Summary
Delivery of the intervention: Family
Aim of the intervention: The aim of the intervention is to create a positive change in a situation, where an adolescent has multiple behavioral and substance abuse problems and the supportive measures of the child welfare open care have been found insufficient. MDFT strengthens the interaction between the adolescent and their supportive network, taking into account the multiple environments, in which the adolescent acts and their closest ones as a part of the work.
Description of the intervention: MDFT is an intensive family intervention targeted for families with 12–19 year-old adolescents suffering from behavioral and substance abuse problems. The theoretical framework of the intervention is based on systemic and structural family therapy, ecological system theoretical framework (Brofenbrenner 1979), constructs of developmental psychology and cognitive behavioral therapy and its interventions to promote change. MDFT-team meets the adolescent, parents, other closest ones and the supportive network of the adolescent together and separately 2–3 times a week according to each particular situation. The duration of the MDFT-intervention varies from 5 to 9 months. The intervention aims to strengthen the functionality of the network and increase the adolescent’s and parents’ motivation for change (Ehrling 2014). The intervention uses a structured model to ensure fidelity, but the model can be tailored based on individual needs. The meetings are video-recorded to be assessed by method trainers.
Availability of the intervention in Finland: MDFT-instructor training is targeted for the social and health care professionals, who have working experience with children and adolescents. The training is targeted at work teams. Mental Health Finland (Mieli ry) jointly with the European MDFT-Academy organizes the trainings. The European MDFT-Academy is responsible for the dissemination of the intervention and certification of the MDFT-instructors in Europe. Multidimensional Family Therapy (MDFT) has been developed in the USA in the 1980´s and Mental Health Finland has been responsible for the development of the Finnish intervention. The development project of the MDFT by the Mental Health Finland has been completed but the intervention has not been implemented.
Research- and evidence-based efficacy of the intervention: There are international randomized controlled trials and two meta-analyses on the MDFT (Filges et al. 2015; van der Pol 2017). Most RCT-studies indicate that MDFT yields better treatment results than other therapies that are used (Henderson et al. 2010; Liddle et al. 2009). The adolescents participating in the intervention reduced substance abused more and faster than the control group (Henderson et al. 2010; Liddle et al. 2004; Liddle et al. 2008) and the change was found also in a 12-month follow up (Liddle et al. 2008; Liddle et al. 2009; Greenbaum et al. 2015). Depression and anxiety problems, behavioral problems as well as criminality were reduced compared to the adolescents who received other treatments (Liddle et al. 2009). Meta-analyses have shown that compared to other treatments, the MDFT is more effective in reducing substance abuse, criminality and behavioral problems (van der Pol et al. 2017) as well as decreasing the severity of substance abuse (Filges et al. 2015). The effect sizes in those meta-analyses were small. No peer reviewed research on the intervention has been conducted in Finland. The intervention has strong research-based evidence of effectiveness and it is evaluated as a strong intervention.
Literature:
- Brofenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press, Cambridge, Massachusetts.
- Ehrling, L. (2014). Multidimensional family therapy. Uusi työtapa nuorten monimuotoisiin ongelmiin. Kokemuksia MDFT:n mahdollisuuksista. Loppuraportti. Helsinki: Suomen Mielenterveysseura.
- Filges, T., Andersen, D. & Klint Jørgensen, A. (2015). Effects of multidimensional family therapy (MDFT) on nonopioid drug abuse: A systematic review and meta-analysis. Research on Social Work Practice, 1–16.
- Greenbaum, P. E., Wang, W., Henderson, C. E., Kan, L., Hall, K., Dakof, G. A. & Liddle, H. A. (2015). Gender and ethnicity as moderators: Integrative data analysis of Multidimensional Family Therapy randomized clinical trials. Journal of Family Psychology, 29, 919–930.
- Henderson, C. E., Dakof, G. A., Greenbaum, P. E. & Liddle, H. A. (2010). Effectiveness of multidimensional family therapy with higher severity substance-abusing adolescents: report from two randomized controlled trials. Journal of Consulting and Clininal Psychology, 78(6), 885–897.
- Liddle, H. A., Rowe, C. L., Dakof, G. A., Ungaro, R. A. & Henderson, C. C. (2004). Early intervention for adolescent substance abuse: Pretreatment to posttreatment outcomes of a randomized clinical trial comparing multidimensional family therapy and peer group treatment. Journal of Psychoactive Drugs, 36, 11, 49–63.
- Liddle, H., Dakof, G., Turner, R., Henderson, C. & Greebaum, P. (2008). Treating adolescent drug abuse: a randomized trial comparing multidimensional family therapy and cognitive behavior therapy. Addiction, 103, 1660–1670.
- Liddle, H., Rowe, C., Dakof, G., Henderson, C. & Greenbaum, P. (2009). Multidimensional family therapy for young adolescent substance abuse: twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 77, 12–25.
- Van der Pol, T. M., Hoeve, M., Noom., M., Stams, G., Doreleijers, T., Domburgh, L. & Vermeiren, R. (2017). Research review: The effectiveness of multidimensional family therapy in treating adolescents with multiple behavior problems – a meta-analysis. Journal of Child Psychology and Psychiatry.