Multidimensional Treatment Foster Care
What is it?
Children chosen for this scheme will usually have very challenging behavioural problems and will have experienced multiple placement breakdowns. They are sent to live with specially trained foster parents who are supported around the clock by a team of professionals from health, education and social care. Individual treatment programmes are created for each child.
Each set of foster parents looks after just one child for between six months and a year, concentrating on behaviour management to promote emotional stability and the skills needed to live in a family.
The specialist foster carers are supported on a daily basis by a team which usually includes:
- a clinical psychologist who develops the intervention programme for each child
- skills coaches who assist the child in social activities
- an education worker who provides guidance to the child's school, teachers and mentors
- a family therapist who works with birth family to ensure contact supports the placement and who helps prepare the follow-on family
The foster carers themselves benefit from:
- specialist training in the MTFC model
- a clear detailed behavioural programme designed for each child which is developed by the programme supervisor - taking some of the stress associated with discipline off the foster parent
- weekly carers support group
- respite care available from other MTFC carers
- 24/7 on-call support from the MTFC team
- a substantial financial remuneration package
The programme is based on teaching children new skills - in their foster home, school and social environments. The focus is on supporting and encouraging positive behaviour and setting clear and consistent limits. Keeping children away from peers who are a bad influence is also central.
Multidimensional Treatment Foster Care was originally developed and evaluated in the USA as a cost-effective alternative to residential treatment for adolescents with complex needs and challenging behaviour, including offending behaviour. Some local authorities have been trialing it in England since 2003 with funding from the Department for Children, Schools and Families (DCSF).
Multidimensional Treatment Foster Care in England programme
The Multidimensional Treatment Foster Care in England programme (funded by DCSF) aims to develop effective placements and services for young people with complex welfare needs who are looked after by local authorities. Complex needs include offending, anti-social behaviour and severe emotional and behavioural difficulties. The scheme in England is managed by a ‘national implementation team’ which is made up of people from the Institute of Psychiatry and two NHS hospitals.
A total of 18 local authorities are currently piloting the programme. Funding for the programme was made available between 2002-03 and 2005-06 through a bidding process. New local authorities came on stream to the programme in each of the 4 years and all are now working towards accreditation with the Oregon Social Learning Center at which point they will cease to be DCSF pilots.
Three programmes are being trialed for children of different ages. The ‘adolescents programme’ is for young people aged 11 to 16 and is designed to help them make the most of relationships with friends and family, to get on well in school and to enjoy leisure activities. The ‘children programme’ is for seven to 11-year-olds and is aimed at helping them develop skills in relationships, improve behaviour and get on well in school. A third programme – ‘prevention’ - is aimed at averting children aged three to six from developing behavioural difficulties and helping them learn to thrive in a classroom environment.
Over the last four years the national MTFCE programme has been developing a sound body of knowledge about what does and doesn't work. The implementation team have found that there are key aspects of the model which, when delivered consistently, combine to produce the best outcomes for young people:
- Quality observations allow for the complexity of young people's presentations to be understood; to see when aggressive behaviours are being driven by anxiety or to see the impact of a young person's impulsiveness on their conduct problems in school. This level of observation allows interventions to be designed that address the functions of the behaviour as well as the behaviour itself. MTFC foster carers are trained to contribute such observations.
- Maintaining a positive focus is crucial; being positive about the small steps that a young person is taking and also about the way these steps contribute to longer term goals for the young person and their family.
- Foster carer recruitment is a continual process. There are now teams across England who have highly trained and experienced foster carers who are able to support newer carers coming on board. Carers consistently report that the support from other carers is the most useful aspect of the MTFC programme.
What happens when a child leaves the scheme?
The introduction of any short-term ‘treatment' fostering provision like this scheme means that participating local authorities have to examine their current practices within fostering. After completing the programme, the child or young person ought to be moved to a well-planned permanent family-based placement where he or she continues to be supported by the extended team to help them build on the skills they have developed.
However, most MTFC teams report difficulties moving children on in a planned way. The following example is not unusual:
Dean (12) had moved into an MTFCE placement exhibiting multiple problem behaviours, including aggression, hyperactivity and emotional withdrawal. He had been excluded from his special school and had no contact with family members due to his behavioural difficulties. After 14 months in an MTFCE placement his behaviours on the PDR were reduced to 2-3 each day, he had re-established himself in school and was having regular contact with three family members. The MTFCE team asked the fostering team for a permanent single placement for him and gave three months for this to be achieved. The fostering service advertised and recruited a couple to care for Dean. However, they used the placement for another ‘emergency' placement. Dean is asking why he has not moved on and his behaviours have deteriorated.
‘Dean' is one of a number of young people in the MTFCE programme whose achievements are being compromised by a lack of planning within the wider fostering service.
Two MTFC teams (Solihull and Salford) have set up additional teams to provide long-term placements for young people leaving the programme and for other young people needing a higher level of support. The Hammersmith and Fulham MTFC team has a permanence planning team working alongside them who recognise the long-term value in matching young people for permanent placements.
However, these examples are the exception rather than the norm. The truth is that if there is a lack of joined-up practice, then children who are considered ready to leave the scheme can be left in limbo as the local authority struggles to find a suitable placement - risking undoing all the good work.
So does it make a difference?
Between 2004 and the end of March 2009 122 young people left the MTFC programme, 72 of whom were classed as ‘graduates’, meaning they had completed their individual programmes and moved on to family-based placements.
Figures for this ‘graduate’ group show a reduction in most high risk behaviours - offending, violence, self-harm, problematic sexual behaviour, absconding, fire-setting and alcohol abuse compared with their behaviour before they went on the programme. Only substance abuse increased, and it's thought that this may be because it had been previously unnoticed but was now detected by closer supervision.
Of the others, 36 were classed as ‘early leavers’, meaning the placement broke down less than three months in, and 14 were ‘late leavers’, meaning they stayed in the programme for more than three months but either did not complete the programme or moved from MTFC to non-family based placements.
So on balance the answer seems to be yes - it reduces high risk behaviours, but the scheme needs to be thoughtfully integrated into a local authority's fostering service, together with any changes in practice and culture that are required to make sure the success of the scheme is sustained and built upon when a child leaves and moves on to another placement.
The Who Cares? Trust would really like to know what you think. Do you work in fostering or are you a young person who's been on a MTFC programme? You can leave a comment below or if you prefer, write to us and let us know your experience or views.
Joan Moore says:
Kate Hamilton says: