Adolescent girls can be treated for delinquent behaviors more effectively in a well-supervised family setting than in residential treatment programs. That is the conclusion of NIDA-funded researchers studying Multidimensional Treatment Foster Care (MTFC). During 6 months of treatment and 18 months of followup, girls in MTFC had fewer incidents of delinquency than a comparison cohort who were treated in group residences. The girls in foster care also attended school more regularly and spent more time on homework.
MTFC was previously shown effective in reducing delinquency among teenage boys. The protocols used in the new study, which was co-funded by the National Institute for Mental Health, enhanced the standard MTFC program to address mood and social problems that are common among delinquent girls. The need for such interventions is clear: A 2001 American Bar Association report described girls under 18 as the fastest growing segment of the U.S. juvenile justice population, citing an 83 percent increase in their rate of delinquency between 1988 and 1997.
"The study demonstrates that even severely delinquent girls can be treated in the community and that placement in family homes with caretakers who are well-trained and supervised can produce results that are superior to those of group care," says Dr. Patricia Chamberlain, who conducted the study with colleague Dr. Leslie Leve. Both are affiliated with the Oregon Social Learning Center in Eugene, Oregon.
Fostering Better Behavior
Girls in MTFC live with foster families and attend local public schools. The program trains the foster parents to provide positive reinforcement and encouragement to the girls while mentoring their academic and living skills. The foster parents closely supervise the girls' whereabouts and provide a daily structure of clear expectations and limits, such as getting to class on time, doing homework, and complying with curfews. They also administer well-specified consequences—for example, loss of privileges for negative behaviors and gift cards for positive behaviors.
Dr. Chamberlain's team tailored the standard MTFC program to the needs of delinquent girls. For many of them, prior exposure to trauma and abuse had contributed to anxiety and mood problems, poor interpersonal relationships, and social aggression. The foster parents and therapists taught the girls how to reduce aggression in social situations and personal relationships. They also provided strategies enabling the girls to recognize and deal with emotional distress, generate options to solve problems, and make long-range plans.
The girls who participated in the study had been court-mandated to care away from their original homes because of chronic delinquency. On average, they had been arrested 12 times, often for drug abuse. Three-quarters of the girls were of European descent, and all were between the ages of 13 and 17. Following an initial assessment, they were randomly placed in either MTFC or group care (GC). The GC girls lived in one of 19 group residences and attended school onsite. Their treatment programs varied. At the end of their time in MTFC or GC, which averaged 6 months, 56 percent of the girls returned to their biological or another family, and 23 percent began living independently. Others were detained for subsequent criminal offenses or remained in a treatment setting.
Both groups exhibited less delinquent behavior during and after treatment than they had before. The MTFC girls' average number of days spent in locked settings fell from 75 in the year prior to the initial assessment to 22 in the year following, while the GC group's average dropped from 89 days to 56 days. During the same period, scores on a delinquency measure that combined the number of criminal referrals, days locked up, and self-reports of delinquent behaviors dropped by about half among the MTFC girls and roughly a third among the GC girls. The MTFC girls' advantages on both measures widened as behavioral improvement continued during the next year.
The researchers linked MTFC's superior outcomes to the program's greater emphasis on homework. "Homework completion was an important factor in reducing the time girls spent in locked settings, and MTFC was better than GC at promoting homework completion," Dr. Leve explains. An analysis of the data found that time spent studying accounted for about 8 percent of both groups' reductions of time in locked settings in the first 12 months. The MTFC girls were given incentives to study at least 50 minutes per day in a quiet setting where adults could monitor and confirm their performance. The number of days per week during which they spent at least 30 minutes on homework increased from an average of 2 days to 3.5 days. The GC girls, without such incentives, slightly decreased their engagement with homework over the same period.
According to the researchers, completing homework was important for several reasons: It got the girls into a nightly routine of working on a task that would help them prepare for the next day, it required that they spend more of their time engaged in supervised activities at home rather than unsupervised activities outside the home, and the repeated exposure and practice made them feel more comfortable performing academic tasks.
