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Intensive Fostering: An Independent Evaluation of MTFC in an English Setting*
Abstract
Nina Biehal, Sarah Ellison and Ian Sinclair present the results of an independent evaluation of the Multidimensional Treatment Foster Care (MTFC) programme for young offenders in England, where it is known as Intensive Fostering (IF). A quasi-experimental, mixed-methods study was carried out at the three pilot sites, with a total sample of 47 at follow-up. Young people sentenced to IF were compared to a similar group, matched on the eligibility criteria for IF, the majority of whom were sentenced to custody. The groups were well matched in terms of their characteristics and criminal histories. Official data on reconviction were collected at baseline and one year after entry to the IF placement or release from custody (Stage 1), and further data on programme completion and secondary outcomes were collected via interviews with young people and parents, and questionnaires to professionals at baseline and follow-up. Official data on reconviction were also collected one year after exit from the IF placements (Stage 2). At Stage 1 the IF group were less likely to be reconvicted, had committed fewer and less-serious recorded offences, on average, and took longer to commit their first recorded offence. At this point the IF group were more likely to be living with their families and less likely to be in custody than the comparison group. However, by Stage 2 no significant differences in patterns of reconviction remained. IF successfully contained a high-risk group in the community, but the effects of the intervention diminished once they left their foster placements. Environmental effects on entry to and exit from the IF placements may help to explain the results at both stages.
... Första brittiska studien av oberoende forskare I en brittisk icke-randomiserad studie undersöktes 45 ungdomar i åldrarna 13-17 år som riskerade att frihetsberövas (83 % pojkar). Ungdomarna matchades utifrån bland annat kriminalitet till TFCO (n=23) eller till institutionsvård (ej närmare beskriven) (n=24) [81]. Effekten av TFCO mättes vid två tillfällen, 12 månader efter påbörjad behandling och 12 månader efter avslutad behandling, i genomsnitt 21 månader efter baslinjemätningen. ...
... Kriminalitet Sex studier med sammanlagt 468 ungdomar redovisade resultat efter 12, 24 och 36 månader som gällde fortsatt kriminalitet baserat på registerdata (t.ex. polisregister) [62,65,70,81,82,84]. Metaanalysen visar på en minskad kriminalitet för ung domarna som fått TFCO jämfört med institutionsplacering (Figur 4.2). ...
... Avdrag har gjorts för osäkerhet om studiekvalitet vad gäller randomisering, blindning och kontrollalternativets innehåll (avdrag för kvalitet -1). Van Ryzin et al 2012, RCT Eddy et al 2004, RCT Chamberlain et al 2007, RCT Author, Year, DesignSex studier med sammanlagt 451 ungdomar redovisade resultat efter 12, 24 och 36 månader[59,60,65,70,81,84]. Utfallet består av andelen ungdomar som placerats i slutenvård efter baslinjemätningen, alternativt antal dagar ungdomarna varit i slutenvård. ...
Varje år placeras ungefär 2 000 ungdomar på institution på grund av allvarliga beteendeproblem. Ungdomarna placeras då antingen på särskilda ungdomshem eller på kommunala eller privata Hem för vård eller boende (HVB). En alternativ placering för dessa ungdomar är i en så kallad behandlingsfamilj. Det är en tidsbegränsad insats där utbildade familjehemsföräldrar tillsammans med ett team bedriver behandling. En version av behandlingsfamilj är Treatment Foster Care Oregon (TFCO). TFCO finns i begränsad omfattning i Sverige sedan början av 2000-talet.
Slutsatser
När ungdomar med allvarliga beteendeproblem placeras i TFCO, leder detta troligtvis till mindre fortsatt kriminalitet och färre placeringar på låst avdelning än när ungdomarna placeras på institution. Det är också möjligt att TFCO leder till färre kriminella kamrater, mindre användning av narkotika och bättre psykisk hälsa, än vid placering på institution.
TFCO kostar i genomsnitt mindre än placering på särskilda ungdomshem och något mer än på HVB, om man räknar med att vårdtiderna är desamma. Väger man in antaganden om långsiktiga effekter är TFCO kostnadsbesparande för samhället jämfört med placering på särskilda ungdomshem eller HVB.
Idag får cirka 30–40 ungdomar i Sverige årligen tillgång till TFCO. Om fler ska få tillgång måste fler behandlingsteam inrättas, vilket kortsiktigt medför kostnader för utbildning och certifiering. behandlingsfamiljer för ungdomar med allvarliga beteendeproblem – treatment foster care oregon
Alternativet till behandlingsfamiljer är institutionsvård som ofta kompletteras med olika behandlingsmetoder. Kunskapen om metodernas nytta och risker är bristfällig eftersom det saknas studier. Ur ett etiskt perspektiv är det angeläget att få tillförlitlig kunskap om för- och nackdelar med de övriga kompletterande behandlingar som används.
... In the UK, Biehal et al.'s (2011) evaluation of support systems for foster parents and juvenile offenders indicates that providing close supervision of foster care arrangements, facilitating mentoring relationships with carers, and the consistent reinforcement of pro-social behaviours benefi ted young people and restricted their opportunities to reoffend and interact with deviant peers. In addition, an earlier study (YJB, 2010) of the same programme highlighted that it also reintegrated young people into education, positively affecting young people's self-esteem and social support. ...
... It also encompasses items on number of GCSEs attained by children in care compared with their peers, percentage of children in care with an SEN, and proportion of children in care excluded from schools (see Harker and Heath, 2014). Biehal et al. (2011) use a mixed-method approach to capture outcomes. This encapsulates focus groups, census data, a survey questionnaire and historical data. ...
... Some of the key indicators used were how many children exited care, whether they aged out of care, were reunified with families of origin or adopted, and how long they spent in foster care. A substantial census sample of 374 children enabled Biehal et al. (2011) to map outcomes for young people, yielding data on how age, carer-related reasons and the severity of behavioural factors shaped permanence. Goodman's (1997) Strengths and Difficulties Questionnaire (SDQ) was also used to chart emotional and behavioural difficulties, facilitating comparisons between children in different forms of care (e.g., adoption and long-term foster care). ...
