Transcript Evaluation of Multidimensional Treatment Foster Care

Nina Biehal and Jo Dixon
Department of Social Policy and Social Work
University of York
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MTFC developed and positively evaluated in the USA
Adolescents programme (MTFC-A) in USA mainly
targeted at young offenders
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Independent English evaluation of MTFC-A by Universities
of York (Biehal, Dixon, Parry, Sinclair) and Manchester
(Green, Kay et al):
MTFC-A for children age 11-16 years who:
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were already in family foster care or residential care
(‘looked after children’)
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had serious emotional and behavioural difficulties
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In an unstable placement/at risk of placement
breakdown
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MTFC-A for looked after children age 11-16 years
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219 children at 18 sites across England
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Quasi-experimental study (n=219)
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Sample
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RCT also attempted but recruitment unsuccessful (n=34)
106 children placed in MTFC, 113 in ‘Usual Care’ (UC)
UC = ordinary foster (34%) or residential care (58%)
UC group: young people who met criteria for MTFC
MTFC children slightly older and more likely to be in
residential care at baseline (analysis took account of this)
Data collection at baseline and 1 year follow-up
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Over 93% had experienced abuse or neglect
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Many had entered care late
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78% at age 5 or over, 44% at age10-15 years
Long exposure to adversity in family
History of placement instability
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Average of 5 previous placements
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Per cent with clinically significant scores on SDQ
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Total score
64%
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Conduct problems
68%
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Emotional problems
37%
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Involvement in crime
26-30% convicted in the last 6 months
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Primary outcome measure: the C-GAS
(Children’s Global Assessment Scale)
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Blind ratings of all data at baseline and follow-up
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MTFC group as a whole did no better than UC
group
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But those who were disruptive/anti-social at
baseline did better in MTFC than in usual care
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MTFC originally designed for those with
behaviour problems
Those who were not anti-social did better in the
usual care placements than in MTFC
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MTFC placements
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Aim: move to a long-term foster family after 912 months in MTFC
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26% disrupted (21% for control group)
But ½ still in MTFC placements at follow-up
Hard to find follow-on foster placements
Of those who had left MTFC
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Only 25% moved to new foster placements
50% moved to residential care (2/3 of those who had
been in residential care pre-MTFC placement)
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No overall difference in involvement in offending
over follow up between MTFC and UC group
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But those previously involved in crime were
less likely to offend if they received MTFC
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MTFC group were less likely to offend if stayed
in MTFC placement for 3+ months
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Intensive educational support provided but
 Engagement in education no better for MTFC-A
group than for UC group
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More of MTFC group excluded from school
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No improvement in school attendance
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Engagement
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Importance of relationship with foster carer
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Could make reluctant children more willing to
accept the structured behaviour management
Displacement of discipline onto programme &
clinical team helpful to foster carers
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MTFC worked better if child was willing to ‘buy in’
to the highly structured nature of the programme
Parents sometimes undermined the programme
Might have helped to keep relationships positive?
Post-MTFC environment important
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Did it reinforce any changes or undermine them?
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Evidence-based
programmes found to be
effective when tested by their developers in tightly
controlled settings
What
affects programme effectiveness when
transferred to other settings?
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Different populations, different outcomes measured
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US studies of MTFC-A
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Mainly seriously delinquent youth/chronic juvenile offenders
Most were living at home prior to MTFC placement
Aim of MTFC-A: reduce re-offending and return child home
Primary outcome: various measures of recorded reoffending
Independent English evaluation
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< 1/3 had recent criminal convictions
93% had histories of abuse and neglect
Were already in care and unlikely to return home
Aim of MTFC-A: address d behavioural and emotional
problems and then move child to long-term foster placement
Primary outcome: measure of children’s global functioning
(C-GAS)
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Difficult to ensure fidelity to MTFC model across
multiple sites despite:
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National programme co-ordinators/teams
Distance supervision by programme developers
Fidelity consistently rated as high for only
1/3 of MTFC-A sites
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Varied between sites and within sites over time
Affected by changing staff and staff vacancies
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Lack of key provision by other agencies
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Hard to find new schools when young people
moved to MTFC and when they left it
undermined work with young people in placement
and after return home
National shortage of foster carers
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Hard to find follow-on foster placements after
programme completed, so many returned to
residential care
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Effects of the new environment
 Behavioural change may not last beyond the
placement
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those who left MTFC-A did worse than those in still
in placement
this was not related to time in placement
Similar findings for companion study of MTFCA for young offenders (Intensive Fostering)
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Reduced re-offending while in placement
No difference 1 year after leaving placement
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Programme effectiveness may be found to vary due to:
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Variation in the population served
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Is the programme delivered to a similar group of children?
The outcomes of interest
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Re-offending versus global functioning
The local service context
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e.g. availability of education provision
Quality and effectiveness of the control condition
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Is UC of similar quality in USA and England?
The wider policy and resource context, which determines
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Who enters care and in what circumstances
The nature, quality and availability of services
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Biehal, N., Dixon, J., Parry, E., Sinclair, I., Green, J., et al (2012) The
Care Placements Evaluation (CaPE). Evaluation of Multi-dimensional
Treatment Foster Care for Adolescents (MTFC-A). Department for
Education. https://www.education.gov.uk/publications/eOrderingDownload/DFERB194.pdf (summary).
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Green, J.M., Biehal, N., Roberts, C., Dixon, J., Kay, C., Parry, E.,
Rothwell, J., Roby, A., Kapadia, D., Scott, S. and Sinclair, I. (2014)
‘Multidimensional Treatment Foster Care for Adolescents in English care:
randomised trial and observational cohort evaluation,’ British Journal of
Psychiatry 204: 214-221
Dixon, J., Biehal, N., Green, J., Sinclair, I., Kay, C. and Parry, E. ‘Trials
and tribulations: challenges and prospects for randomised controlled
trials of social work with children’. British Journal of Social Work.
Advance access doi:10.1093/bjsw/bct035 March 4th 2013.
Biehal, N., Ellison, S. and Sinclair, I. (2011) ‘Intensive fostering: an
independent evaluation of MTFC in an English setting,’ Children and
Youth Services Review 33: 2043-2049 (other MTFC-A study).
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