Multidimensional Treatment Foster Care (MTFC) has demonstrated advantages over group residential placement for teen girls who are mandated to out-of-home care by the juvenile justice system (see Program Reduces Girls' Delinquent Behavior). New findings from a follow-up to a NIDA-supported trial indicate that those benefits extend to a reduction in illegal drug use in young adulthood.
Researchers re-contacted 153 young women who as teenagers had participated in a randomized controlled trial of MTFC in the State of Oregon. In the trial, half of the girls had been placed into MTFC at 22 state-supervised homes with highly trained foster parents, and half had been assigned to 35 community-based programs, consisting mostly of group-care facilities. The girls were 13 to 17 years old when placed, and spent roughly 5 to 6 months, on average, in their placements. In interviews that were scheduled every 6 months during a 2-year period that began 7 to 9 years after the start of the trial, women reported on their own and their romantic partners’ use of illegal drugs, excluding marijuana, over the past 6 months.
Figure. A Foster Care Program for Girls Who Had Shown Delinquent Behavior Reduces Drug Use 7 to 9 Years Later Drug use declined during the 2-year study period among young women who had been court mandated to out-of-home care as teens and had received Multidimensional Treatment Foster Care, but not among those who had been assigned to group care. The women self-reported drug use in the past 6 months on a scale ranging from “never” (1) to “one or more times per day” (5).
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The figure shows a line chart of the frequency of drug use over time among young women who were in MTFC or had received treatment as usual. The vertical (y) axis indicates drug use frequency in the past 6 months, and the horizontal (x) axis shows the time of each assessment for drug use at 0, 6, 12, 18, and 24 months. Both groups of women showed a similar frequency of use of about 1.4 to 1.5 on the frequency scale during the last 6 months up to the 6-month assessment. After 6 months, use among the women who had been in MTFC (indicated by red circles and lines) steadily declined to about 1.2 during the last 6 months at the last assessment at 24 months, while use among the women who had received the treatment as usual (shown by blue diamonds and lines) slightly increased to about 1.55 during the last 6 months.
The women who had been placed in MTFC and those who had been in group care both reported low levels of drug use, ranging between “never” and “once or twice.” However, those who had been in MTFC reported declining drug use over the course of the five assessments, while those who had been in group care reported stable drug use (see Figure). MTFC exerted small to medium beneficial effects both on the change in drug use over the 2-year period (effect size of 0.39) and on the use at the final follow-up (effect size of 0.45).
Dr. Kimberly Rhoades, of the University of Oregon and Oregon Social Learning Center (OSLC), says that the trajectory of drug use reported by the women in the MTFC group conforms to the norm for the general population, in which use tends to rise in adolescence, peak at ages 18 to 20, and then fall.
Dr. Rhoades says, “We saw a normative decline of drug use in the young women who had been in MTFC. Their use therefore more closely resembled what you would expect to see in a community population with lower to average risk for drug use.” She adds that MTFC may provide teenagers with the tools to make healthy decisions when they reach young adulthood.
“In a high-risk group of adolescent girls, the intensive intervention provided by MTFC can mitigate some of the risk for drug use in the young adult period,” concludes Dr. Rhoades, who conducted the study with colleagues at OSLC and the University of Sussex, United Kingdom.
The MTFC program places teens in homes with foster parents who are trained to use positive reinforcement and encouragement. The program provides intensive supervision and guidance, including:
- Daily phone calls to foster parents to monitor the girls’ progress
- Weekly group meetings for the foster parents
- Daily in-home behavior management program for the girls
- Regular monitoring of the girls’ school attendance, performance, and homework completion
- Family therapy for the aftercare placement family (usually the biological family) focused on parent management strategies
The teenagers typically continue to attend their local high school, and MTFC teaches them to understand expectations and consequences, manage their emotions, and develop refusal skills to avoid high-risk behaviors, including drug use and risky sexual activity.
This study was supported by NIH grants DA015208, DA024672, and DA023920.
Source:
Rhoades, K.A.; Leve, L.D.; Harold, G.T. et al. Drug use trajectories after a randomized controlled trial of MTFC: Associations with partner drug use. Journal of Research on Adolescence 24(1):40-54, 2014. Full text