... The Youth Justice Board (YJB) subsequently introduced another MTFC pilot programme, known as Intensive Fostering, with the aim of reducing re-offending by persistent young offenders. This was targeted at young people in the youth justice system rather than the care system and has been separately evaluated Biehal, Ellison and Sinclair, 2011 ). ...
... However, during the year after the MTFC group left their Intensive Fostering placements they moved from a situation of intensive support to very little and were no longer diverted from pro-criminal peers. In this context the gains made while in MTFC appeared to wash out and reconviction rates rose sharply Biehal, Ellison and Sinclair, 2011 ). ...
... This has been most fully documented for children leaving residential care and returning to the community (Allerhand, Weber and Haug, 1966;Sinclair, 1971;Taylor, 1973;Coates, 1978;Petrie, 1980;Lewis, 1982). There is similar evidence on the effects of return to the community on foster children where it has been documented for a wide range of social and behavioural problems (Sinclair, Baker, Wilson et al., 2005;Berridge, Biehal, Lutman, et al., 2011;Wade, Biehal, Farrelly et al., 2011;Biehal, Ellison and Sinclair, 2011 ). So the price of being able to achieve change in care -or even, perhaps in intensive community treatment (Bank, Hicks Marlowe, Reid, et al., 1991) -is often that the change is temporary and reversible. ...
... Första brittiska studien av oberoende forskare I en brittisk icke-randomiserad studie undersöktes 45 ungdomar i åldrarna 13-17 år som riskerade att frihetsberövas (83 % pojkar). Ungdomarna matchades utifrån bland annat kriminalitet till TFCO (n=23) eller till institutionsvård (ej närmare beskriven) (n=24) [81]. Effekten av TFCO mättes vid två tillfällen, 12 månader efter påbörjad behandling och 12 månader efter avslutad behandling, i genomsnitt 21 månader efter baslinjemätningen. ...
... Resultatet bedöms ha måttligt starkt vetenskapligt stöd ( ). Avdrag har gjorts för osäkerhet om studiekvalitet vad gäller randomisering, blindning och kontrollalternativets innehåll (avdrag för kvalitet -1).Van Ryzin et al 2012, RCT Eddy et al 2004, RCT Chamberlain et al 2007, RCT Author, Year, DesignSex studier med sammanlagt 451 ungdomar redovisade resultat efter 12, 24 och 36 månader[59,60,65,70,81,84]. Utfallet består av andelen ungdomar som placerats i slutenvård efter baslinjemätningen, alternativt antal dagar ungdomarna varit i slutenvård. ...
Social dygnsvård aktualiserar svåra etiska frågor om samhällets särskilda ansvar för ungdomar som begår allvarliga och upprepade brott, komplicerade maktstrukturer som styr vården, kvaliteten på kunskapsunderlag om speci ka insatser, samt organisationen som ansvarar för vården. Det är ett etiskt problem att det är få behandlingsmetoder som används i Sverige som är utvärderade. Därmed är det oklart om olika typer av placeringar gynnar ungdomar och uppfyller grundläggande etiska krav påansvarstagande från samhällets sida.
... Heightened understanding of the carer-child relationship is essential for policy makers and practitioners to work more effectively to enhance the capacity of carers to contribute to improved mental health outcomes for children living in out-of-home care. The recognition of carers as important in improving mental health outcomes for children in care has led to the implementation of forms of home-based care that have an articulated therapeutic framework in countries including Australia, the USA, and the UK (Biehal, Ellison, & Sinclair, 2011;Frederico et al., 2012;Troutman, 2011). ...
... Several researchers have advocated the referral of children in foster care to programmes that utilise traumafocused behavioural interventions, such as MTFC, also known as Intensive Fostering in the UK (for example Biehal, Ellison, & Sinclair, 2011;Fisher & Kim, 2007). MTFC provides carers with training and support to establish nurturing and trusting relationships with children, to manage difficult behaviour, and to promote positive behaviour. ...
Across the developed world, efforts are being made to identify and develop effective interventions that will reduce the prevalence and severity of mental health problems among children and young people in out-of-home care. Foster and kinship carers have been identified as critically important in this process. In order to develop an understanding of what interventions and/or supports assist carers in responding effectively to the mental health needs of the children and young people in their care, a scoping review was undertaken. Using the scoping study method, 1064 publications were identified, and 82 publications were selected for further analysis. The review shows that promising interventions that aim to improve the mental health of children and young people living in out-of-home care have been developed and trialled both in Australia and internationally. However, the review also highlights the lack of research specifically focused on the role of the carer.
... A wider variety of informants are used (carers, social workers, young people, justice statistics), but the use of different measures across studies makes it difficult to compare findings. Follow-up periods are generally better than for other types of intervention, and most include measures taken one year after entry to the placement; some also include follow-ups at 24 months after entry (eg Biehal et al, 2011;Chamberlain et al, 2007;Hansson and Olsson, 2012). ...
... Behavioural evidence from England comes from one pilot and one main trial, and outcomes have been compared with the US. Biehal, Ellison, and Sinclair (2011) compared young offenders (with a mean age of 15 years) in Intensive Fostering (the name of the MTFC pilot for young offenders in England) to others in custody or serving supervised community sentences. Comparisons of offending rates in the year after entry (IF/community sample) or exit (convicted sample) -ie when the opportunity to reoffend was present -showed fewer and less serious offences and fewer reconvictions in the IF group; the latter was unrelated to placement length. ...
... However, these benefits quickly dissipated once the young people left the programme, and within a year of leaving their IF placement or custody there was little difference between the groups (Youth Justice Board, 2010). A further, independent evaluation of IF in England by Biehal et al (2011) reported similar findings. It concluded that: ...
... The authors also raised some concerns as to the generalisability of the research, considering that all studies included in the review were from the USA and were conducted by those involved in developing the TFC programme. Although positive effects on behaviour have also been reported in Sweden [69], such findings are yet to be replicated in the UK, with an evaluation of the Multi-Dimensional Treatment Foster Care -Adolescents programme finding no effect of TFC on offending behaviour [70]. ...
In order to further inform the delivery of service provision to support looked after children and young people (LACYP) in Blackburn with Darwen (BwD), Liverpool John Moores University, were commissioned to undertake research to identify gaps and make recommendations for improving the health and wellbeing of LACYP in BwD.
A comprehensive research framework was implemented to inform the development and delivery of services for LACYP in BwD. The key focus for the research aims were to: describe the epidemiology of health outcomes for LACYP in BwD, identify gaps in current service provision, and assess the quality of service experienced by LACYP. A mixed-methods approach was used to enable the triangulation of a range of qualitative and
quantitative evidence.
... With fewer young people being referred by the courts to locked facilities, there was less demand for foster placements as an alternative to custody. The fact that the evaluation of intensive fostering (Biehal et al., 2010(Biehal et al., , 2011 raised the question of treatment effect 'wash out' may also have been a factor in the decommissioning process. Consequently, TFCO has disappeared from the sentencing options available to UK judges. ...
Treatment Foster Care Oregon (TFCO) is one of a number of systemic, therapeutic ‘family focused’ models brought from the USA to Europe in recent decades. This paper looks at a large-scale implementation of TFCO and how its systemic principles sought to positively impact the ‘looked after children's’ sector within the UK. However, following a 15-year government-driven nationwide implementation initiative, only one UK TFCO site remains, despite the efforts of many skilled and dedicated workers striving to sustain it across the country. This paper explores some of the factors that contributed to the rise and fall of TFCO in Britain, outlining implementation challenges and the learning gained through the UK implementation of TFCO.
Practitioner points
• Treatment Foster Care Oregon (TFCO) is a coherent programme for children and young people who display pronounced, anti-social behaviour
• When an alternative family-based placement is required—and where a return home is feasible—TFCO might be an intervention to consider
• The USA and UK are very different contexts, which makes the transportability of evidence-based programmes challenging
• We must learn lessons from wide-scale implementations that have not been sustained
... In an effort to prevent children from entering the residential care system, some Australian states have imported foster care programs designed in the USA, such as the Oregon model (formerly MTFC) and Children and Residential Experiences (CARE) program, as a way to deal with the crisis. The results of their effectiveness are contentious, with some research finding that young people who had committed offences and were subsequently placed in MTFC foster care reduced their offending behaviour, but that this effect was not sustained beyond the time they were in foster care (Biehal et al. 2012). This indicated that prosocial behaviour had not been Binternalised^. ...
This paper discusses two key strategies detailing how “relationship-focused” and “trauma-informed” intervention practices, which form the basis of an Australian therapeutic program called Treatment and Care for Kids (TrACK), made a difference in the lives of highly traumatised children. The TrACK program fosters highly traumatised children who, due to the complexity of their trauma needs, cannot be placed in traditional generalist foster care. Case files of 48 children were reviewed. Children were either current or former clients over a period of 18 years since the program was initiated. In analysing the data, we noticed that children who were once highly dysregulated in the domains of foster care placement, education, arousal regulation and peer relationships were now enjoying an enhanced level of stability in their lives.
... However, not all research findings have been positive. A significant study conducted by Biehal, Ellison, and Sinclair (2012) found that young people who had committed offences and were subsequently placed in MTC foster care reduced their offending behaviour, but that this effect was not sustained beyond the time they were in foster care. This indicated that prosocial behaviour had not been 'internalised'. ...
There is now considerable evidence to suggest that children placed in foster care experience greater levels of adversity compared to those in the general population. Early adversity has been shown to continue across the lifespan: those who have experienced the sustained trauma of threat or deprivation have a range of poor life outcomes including homelessness, poor mental health, and over-representation in the criminal justice system and low educational attainment.
This paper reports on a study of a program response to children who have experienced trauma and are placed in out-of-home care. The program model, known as Treatment and Care for Kids (TrACK), introduced a paradigm shift in the treatment and care of children in Australia, in that it was designed to provide intensive, home-based therapeutic intervention for children presenting with complex trauma and challenging behaviours. This program sought to integrate knowledge about the neurobiology of trauma with therapeutic practice and care, reflecting growing recognition that ‘care is not enough’ to achieve holistic and effective healing for children who have experienced severe trauma. As such, the relationship that encircles the child was seen as the vehicle for recovery.
The study examined client files and interviewed carers, key professionals and young people who had experienced the therapeutic care program since its inception 18 years ago. Data, informed by narrative inquiry methodology, were analysed. Key findings highlight the significance of relational practice to interrupt the projected trauma trajectory and for young people to stabilise and self-regulate.
... Although quite some efforts have been made in the past years to improve the quality of foster care in Switzerland, one additional way to potentially improve outcomes for youths placed in out-ofhome care could be to integrate structured intensive and individualised support systems into the out-of-home placement. So-called therapeutic foster care programs that provide foster parents with the skills needed to manage and change challenging behaviour have been shown to be capable of decreasing externalising and internalising behavioural problems and improving school engagement and employment (Chamberlain et al., 2008;Knorth, Harder, Zandberg, & Kendrick, 2008;Reddy & Pfeiffer, 1997;Macdonald & Turner, 2008;Westermark et al., 2011), although this may not extend to all child protection systems Biehal, Ellison, & Sinclair, 2012). ...
