone contact (M-F) and data collection (PDR) weekly support and training meetings 20 Hours pre-service training course 24-hour, 7-day on call case manager emergency crisis intervention Respite Core Components for Foster Parents

5. Core Components for Families • Weekly family counseling focusing on Parent Management Training • Instruction in behavior management methods • Home visits with crisis back-up • 24-hour, 7-day on call to case manager

6. Data from Juvenile Justice studies First the boys…

7. Outcomes: Criminal Referrals

8. Average Arrest Rates at One Year follow-up for Boys in GC & TFC who Stayed in Treatment > 3 mos. versus Boys who left before 3 mos.

10. Time with delinquent peers: # of minutes with non-program delinquent peers

11. Discipline in the last 24 hours% of problems that received a consequence

12. Discipline by adults and subsequent arrests 1 year after baseline Consistent discipline score

13. Mean Deviant Peer Score

14. Two Year Follow-upNumber of Serious Violent Offenses Per Youth

15. Now the girls…

16. Adaptations for girls • Reinforcement (and sanctions) for coping with and avoiding social/relational aggression • Practice strategies for emotional regulation • early recognition of their feelings of distress • problem solving coping mechanisms • Peer relationship building skills • initiating conversations • modulating their level of self disclosure to fit the situation • Strategies for sexually risky and coercive situations • Personal risks for drug use • priority setting using motivational interviewing • provision of incentives for abstinence from drug use

17. MTFC-A GirlsFamily History & Caregiver Transitions • 17 transitions in parent figures (6 before age 13) • 2.8 prior out-of-home placements • 74% had at least one parent convicted of a crime • 93% have a history of documented physical or sexual abuse • 79% have witnessed domestic violence • First sexual abuse (self-report) at age 8 (Leve & Chamberlain, 2004)

18. Early Predictors of Age of First Arrest b Girl age .17 Menstrual onset .11 IQ .21+ ADHD .00 Severe punishment .00 Sexual abuse -.05 Parental transitions -.42** Biological parent criminality -.28* R2 = .52*** F (8, 45) = 5.98, p < .0005. (Leve & Chamberlain, 2004)

19. Why is Early Arrest Important? Girls who were first arrested before age 12… • Had significantly more participation in health-risking sexual behavior • Had significantly more self-reported delinquent acts by age 16 • Had an increased likelihood of unplanned pregnancy and of becoming teen mothers

20. StudyDesign • 200 girls aged 13 – 17 recruited through the juvenile justice system • Had an average of 12.7 prior arrests • Were court-mandated to an out-of-home treatment placement • Random assignment into services as usual (Group Care) or MTFC

21. Decrease in Days in Locked Settings over Time (in 12-month increments) Days in Locked Settings

22. Arrest Rates over Time (in 12-month increments) Number of Arrests

23. Pregnancy Outcomes Kerr, D., Leve, L., & Chamberlain (2009), Journal of Consulting & Clinical Psychology, 77, 588-593 Covariates: Age BL criminal bx Sexual activity BL Pregnancy Odds for pregnancy post BL 2.44 times larger for GC than MTFC

24. Known Risk and Protective Factors mediate treatment effects • close supervision (home, school, neighborhood) • consistent limits and consequences for rule violations and antisocial behavior (non-harsh discipline) • decrease influence of delinquent peers • daily adult mentoring • reinforcement for normative behavior &attitudes • parents increase skills at supervision, limit setting, reinforcement • daily homework completion

25. MTFC Girls Appear to Associate with Fewer Delinquent Peers During Treatment

26. MTFC Girls Receive More Supervision During Treatment

27. Mental Health: BSI Anxiety

28. MTFC -P

30. Program Elements • Play group • Not individual therapy • Individually tailored contingencies • Home visits • Focus on scaffolding and support

31. MTFC-P: Foster placement failure and foster parent retention Regular Foster Care MTFC

32. Risk for permanent placement failure increases as the number of out of home placements increase Figure 2. Association between # of out of home placements and probability of permanent placement failure (Fisher, Burraston, & Pears, 2005)

33. MTFC-P mitigates risk of failed permanent placement resulting from prior placements Figure 4. Number of prior placements not associated with increased risk for permanent placement failure for MTFC-P participants (Fisher, Burraston, & Pears, 2005)

34. MTFC-P improves attachment Figure 5. Secure and insecure attachment at 3 month intervals Fisher & Kim (2007)

35. MTFC-P improves children’s sleep patterns Tininenko. Fisher, Bruce, & Pears (in press), Child Psychiatry and Human Development

36. MTFC children go to bed earlier

37. MTFC children spend more time in bed

38. MTFC children fall asleep sooner

39. 1.1 1.0 .9 .8 Condition .7 FCI .6 FCI - censored Cum Survival .5 FCC .4 FCC - censored - 10 0 10 20 30 40 Time in perm placement Once placed in out of home care, children’s rates of re-entry into care are very high Figure 1. Permanent placement failures following out of home care % of children in remaining in permanent placements Months following permanent placement (Fisher, Burraston, & Pears, 2005)

40. MTFC-P increases success of permanent placements Figure 3. Effects of MTFC-P on reducing permanent placement failure % of children in remaining in permanent placements Months following permanent placement (Fisher, Burraston, & Pears, 2005)