Transcript Document

MTFC and Multifunc
Réttur til verdnar, virkni og velferdnar
Barneverndarting 2014
Bernadette Christensen
Norwegian Center for Child Behavioral Development
Unirand, University of Oslo, Norway
7/17/2015
© The Norwegian Center for Child
Behavioral Development
Slide 1
Multidimensional Treatment Foster
Care (MTFC) Intervention Model
• Alternative to treating delinquent youth in institutions
• Youth are placed individually in foster homes
• Treatment in a family setting and focusing on the youth
and the family
Intensive support and treatment in a setting that closely
mirrors normative life
• Intensive parent management training is provided
weekly to biological parents (or other aftercare
resource)
• Youth attend public schools
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© The Norwegian Center for Child
Behavioral Development
Side 2
MTFC
• Objective: To prevent the negative trajectory
of delinquent behavior by improving social
adjustment with family members and peers
through simultaneous and well-coordinated
treatments in the youth’s natural
environment: home, school, & community.
• Treatment is provided in a family setting
where new skills can be practiced and
reinforced.
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© The Norwegian Center for Child
Behavioral Development
Side 3
Critical Components of MTFC: Known Risk
and Protective Factors
• Provision of close supervision
• Provision of consistent limits and consequences
for rule violations and antisocial behavior (nonharsh discipline)
• Minimization of influence of delinquent peers
• Daily adult mentoring
• Encouragement/reinforcement for normative
appropriate behavior and attitudes
• Youth’s parents increase skills at supervision, limit
setting, reinforcement
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© The Norwegian Center for Child
Behavioral Development
Side 4
Clinical Team
• Program Supervisor– treatmentdirector
• Family Therapist
Individual Therapist
Skills Trainer
Foster Parent Recruiter/PDR Caller Foster
Parent
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© The Norwegian Center for Child
Behavioral Development
Side 5
Individualtherapist
Familytherapist
Skillstrainer
Familieterapi
Family
Supervisor
Youth
Fosterparents
MTFC
Fosterparent
recruiter
School
Friends
Recreati
on
Clinical Dynamic
• Youth referred to MTFC
Present with a high level of challenging behaviors
–
• typical parenting strategies are ineffective
• Draw adults to set harsh reactive limits, to be
negative, & to focus on discipline
• Treatment supports foster parents & parents to
re- establish the balance - reinforce normative &
positive and to set non-punitive, appropriate
limits
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© The Norwegian Center for Child
Behavioral Development
Side 7
Behavioral Program
• The Point and Level system is a daily behavior
management program. It provides a concrete way
for parents to:
• Teach appropriate skills
• Reinforce desired behaviors or attitudes
• Provide consequences for problem behavior
• The pont and level system is developed tby the
program supervisor to tailor the individual needs
of each youth and it is implemented by
fosterparents
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© The Norwegian Center for Child
Behavioral Development
Side 8
Legislative changes
• MTFC is a hybrid between institutional placement and
foster care
• Until recently the legal position of MTFC was unclear
• MTFC is now legally defined as an «institution with homes»
• New regulations are in progress, and will define:
–
–
–
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The use and limits for use of ”force” for treatment purposes
The obligations of the treatment team and foster home
The competency demands on the team and foster home
The need for at case manager with responsibility for all aspects
of the treatment
– The material demands on the foster home to be used
– The need for quality assurance of the treatment
8 Randomized Trials
• Youth (ages 9–18) leaving the Oregon State mental hospital fared
better in MTFC than in usual community services (Chamberlain &
Reid, 1991)
• placed more quickly
• lower rates of behavioral and emotional problems
• stayed out of the hospital more days in follow-up
• JJ Boys (ages 12–18) -- average of 14 criminal referrals (Chamberlain
& Reid, 1998; Eddy, Whaley, & Chamberlain, 2004)
• fewer official and self-reported follow-up offenses
• spent more time in assigned placements
returned to their families more often
spent less time incarcerated and as runaways
• had fewer violent offenses
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© The Norwegian Center for Child
Behavioral Development
Side 13
• JJ Girls (ages 13–17) -- average of 11 previous
criminal referrals
• (Chamberlain, Leve, & DeGarmo, 2007)
• fewer incarcerations and less delinquency at
follow-up
• the amount of unsupervised time youth spent
associating with antisocial peers was a strong
predictor of official and self-reported
delinquent activities at follow-up (Eddy &
Chamberlain, 2000)
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© The Norwegian Center for Child
Behavioral Development
Side 14
Mediation Outcomes
• Specific processes that drive positive
outcomes:
• positive relationship with a mentoring adult
• close supervision
• fair and consistent discipline for rule violations
and
antisocial behavior
• completion of homework assignments
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© The Norwegian Center for Child
Behavioral Development
Side 15
Contingency Management (CM)
• The early focus is engaging all key family members to participate
and motivating them to alter their patterns that create and sustain
substance use of youth and/or parents.