The aim of this study was to examine the outcomes of out-of-home placement in adolescence. We used data from a longitudinal study of Swiss youths and measured all outcomes, including externalising problem behaviour, anxiety and depression, education, and self-efficacy at age 17. Propensity score matching was used to reduce selection effects and multiple imputation to treat the missing values. The findings revealed that youths who were placed in out-of-home care come from disproportionately problematic backgrounds, which complicated their proper matching to youths who were not placed in out-of-home care. Outcome analyses including multiple robustness checks suggest that negative outcomes among youths who were placed in out-of-home care are not so much due to the placement itself, but largely to pre-existing difficulties present already before the placement. © 2018, Society for Longitudinal and Life Course Studies. All rights reserved.
... However, with one exception, all published evaluations were conducted by the programme developers in the USA or in Sweden by the implementation team (Westermark et al., 2011). The first independent evaluation, our earlier quasi-experimental study of MTFC as an alternative to custody for young offenders, sounded the only cautionary note (Biehal et al., 2010(Biehal et al., , 2011. ...
Randomised controlled trials (RCTs) have rarely been used in evaluations of social work interventions with children in the UK. This article discusses the use of an RCT in the national evaluation of Multi-dimensional Treatment Foster Care for Adolescents (MTFC-A) in the English care system. A number of challenges were encountered in recruiting young people to the trial. These included professional anxieties about randomisation, concerns about accountability, a wish to maintain managerial control over allocations to expensive resources and the small number of MTFC-A places available in each local area, which meant that new placements became available infrequently. We discuss the challenges to the trial and the strategies developed to address these, including the adaptation of the design to take account of both professional concerns and of the particular circumstances of the children involved. Thirty-four children were eventually randomised either to an offer of an MTFC-A placement or to 'treatment as usual', an alternative placement selected by their social workers. A further 185 were included in the parallel observational arm of the study. Recommendations are made for the conduct of future trials in children's social care.
... These benefits seem limited to-or most pronounced amongthose with the most challenging behaviour [11][12][13]-and are probably related to changes in an underlying variable of antisocial behaviour [24]. In two of the five studies they did not persist after the MTFC placement [8,25]. ...
Multi-dimensional Treatment Foster Care (MTFC), recently renamed Treatment Foster Care Oregon for Adolescents (TFCO-A) is an internationally recognised intervention for troubled young people in public care. This paper seeks to explain conflicting results with MTFC by testing the hypotheses that it benefits antisocial young people more than others and does so through its effects on their behaviour. Hard-to-manage young people in English foster or residential homes were assessed at entry to a randomised and case-controlled trial of MTFC (n = 88) and usual care (TAU) (n = 83). Primary outcome was the Children’s Global Assessment Scale (CGAS) at 12 months analysed according to high (n = 112) or low (n = 59) baseline level of antisocial behaviour on the Health of the Nation Outcome Scales for Children and Adolescents. After adjusting for covariates, there was no overall treatment effect on CGAS. However, the High Antisocial Group receiving MTFC gained more on the CGAS than the Low group (mean improvement 9.36 points vs. 5.33 points). This difference remained significant (p < 0.05) after adjusting for propensity and covariates and was statistically explained by the reduced antisocial behaviour ratings in MTFC. These analyses support the use of MTFC for youth in public care but only for those with higher levels of antisocial behaviour. Further work is needed on whether such benefits persist, and on possible negative effects of this treatment for those with low antisocial behaviour.
Trial Registry Name: ISRCTN
Registry identification number: ISRCTN 68038570
Registry URL:www. isrctn. com
... A UK trial where foster parents were taught cognitive methods for handling children's behavioural problems showed no effects on risk of placement breakdown (Macdonald & Turner 2005). In the US and Sweden, trials with the intensive (and expensive) manual-based programme multi-treatment foster care (MTFC) have shown radically lower placement breakdown rates than ordinary foster care (Smith et al. 2001;Kyhle Westermark et al. 2008), even though a UK trial found no sustainable effects on juvenile delinquency ( Biehal et al. 2011). Tools developed in the MTFC programmes have in the US been tried in more mainstream foster care and seem to be effective in reducing both placement disruptions and behavioural problems (Chamberlain et al. 2006;Price et al. 2009Price et al. , 2012. ...
This study examined the role of placement and child characteristics in the unplanned termination of foster placements. Data were used from 169 foster children aged 0 to 20. Results showed that 35% of all foster placement terminations were unplanned. Outcomes of logistic regression analyses demonstrated that behavior problems, parenting stress and a non-Dutch ethnic background of the foster child increased the likelihood of a placement termination. Furthermore, risk accumulation contributed to unplanned terminations. The results indicate that supporting foster parents in managing problem behavior of the foster child and reducing parenting stress may be a key to an effective prevention of disrupted foster care placements.
... The first study is an evaluation of MTFC compared to various alternative placements. Results indicate that while on the programme, MTFC helps to contain and manage a difficult highrisk group of young offenders (Biehal, Ellison & Sinclair, 2011). The second RCT evaluated whether placement in MTFC-A results in improved outcomes relative to typical care placements and which children are most likely to benefit from it. ...
Multi-dimensional Treatment Foster Care
(MTFC): Preventing and treating offending
among looked after children
... However, with one exception, all published evaluations were conducted by the programme developers in the USA or in Sweden by the implementation team (Westermark et al., 2011). The first independent evaluation, our earlier quasi-experimental study of MTFC as an alternative to custody for young offenders, sounded the only cautionary note (Biehal et al., 2010(Biehal et al., , 2011. ...
... A UK trial where foster parents were taught cognitive methods for handling children's behavioural problems showed no effects on risk of placement breakdown (Macdonald & Turner 2005). In the US and Sweden, trials with the intensive (and expensive) manual-based programme multi-treatment foster care (MTFC) have shown radically lower placement breakdown rates than ordinary foster care (Smith et al. 2001;Kyhle Westermark et al. 2008), even though a UK trial found no sustainable effects on juvenile delinquency (Biehal et al. 2011). Tools developed in the MTFC programmes have in the US been tried in more mainstream foster care and seem to be effective in reducing both placement disruptions and behavioural problems (Chamberlain et al. 2006;Price et al. 2009Price et al. , 2012. ...
We used a regional sample of children in long-term foster care to investigate the prevalence of placement breakdown in adolescence, and to assess risk factors/risk markers for placement disruption. The sample consisted of all 136 foster children in the region, born 1980–1992, who on their 12th birthday had been in the same foster family for at least 4 years. They were followed in case files until date of disruption or their 18th birthday. Data on conditions before and during placement were retrieved from case files, and analysed in bi- and multivariate models. Results showed that one in four placements broke down in adolescence. The median child who experienced a breakdown was 14 years old, and had been in the same foster home for more than 10 years. Prominent risk factors were (i) being placed after age 2 and (ii) having a birth sibling in the same foster home. We also uncovered strong risk markers that can be viewed as precursors of placement disruption. When the child or the foster parents repeatedly over time expressed dissatisfaction with the placement, this ended with a placement breakdown in 60% of cases. Implications for practice are discussed.
... There is also some empirical evidence to support the use of the Multi-Dimensional Treatment Foster-Care model (MDTFC; Westermark, Hansson & Olsson, 2011;Chamberlain, 2003), although this is equivocal, with research suggesting that the model is effective only in the short-term (Biehal, Ellison & Sinclair, 2011). This model can be adapted for use with any child between the ages of 3 and 18 years. ...
Looked after children (LAC) often experience multiple placements although different rates of placement instability apply across different local authorities. The aim of this research by Roger Norgate, Amy Warhurst, Carol Hayden, Cara Osborne and Maria Traill was to examine social workers' views on factors influencing placement instability. The research focused on a local authority with higher than average rates of placement changes. Eight groups of social workers across the area were identified and members from each team (N = 71) completed a questionnaire and participated in group interviews. The main themes emerging from staff responses were a difficulty accessing mental health services, lack of placement options and limited foster placements, and over-hasty placement decisions due to strict time restrictions on emergency placements. Additionally, children's challenging behaviours and foster carers' unwillingness to manage, or inexperience in managing, such behaviour was identified as a contributory factor. The need to offer more support to foster carers, with a view to improving recruitment and retention, was identified as a key aspect in reducing the need for placement moves.
Serious youth violence is a complex issue affecting children and young people (CYP), who are disproportionately more likely than adults to be victims of violent crime in the UK and Ireland. There are a range of interventions and approaches to prevent CYP from being involved in crime and violence. The focus of the literature has mostly been on discrete interventions. The literature on system effects and system-level approaches has not yet been systematically collated. That is the task of this EGM.
O objetivo dessa revisão sistemática foi levantar estudos empíricos que tiveram o objetivo de minimizar ou prevenir problemas de comportamento em crianças e adolescentes em situação de acolhimento institucional. Foram utilizadas seis bases de dados: PsycINFO, SageJournals, Web of Science, PubMed/Medline, Lilacs e Scopus. Os critérios de seleção incluíram todos os estudos, publicados em inglês e português, disponíveis entre 2009 e 2019 que tivessem o objetivo avaliar a eficácia e aplicabilidade de intervenções para reduzir ou prevenir problemas de comportamento com essa população. Ao todo foram encontrados 155 estudos e após o processo de exclusão e elegibilidade, restaram 24 artigos incluídos em análise quantitativa. A qualidade dos estudos foi avaliada utilizando Cochrane Risk of Bias Tool e a Quality Assessment Tool. Verificou-se forte evidência do Multidimensional Treatment Foster Care (MTFC) na prevenção e tratamento de problemas de comportamento em crianças e adolescentes em acolhimento institucional.
Palavras-chave: problemas de comportamento, acolhimento institucional, intervenção.
This report provides an overview of the internal scientific evidence on violence prevention. A broad definition of violence is used, which includes legally punishable as well as nonpunishable and (early) risk factors for violence. A total of 26 prevention approaches were identified in the areas of the individual, the family, the school and victim assistance - the effectiveness of which are underpinned by international research results. Each chapter gives practitioners and decision-makers an idea of the objectives, program features and performance of the approaches. The purpose of this report is to strengthen the emerging momentum towards more evidence-based violence prevention around the world and provide a preliminary compass for prevention practitioners.
Il presente rapporto fornisce una panoramica a livello internazionale delle conoscenze scientifiche sulla prevenzione della violenza. Viene utilizzata una definizione ampia del temine «violenza», che comprende sia le forme di violenza penalmente perseguibili sia quelle non perseguibili e i fattori di rischio precoci. Il rapporto si basa su disamine di studi internazionali sull’efficacia della prevenzione della violenza nonché su una ricerca relativa alla struttura dell’offerta esistente e alle valutazioni svolte in Svizzera. Nel complesso, sono stati individuati 26 approcci preventivi incentrati sull’individuo, sulla famiglia, sulla scuola e sull’aiuto alle vittime, la cui efficacia è suffragata dai risultati di ricerche internazionali. In ogni capitolo del rapporto gli operatori del settore e i responsabili politici possono farsi un’idea degli obiettivi, delle caratteristiche dei programmi e dell’efficacia degli approcci in questione. È inoltre fornita una panoramica sulla prassi svizzera e vengono formulate conclusioni e raccomandazioni per possibili strategie e ricerche ulteriori. Sebbene negli ultimi anni in Svizzera siano stati compiuti notevoli progressi nell’ambito della prevenzione della violenza, le conoscenze di base in materia restano comunque troppo esigue per poter fornire raccomandazioni precise per programmi efficaci a livello nazionale. La maggior parte dei programmi proposti in Svizzera non è stata valutata scientificamente in termini di efficacia. Il presente rapporto intende rafforzare ulteriormente il riorientamento in corso verso una prevenzione della violenza maggiormente basata su prove scientifiche e funge da punto di riferimento provvisorio per il lavoro preventivo.
Le présent rapport donne un aperçu des résultats de la recherche en matière de prévention de la violence sur le plan international. La notion de violence est prise ici dans une acception large et englobe aussi bien les formes de violence qui tombent sous le coup de la loi que celles qui ne sont pas punissables, ainsi que les facteurs de risque (précoces) de violence. Le rapport se fonde, d’une part, sur une présentation d’études de synthèse internationales portant sur l’efficacité de la prévention de la violence et, d’autre part, sur une recherche consacrée à la structure actuelle de l’offre et aux évaluations déjà menées en Suisse. Ce sont, au total, 26 stratégies de prévention et d’intervention aux niveaux de l’individu, de la famille, de l’école et de l’aide aux victimes qui ont été identifiées; leur efficacité est avérée par de nombreuses études internationales. Chaque chapitre fournit aux acteurs de terrain et aux décideurs un aperçu des objectifs, des caractéristiques et de l’efficacité des différentes approches. Le rapport donne également une vue d’ensemble de la pratique en Suisse et émet des conclusions et des recommandations pour des stratégies d’approfondissement de la prévention ainsi que pour la recherche. Bien que des progrès considérables aient été réalisés ces dernières années en Suisse, la base de connaissances est encore trop mince pour émettre des recommandations précises quant à l’efficacité des programmes. En effet, la plupart de ceux qui sont proposés n’ont pas fait l’objet d’une évaluation scientifique sur ce point. Le présent rapport, telle une boussole provisoire pour les mesures à prendre, pourra servir à renforcer la dynamique amorcée vers une prévention de la violence davantage axée sur les résultats de la recherche.
Hope for Children of Trauma: An International Perspective synthesizes all the existing evidence, policy and practice from around the world for children and youth who have experienced different forms of complex trauma-such as abuse, neglect and war violence and also presents a real advance in the literature, by covering new material from the author’s extensive visits and collaborations in low and middle-income countries in Asia, Africa and Latin America.The book covers a historical and research overview of developments in trauma and child mental health, global policy and evidence on the impact of trauma on child mental health. In particular, this book communicates real experiences through narratives and supporting photographic material from children in slum areas, orphanages or on the streets, and explores the application of therapeutic approaches by frontline practitioners, therapeutic interventions, service development and training programmes.Integrating testimonies, observations, therapeutic interventions and research findings, Hope for Children of Trauma shows how these problems can be addressed, and will be thought-provoking reading for child and adolescent mental health practitioners, NGOs and policy-makers.
This chapter focuses on programme fidelity in relation to parenting interventions. It discusses the importance of fidelity, outlines strategies for promoting fidelity, and emphasises fidelity and evidence-based parenting programmes. Two major barriers to high fidelity are intervention complexity and a lack of fidelity-facilitation strategies, such as the provision of manuals, guidelines, training, monitoring and feedback, capacity building and incentives. With these obstacles in mind, six ways to promote programme fidelity are described in the chapter. The same programmes also stress aspects of adherence (e.g., the importance of role play rehearsal of new skills) and quality and user engagement (e.g., the importance of the practitioner building a reciprocal relationship with parents). While much about fidelity remains unknown, it is important to measure fidelity in efficacy and effectiveness studies because these fidelity constructs can help to explain the results.
This chapter considers how clinical interventions in edge-of-care contexts can be informed by research demonstrating the effectiveness and potential of various types of intervention. An overview of relevant approaches and their evidence base is given. It is argued that multi-component interventions are likely to be more effective than those used in isolation. The issue of how interventions should be delivered is also discussed, including evidence that interventions are more likely to be effective if attention is paid to engagement issues, if they are based on robust case conceptualisation and if they are appropriately sequenced and goal-oriented. Case examples illustrate the realities of evidence-oriented interventions in practice.
Recently there has been a conceptual shift in thinking, reflected in the use of the phrase ‘intensive services’ rather than ‘alternatives to inpatient provision’ for the range of non-residential intensive CAMHS models on offer. This is a recognition based on the growing evidence, and philosophical changes, that children and young people are best cared for in their community and home settings, which also have the advantage of preserving the use of inpatient units for those who will most benefit from them. However, as we will discuss in this chapter, the evidence base is not sophisticated enough to direct us well about who will most benefit from residential or non-residential intensive model of care, and which community intensive models would be best developed in particular localities for specific groups of young people. Inpatient units are scarce resources especially in LMIC (low and middle income countries). Economic costs are potentially the major limiting factor in the development of inpatient services, and even with improved therapies and delivery there is likely an irreducible cost for inpatient care.
Dieser Bericht bietet einen Überblick über die wissenschaftlichen Erkenntnisse zur Gewaltprävention auf internationaler Ebene. Dabei wurde eine breite Definition von Gewalt angewendet, die sowohl rechtlich strafbare wie nicht strafbare und (frühe) Risikofaktoren für Gewalt beinhaltet. Der Bericht stützt einerseits auf einer Darstellung von internationalen Übersichtsstudien zur Wirksamkeit von Gewaltprävention und anderseits auf einer Recherche zur aktuellen Angebotsstruktur und Evaluationen in der Schweiz. Insgesamt wurden 26 Präventionsansätze in den Bereichen Individuum, Familie, Schule und Opferhilfe identifiziert, deren Wirksamkeit durch internationale Forschungsergebnisse untermauert wird. Jedes Kapitel vermittelt Praktikerinnen und Praktikern sowie Entscheidungsträgerinnen und -trägern einen Eindruck von den Zielen, den Programmmerkmalen und der Wirksamkeit der Ansätze. Zudem wird eine Übersicht über die schweizerische Praxis gegeben und es werden Schlussfolgerungen und Empfehlungen für mögliche weiterführende Strategien und Forschung formuliert. Obwohl in den letzten Jahren in der Schweiz erhebliche Fortschritte im Bereich Gewaltprävention erzielt wurden, ist die Wissensbasis immer noch zu dünn um eindeutige Empfehlungen zu wirksamen Programmen in der Schweiz abzugeben. Die meisten in der Schweiz angebotenen Programme wurden nicht hinsichtlich ihrer Wirksamkeit wissenschaftlich evaluiert. Der vorliegende Bericht soll die begonnene Dynamik hin zu mehr erkenntnisbasierter Gewaltprävention weiter stärken und stellt ein vorläufiger Kompass für die Präventionsarbeit dar.