Intervention Lowers Risk of Pregnancy
Adolescent girls who participated in Multidimensional Treatment Foster Care (MTFC), an intervention designed for young people with histories of arrest for illicit drug use and other crimes, were half as likely as their peers in standard residential treatment to get pregnant within 2 years of enrollment. This is the finding of a new study, funded by NIDA and the National Institute of Mental Health, by Dr. Patricia Chamberlain and Dr. Leslie Leve of the Oregon Social Learning Center.
Drs. Chamberlain and Leve had previously shown that the well-supervised foster care provided by MTFC reduced arrest and lockup rates and increased homework completion and school attendance among chronically delinquent 13- to 17-year-old girls (see article page 12). In their new study, with colleague Dr. David Kerr, the researchers randomly assigned 81 girls to MTFC and another 85 girls to group residences. At the 2-year followup, 27 percent of the MTFC girls had reported a pregnancy since enrollment, compared with 47 percent of the girls in group care.
The study was designed principally to compare the two interventions, but researchers also wanted to explore whether MTFC would produce better outcomes if it included a component that targeted risky sexual behaviors. Hence, half of the MTFC girls received counseling in how to avoid risky sexual behaviors and practice responsible dating, while the other half received no such counseling. Both of those MTFC groups had similar pregnancy results, which "suggests that the general approach of increasing supervision and reducing delinquent peer associations might be just as effective as programs that specifically focus on preventing sexual risk taking," says Dr. Leve.
"Delinquency prevention programs, such as MTFC, that aim to increase supervision through positive relationships with caring adults and to reduce the amount of time that adolescents spend with delinquent peers may have an unexpected benefit of simultaneously reducing other risk behaviors, such as unplanned pregnancies," Dr. Leve adds.
Kerr, D.C.R.; Leve, L.D.; and Chamberlain, P. Pregnancy rates among juvenile justice girls in two randomized controlled trials of Multidimensional Treatment Foster Care. Journal of Consulting and Clinical Psychology 77(3):558-593, 2009. [Abstract]
Power of the Family
In designing the MTFC intervention, Dr. Chamberlain hypothesized that life lessons learned in a family setting would be more directly applicable post-treatment than lessons learned in institutional environments. "The intervention also capitalizes on the power of the family environment," says Dr. Leve. Both the foster parents with whom the girls live during MTFC and the adult with whom they will live after treatment receive training in well-tested techniques to encourage and reinforce acceptable behavior. The foster parents also receive daily support via telephone from project staff.
MTFC may also confer another major advantage: cost savings. Even though the current study did not analyze expenses, other research has shown that MTFC costs, depending on location, are one-half to two-thirds those of group care. MTFC for boys has saved about $22,000 to $88,000 per child in long-term costs. These costs were estimated by the Washington State Institute for Public Policy and included savings to taxpayers for victim and crime costs - see, for example, www.wsipp.wa.gov/rptfiles/07-06-1201.pdf (PDF, 590KB).
|Characteristic (mean value)||MTFC||Group Care|
|Days per week during which girls spent at least 30 minutes of homework||3.5||2.0|
|Days in locked settings**||22||56|
|Number of arrests||0.76||1.3|
|Caregiver reports of delinquency***||65||70|
* Rated on a scale of 1-6, where 5 represents attending regularly and 6 represents attending 100 percent of the time.
** Includes juvenile detention or correctional facilities, jail, and prison.
*** Score on the Child Behavior Checklist delinquency subscale.
The MTFC model is now being implemented in more than 75 sites in the United States and Europe, including Latino and African-Amercan communities in these areas. According to Dr. Eve Reider of NIDA's Division of Epidemiology, Services and Prevention Research, these studies address a growing need for research-based interventions that are effective for delinquent girls. "The next steps for this area of research can include examining more ethnically diverse juvenile justice populations and performing effectiveness trials," Dr. Reider says.
Chamberlain, P.; Leve, L.D.; and DeGarmo, D.S. Multidimensional Treatment Foster Care for girls in the juvenile justice system: 2-year follow-up of a randomized clinical trial. Journal of Consulting and Clinical Psychology 75(1):187-193, 2007. [Abstract]
Leve, L.D., and Chamberlain, P. A randomized evaluation of Multidimensional Treatment Foster Care: Effects on school attendance and homework completion in juvenile justice girls. Research on Social Work Practice 17(6):657-663, 2007. [Full Text (PDF, 537KB)]