• interventions are based on a functional analysis of the antecedents
and consequences of drug use
• Urine analyses are incorporated into treatment to provide a
possibility for reward for clean urine screens
• To support long term change once the urine screens and treatment
are complete, positive incentives are awarded for other treatment
activities such as session attendance and homework completion
• Youth and adults proceed through treatment phases as their
substance use is eliminated
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© The Norwegian Center for Child
Behavioral Development
Side 16
CM
• Urine analyses are not conducted by FFT therapists but
instead by family members in a way that empowers them
to support each other’s efforts to eliminate substance use
• Cognitive behavioral interventions are not merely therapist
driven processes. Rather, family members are fully engaged
by the therapist to participate and lead these activities to
facilitate new relational processes and individual skills,
• including core communication skills, supervision and
monitoring skills,
• builds comfort and confidence in talking about and
monitoring substance use
• families are taught new skills and strategies to combat
triggers, urges, and cravings for substance use,
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© The Norwegian Center for Child
Behavioral Development
Side 17
CM
• The families are provided with a range of positive and
negative reinforcement strategies to increase healthy
behaviors that replace unhealthy behaviors.
• In the final phase of treatment, Generalization, youth
and families extend the changes made during
treatment into new situations and systems
• A primary focus is on anticipating future triggers for
relapse and high risk situations and developing and
practicing strategies that can be implemented to
prevent relapse
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© The Norwegian Center for Child
Behavioral Development
Side 18
The MultifunC-project was sponsored by the Ministry of Children
and Equality in Norway, The National Board of Institutional Care (SiS)
and Centre for Evaluation of Social Services (IMS) in Sweden.
1.
Review of the research on residential treatment
of antisocial behaviour in juveniles (2001-2002).
2. Development of a residential treatment
program based on the research (2003-2004).
3. Implementing the treatment program –
MultifunC - in Norway (five units) and in Sweden
(two units) (2005-2007). Later also in Denmark.
4. Evaluation of the program (2010-14)
The MultifunC-institutions
 Small units (8 juveniles in each unit)
 Open institutions (non-secure). This does not mean that
they are free to go………..
 Located close to community services (school,
leisure/recreation activities and communication /transport)
Makes it possible to establish prosocial contacts, to be in
local schools, training in new skills in natural settings,
and to maintain contact with family.
Target group for MultifunC
 Juveniles with serious behaviour problems (crime,
substance abuse, violence, etc.).
 High risk for future criminal behaviour (high total sum of
risk factors – static and dynamic)
 Before placement the Risk level is assessed with the risk
inventory Youth Level of Service/Case Management
Inventory (YLS/CMI)
Risk assessment tools
Youth Level of Service / Case Management Inventory
(YLS/CMI):
• 42-item instrument designed to measure risk, need,
and responsivity factors in adolescents who have had
contact with the justice system.
• It has been validated for use with both males and
females between the ages of 12 and 17
YLS/CMI: Risk domains
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Prior and current offences/dispositions
Family circumstances/parenting
Education/Employment
Peer relations
Substance abuse
Leisure/recreation
Personality/behaviour
Attitudes/orientation
Risk level (YLS)
25
20
15
Admission
Discharge
10
5
0
FFT
MST
MTFC
YLS/CMI: Risk domains
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•
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•
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Prior and current offences/dispositions
Family circumstances/parenting
Education/Employment
Peer relations
Substance abuse
Leisure/recreation
Personality/behaviour
Attitudes/orientation
Family
Peers
•Parental skills
•Decrease antisocial
•Communication
•Increase prosocial
Treatment
Targets
Juvenile
School
•Behaviour
•Attendance
•Skills
•Skills
•Attitudes
•Behaviour
Treatment process
Residential / institution
Community
Inntake
Treatment
Transition
Motivation
Motivation
Prepare
Family
re-entry
support
Assesment Focused Treatment
Structure
Reintegration / aftercare
Treatment climate
Duration of residential stay:
Duration of aftercare:
about 6 months (not fixed)
about 4-5 months (not fixed)
Juvenile
Focus of
School
treatment
Peers
Family
Organizational model for each
MultifunC-unit
Leader
Assessment
and
Planning team
Mileau therapy
-team
Educational/
Pedagogical
team
Family- and
After-care team
For each juvenile there areTreatment teams across all teams
including one or several staff from each team.