Jongeren met ernstige gedragsproblemen die zich structureel onttrekken aan hulp kunnen sinds een aantal jaren gedwongen geplaatst worden in een voorziening voor JeugdzorgPlus. Het toerusten van deze jongeren voor deelname aan de samenleving vraagt echter om zorg die verder reikt dan de behandeling in JeugdzorgPlus. Om de behandelresultaten te laten beklijven, is niet slechts nazorg maar langdurig doorgaande zorg nodig.
Staff assumptions and program practices in two models of residential care for male adolescent offenders were compared. Group care settings had from 6 to 15 youths in residence and used peer-mediated treatments. Treatment Foster Care settings had one youngster placed in each home and treatments were adult-mediated. Results showed that group care and Treatment Foster Care program models differed on staff assumptions about therapeutic mechanisms of change, and different patterns of daily program practices were found.
The practice of placing children and adolescents with severe antisocial behavior and delinquency in residential and group home settings is commonplace in most communities in the United States, yet little research exists on the short- or long-term effectiveness of such placements. Furthermore, recent evidence suggests that there are potentially damaging effects from placement in congregate care settings that relate to negative influences that problem youth who are placed together tend to have on each other. The Oregon Multidimensional Treatment Foster Care (MTFC) model was developed as an alternative to group and residential care for youth with delinquency and severe emotional and behavioral problems. The central features of the Oregon MTFC model are described, evidence on the efficacy of the model is reviewed, and practical aspects relating to dissemination are discussed along with conditions that act to facilitate or create barriers to implementation.
The disposition of a large sample of early childhood abuse and neglect cases was followed up via criminal records. The majority of the children were placed outside the home, primarily in foster care. Kinds of placement and factors affecting placement decisions were examined. Differences in arrest rates were found between children placed solely because of abuse or neglect and those placed for abuse or neglect in conjunction with delinquency. Similar results were found for foster care placement. Placement alone did not appear to increase risk of criminal behavior.
Previous reports of child maltreatment sequelae have not systematically examined the effects of societal intervention. A historical cohort study has been undertaken to examine the impact of one intervention, foster care, on the subsequent development of juvenile delinquency among child victims. One hundred fourteen foster children, aged 11 to 18 years, in foster care for three or more years, and who were in foster care as a result of maltreatment were studied. A comparison cohort was composed of 106 victims of maltreatment who were left in their family home; these children were similar to the children in foster care with regard to age, race, sex, and year of diagnosis. Cohort differences in maternal education, type of abuse, history of prior maltreatment, sex, and race were controlled in the analysis. Foster children committed 0.050 crimes per person-year after age 11 years; home care children committed 0.059 crimes per person-year after age 11 years (P greater than .2). Foster children were more likely to have committed criminal assault. Among foster children, increased number of foster home placements correlated with increased number of delinquency convictions. Overall, there appears to be no support for the idea that foster care is responsible for a significant portion of later problems encountered by victims of maltreatment.
The relative effectiveness of group care (GC) and multidimensional treatment foster care (MTFC) was compared in terms of their impact on criminal offending, incarceration rates, and program completion outcomes for 79 male adolescents who had histories of chronic and serious juvenile delinquency. Results show that boys who participated in MTFC had significantly fewer criminal referrals and returned to live with relatives more often. Multiple regression analyses showed that assignment to a treatment condition (i.e., GC or MTFC) predicted official and self-reported criminality in follow-up beyond other well-known predictors of chronic juvenile offending (i.e., age at 1st offense, number of previous offenses, age at referral).
This article explored developmental and intervention evidence relevant to iatrogenic effects in peer-group interventions. Longitudinal research revealed that "deviancy training" within adolescent friendships predicts increases in delinquency, substance use, violence, and adult maladjustment. Moreover, findings from 2 experimentally controlled intervention studies suggested that peer-group interventions increase adolescent problem behavior and negative life outcomes in adulthood, compared with control youth. The data from both experimental studies suggested that high-risk youth are particularly vulnerable to peer aggregations, compared with low-risk youth. We proposed that peer aggregation during early adolescence, under some circumstances, inadvertently reinforces problem behavior. Two developmental processes are discussed that might account for the powerful iatrogenic effects.
The influence of family management skills (i.e., supervision, discipline, and positive adult-youth relationship) and deviant peer association on youth antisocial behavior was examined within the context of a randomized clinical trial contrasting multidimensional treatment foster care and services-as-usual group care. Participants were male adolescents with histories of chronic and serious juvenile delinquency who were mandated into residential care by the juvenile court. As hypothesized, family management skills and deviant peer association mediated the effect of treatment condition and accounted for 32% of the variance in subsequent antisocial behavior.
Returning children to their biological families after placement in foster care (ie, reunification) has been prioritized with legislation. Comprehensive studies of child behavioral health functioning after reunification, however, have not been conducted. This study examined outcomes for youth who were reunified after placement in foster care as compared with youth who did not reunify.
Prospective cohort.
Children who entered foster care in San Diego, California, and who remained in foster care for at least 5 months. Participants. A cohort of 149 ethnically diverse youth, 7 to 12 years old, who entered foster care between May 1990, and October 1991. Seventy-five percent of those interviewed at Time 1 were interviewed at Time 2 (6 years later).
1) Risk behaviors: delinquent, sexual, self-destructive, substance use, and total risk behaviors; 2) Life-course outcomes: pregnancy, tickets/arrests, suspensions, dropping out of school, and grades; 3) Current symptomatology: externalizing, internalizing, total behavior problems, and total competence.
