Shared learning database

Action for Children - Multi-treatment Foster Care (MTFC), also known as Intensive Fostering
Published date:
March 2014

Multi-treatment Foster Care (MTFC), also known as Intensive Fostering (IF), is based on social learning theory. Intensive support is given to the young person in a solo foster placement, supported by a multi-disciplinary team, each with a clearly defined role and set of responsibilities. The intention is to change behaviour through promoting positive role models.

Placements, which last between 9 and 12 months, are intense and tailored to the young person's specific needs, with 24-hour support from the programme supervisor. During the placement, the young person's behaviour is closely monitored and good behaviour is rewarded by a points-based system.

Young people are placed with a specially trained foster family, who positively reinforce appropriate behaviour. Family therapy is provided for birth parents, and they are taught the same MTFC strategies in preparation for reuniting them with their child. This initiative aligns with quality statements 2, 5 and 7 in QS31.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

MTFC is a community-based intervention, in which a multi-disciplinary team works intensively with young people and their families during a placement with specifically trained foster carers, encouraging and reinforcing positive behaviours and diverting young people from anti-social behaviour and peers who encourage that behaviour. We aim to promote stability in their lives and the ability to live in a family, whether the outcome is a return to their birth or extended family, long-term fostering, or adoption.

- To support positive behaviour through individual behaviour management plans, using a system of points and levels.
- To return a young person to their family, if it is their best interests to do so. Where this is not possible, alternative carers are identified to meet their needs once the time limited programme is completed.
- To ensure that any gains made during the placement are retained when the young person leaves the programme, and that the young person receives consistent and authoritative care and support aimed to reinforce desired behaviours.
- To deliver the programme, with fidelity to the Oregon model, in order to maximise its impact.

Reasons for implementing your project

The Anti-social Behaviour Act 2003 gave courts the power to include a fostering requirement as part of a Supervision Order in cases where young people's behaviour was to a large extent due to their home circumstances and lifestyle.

In 2005, the Youth Justice Board (YJB) commissioned agencies in three parts of England to pilot the evidence-based MTFC intervention. Three years later, the Criminal Justice and Immigration Act 2008 created new circumstances in which young people could be sentenced to IF. Under this Act, courts may now require a minimum of six months in Intensive Fostering as a condition of a Youth Rehabilitation Order (YRO). After the initial pilot phase, Action for Children has continued to deliver services in two locations in England.

To enable outcomes monitoring and to ensure that young people have the motivation and understanding to succeed, all entrants aged between 10 and 17 are assessed prior to acceptance on the programme. Baseline data is collected about key outcomes achieved through the programme, such as school attendance, offending behaviour and safeguarding issues.

It is important to be clear about a young person's welfare, mental health and youth justice needs at the start of the programme, in order to put in place target outcomes. The assessment prior to entry on to the programme is essential for three main reasons:
1. To assess the young person's level of understanding of the programme and cognitive ability to understand the key concept of losing and gaining points, and its relationship to their behaviour and consequences.
2. To identify the young person's motivation for being involved in the programme. This might only be to avoid custody, residential or secure accommodation (i.e. to avoid something 'worse'). Young people need to demonstrate some willingness to comply with the programme.
3. To identify something the young person wants to work towards.
Parent Daily Report (PDR) monitoring is at the heart of the programme. This is the professionals' tool to record behaviour across 37 indicators and to govern the points awarded to the young person. Frequent trend reporting allows for concerns to be picked up quickly and resolved before they escalate and threaten disruption. It also allows the team to detect patterns or cycles of behaviour. Referrals to the programme come from Local Authorities for welfare placements and from YOTs for alternative to custody placements.

How did you implement the project

Carers are specially recruited to be Intensive Fostering Carers. They receive 12-14 hours pre service training in the MTFC programme and their role. Approved carers are seen as integral members of the multi-disciplinary team, which supports individualised programmes for each young person based on the MTFC model. Support for carers, families and young people is available 24 hours a day.

Foster carers meet weekly with other Intensive Fostering carers on the programme to learn from and support one another.