Treatment that takes place during the residential
stay with focus on the youth
 The treatment mileau:
Control where this is neccesary, but no unneccessary control
Involvement of the juveniles wherever this is possible
Structure, but not unneccessary structure
Principles from ”Core correctional practice” - staff behaviour
Interventions with focus on individual juveniles:
Motivating for change (based on Motivational Interviewing)
Behavioural analysis and/or MST’s fit-cirkel
Contingency Management Systems/Tocen economy and
behavioural contracts
Aggression Replacement Training (ART)
Weekly treatment goals and evaluation of progress (intesivity)
«Core correctional practice»
(Andrews et al., 2004)
• The firm, fair and clear use of authority
• Modelling prosocial and anti-criminal attitudes and
behaviour
• Teaching concrete problem solving skills
• Using community resources
• Forming and working through warm, open and enthusiastic
relationships
Motivational interviewing
• Motivational interviewing is a directive, clientcentered counseling style for eliciting behaviour
change by helping clients to explore and resolve
ambivalence.
• Compared with nondirective counselling, it is more
focused and goal-directed. The examination and
resolution of ambivalence is its central purpose, and
the counselor is intentionally directive in pursuing
this goal.
Treatment levels & Contingency
Management
Intake
Residential treatment
Re-entry
CC (further)
Contingency contract
Individual
General
Intensive
Aftercare
Family contract
Aggression Replacement Training (ART)
Tocen economy and Motivational Interviewing
motivates for change. The basis for actual
change is new skills which makes changes
possibly.
Aggression Replacement Training (ART) consists
of a multimodal intervention design that
combines:
 Training in control of aggression (ACT),
Training of social skills, and
Learning of moral thinking
(Goldstein og Glick, 1994).
Model for Aftercare
Youth
Family
team
Parents
School or
work
Peers
Family support and aftercare
Focus
 Increasing family affection/communication
 Increasing monitoring/supervision skills
Methods:
 Principles from Parental Management
Training (PMT) during the residential stay
 Principles from Multisystemic Therapy
(MST) during leaves and aftercare
Quality assurance systems
• Written Manuals for each topic (assessment,
treatment, aftercare and so on) is included in the
treatment model
• Training program for staffs
• Weekly phone-consultations with checklists and
discussions with each institution
• Regularly Boosters on spesific topics
The existing
MultifunCTromsø Youth
Centre
institutions
Stjørdal Youth
Centre
Bergen Youth
Centre
Brättegården
Sandefjord
Youth Centre
Ås Youth Centre
Two units in Denmark
Råby Youth Centre
Conclusions from a recent review
(Mark Lipsey, 2010)
The challenges in treatment of juvenile justice involved youth is
not a result of a lack of knowledge. We now have research on best
practices.
We have learned about the importance of advancing our work on
an ecological platform and to target risk factors on several
domains, better connecting youth to family, school and to prosocial peers while utilizing a strenght based approach.
The true challenge is not a lack of knowledge of what works,
but rather in translating the robust body of knowledge into
practice.
MultifunC is presented in a chapter in a book in USA and
England 2014: THERAPEUTIC RESIDENTIAL CARE WITH
CHILDREN AND YOUTH, IDENTIFYING PROMISING
PATHWAYS TO EVIDENCE-BASED INTERNATIONAL
PRACTICE. Publicated: Jessica Kingsley Publishers, London, U.K.
and Philadelphia,U.S.A. Edited by Whittaker, Fernandez del Valle and
Holmes.
We have some guidelines from reserach, but there is no «Magic
bullet» (Lipsey, 2007).
The End