Compared with youth who were not reunified, reunified youth showed more self-destructive behavior (0.15 vs -0.11), substance use (0.16 vs -0.11), and total risk behavior problem standardized scores (0.12 vs -0.09). Reunified youth were more likely to have received a ticket or have been arrested (49.2% vs 30.2%), to have dropped out of school (20.6% vs 9.4%), and to have received lower grades (6.5 vs 7.4). Reunified youth reported more current problems in internalizing behaviors (56.6 vs 53.0), and total behavior problems (59.5 vs 55.7), and lower total competence (41.1 vs 45.0). There were no statistically significant differences between the groups on delinquency, sexual behaviors, pregnancy, suspensions, or externalizing behaviors. Reunification status was a significant predictor of negative outcomes in 8 of the 9 regression equations after controlling for Time 1 behavior problems, age, and gender.
These findings suggest that youth who reunify with their biological families after placement in foster care have more negative outcomes than youth who do not reunify. The implications of these findings for policy and practice are discussed.
Preschool-aged foster children face multiple risks for poor long-term outcomes. These risks appear to increase with the number of placement changes experienced. The Early Intervention Foster Care Program (EIFC) targets the spectrum of challenges that preschool-aged foster children face via a team approach delivered in home and community settings. In this article, we report on permanent placement outcomes from the EIFC randomized clinical trial. Children in EIFC had significantly fewer failed permanent placements than children in the regular foster care comparison condition. The number of prior placements was positively associated with the risk of failed permanent placements for children in the comparison condition but not for children in EIFC. Type of prior maltreatment did not predict permanent placement outcomes. These results provide the foundation of an evidence base for the EIFC program as a preventive intervention to improve permanent placement outcomes for preschool-aged foster children.
Although association with delinquent peers is a recognized precursor to ongoing delinquency problems, youth in the juvenile justice system are commonly prescribed intervention services that aggregate delinquent youth. However, little is known about the process variables that mediate the relationship between aggregating youth in intervention settings and poor subsequent outcomes. We examined data from two randomized intervention trials (one male sample and one female sample) with delinquent adolescents placed either in Multidimensional Treatment Foster Care (MTFC) or in group care. Path analyses suggested that the MTFC youth had fewer associations with delinquent peers at 12 months than did the group care youth. Further, associating with delinquent peers during the course of the intervention mediated the relationship between group condition and 12-month delinquent peer association. Implications for the development of interventions with delinquent youth are discussed.
An increasing number of girls are entering the juvenile justice system. However, intervention programs for delinquent girls have not been examined empirically. The authors examined the 12-month outcomes of a randomized intervention trial for girls with chronic delinquency (N = 81). Girls were randomly assigned into an experimental condition (Multidimensional Treatment Foster Care; MTFC) or a control condition (group care; GC). Analyses of covariance indicated that MTFC youth had a significantly greater reduction in the number of days spent in locked settings and in caregiver-reported delinquency and had 42% fewer criminal referrals than GC youth (a trend) at the 12-month follow-up. Implications for reducing girls' chronic delinquency are discussed.
It has been argued that group treatment of antisocial adolescents may increase rather than decrease conduct problems. One mechanism that has been suggested to underlie this effect is "deviancy training," wherein during group sessions deviant peers reinforce each other's antisocial actions and words. These 2 hypotheses have important implications and warrant close review at conceptual and empirical levels. In this article, the authors present such a review. Conceptually, deviancy training potential of treatment sessions appears less significant than the more extensive peer influences outside treatment. Empirical findings previously cited in support of iatrogenic effects appear on close examination to provide little support. Finally, 17 of 18 new meta-analytic tests produced results not supportive of iatrogenic or deviancy training effects.
Abstract In the Cambridge Study in Delinquent Development, 411 South London males have been followed up from age 8 to age 32. The most important childhood (age 8–10) predictors of delinquency were antisocial child behaviour, impulsivity, low intelligence and attainment, family criminality, poverty and poor parental child-rearing behaviour. Offending was only one element of a larger syndrome of antisocial behaviour that arose in childhood and persisted into adulthood. Marriage, employment and moving out of London fostered desistance from offending. Early prevention experiments are needed to reduce delinquency, targeting low attainment, poor parenting, impulsivity and poverty.
This study examines 24-months post-baseline outcomes for thirty-five Swedish antisocial youths who received either treatment in multidimensional treatment foster care (MTFC) or treatment as usual (TAU). MTFC is a community-based treatment programme that has been successful in treating chronic juvenile offenders in the USA. This study is the first randomized control study outside the USA. The youth treated in the MTFC programme consistently showed some statistically significant positive treatment effects compared to the youth exposed to TAU. The results suggest that MTFC might be an effective method in treating youth with severe behaviour problems in a Swedish context. The authors conclude that the programme ought to be of great interest for Swedish social services as an alternative to traditional care.
A substantial body of literature suggests that childhood maltreatment is related to negative outcomes during adolescence, including delinquency, drug use, teenage pregnancy, and school failure. There has been relatively little research examining the impact that variation in the developmental stage during which the maltreatment occurs has on these relationships, however. In this paper, we reassess the impact of maltreatment on a number of adverse outcomes when developmentally specific measures of maltreatment-maltreatment that occurs only in childhood, only in adolescence, or in both childhood and adolescence-are considered. Data are drawn from the Rochester Youth Development Study, a broad-based longitudinal study of adolescent development. The analysis examines how maltreatment affects delinquency, drug use, alcohol-related problems, depressive symptoms, teen pregnancy. school dropout, and internalizing and externalizing problems during adolescence. We also examine whether the type of maltreatment experienced at various developmental stages influences the outcomes. Overall, our results suggest that adolescent and persistent maltreatment have stronger and more consistent negative consequences during adolescence than does maltreatment experienced only in childhood.