The Intensive Fostering team work to:
- provide the young person with close supervision
- provide the young person with fair and consistent consequences
- provide a supportive relationship with at least one mentoring adult
- minimise association with peers who may be a negative influence
- teach skills required for getting along in a family, community or school setting

The University of York evaluation concluded that on average the IF placement cost £68,736 and the index custodial placement cost £53,980. However, this is due to the length of placement: for the IF group, placements were nine months, compared to an average of around four months for the custody group. The analysis therefore tentatively shows that unit cost per placement day with IF tends to be lower than custodial facilities.

Replication of IF and programme fidelity
The University of York evaluation recognised that, as IF was running as a pilot study at the time, many of the processes were underdeveloped. It also highlighted how the programme has changed to ensure greater model fidelity and improved delivery, especially the after-care phase, which supports the young people and families post placement.

Action for Children has also worked with stakeholders to realise and demonstrate the benefits of such a different way of working. For example, we have developed close relationships with courts and YOTs to ensure a clear understanding and effective use of IF.

We found that the impact of the intervention diminished a number of months after the placement ended and in response we have improved our after-care, with tailored programmes. We understand that young people's needs change over time. Some young people will move into independent living following the programme, so in these cases we gear our work to support them in the initial stages of living independently.

Key findings

Our Wessex programme was externally evaluated by the University of York and the findings were published in 2010. The research showed that the MTFC service was successful in preventing offending behaviour of young people in placements in 90% of cases. This outcome is in line with random controlled test findings in the USA, demonstrating that we have matched the high levels of success that this evidence-based programme has achieved previously. The University of York evaluation study also found that:
- the young people who had experienced Intensive Fostering were more likely to be engaged in education or training (70% rather than 30% in the comparison group of young people in custody)
- over half of the young people returned home to their families
- none of the Intensive Fostering group were in custody or homeless
Outcomes from Wessex MTFC service:
- Since the Wessex service began in 2005, there have been over 100 referrals and 62 placements. Of these, 40 young people have successfully 'graduated' from the programme.
- All graduates were in education, training or employment at time of graduation.
- 25 of the 40 graduates returned home to live with their parents.
- 12 of the 40 graduates moved into supported accommodation.
- Two remained with Action for Children foster carers.
- All young people reported improved relationships with their birth families.
- A minimal number of young people have committed offences whilst on the programme.
- All young people achieved at least one GCSE.
The Howard League sets out comparative unit costs of custodial places for children. This shows the potential of IF to be a cost-effective option:
- based on full occupancy for 10 beds, IF costs £1,632 per week - £84,864 per annum - Secure Children's home costs £4,135 per week - £215,000 per annum - Secure Training Centre costs £3,075 per week - £160,000 per annum Youth Offender's Institute costs £1,153 per week. This amounts to £60,000 per annum (not suitable for many of the children placed on IF) and does not include costs of education, mental health/therapeutic input or the cost of buildings.
Loughborough University completed a report on behalf of the then Department for Children, Schools and Families to evaluate the costs of MTFC and its effectiveness in comparison to alternative placements for a similar cohort of young people. The study found that there was a reduction in social care costs, and costs to other agencies.

Key learning points

When developing IF, it is useful to think about Remand Fostering, as it provides a continuum of care from early intervention through to custody level and can provide a larger pool of carers who have experience in working with children in the youth justice system. The use of Remand Fostering also provides more opportunities to identify young people via the placements who may be suitable for IF. This option gives young people a chance to show that they can manage a community option in a foster placement. That said, IF does not need to be run in tandem with Remand Fostering as they are two very different services. Remand Fostering is much more time limited and faces its own challenges in engaging young people.

At Action for Children we work to ensure that staff are supported and trained to run the MTFC model and that the right carers are recruited. Both are essential to ensuring model fidelity. Managers addressed challenges by creating a positive environment and role-modelling the positive attitude that is needed to work on the model. We also learned a great deal about what attributes are needed from carers/staff which as resulted in a strong, committed team.

Our IF team in London has faced particular challenges in implementation of the programme, not least the challenges in building relationships with 32 different Youth Offending Teams (YOTs) and the difficulties in recruiting foster carers in London, with a lack of foster carers willing to sign-up with the right skills set.

Contact details

Kate Mulley
Head of Policy and Research
Action for Children - Multi-treatment Foster Care (MTFC), also known as Intensive Fostering

Social services
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