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Multidimensional Treatment Foster Care for Adolescents in English care: randomised trial and observational cohort
J M Green1, N Biehal, C Roberts
1J. M. Green, BA, MA, MBBS, DCH, FRCPsych, Institute of Brain Behaviour and Mental Health, The University of Manchester, Manchester; N. Biehal, BA, MA, PhD, Department of Social Policy and Social Work, University of York, York; C. Roberts, BSc, MSc, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, BA, MA, Social Policy Research Unit (SPRU), University of York, York; C. Kay, BSc, PhD, Institute of Brain Behaviour and Mental Health, The University of Manchester, Manchester; E. Parry, BA, MSc, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, BSc, PhD, A. Roby, BSc, MSc, ClinPsyD, D. Kapadia, BSc, MSc, Institute of Brain Behaviour and Mental Health, The University of Manchester, Manchester; S. Scott, MB BChir, FRCP, FRCPsych, Institute of Psychiatry, King's College London, London; I. Sinclair, BA, PhD, Social Policy Research Unit (SPRU), University of York, York, UK.
Background:
Children in care often have poor outcomes. There is a lack of evaluative research into intervention options.
Aims:
To examine the efficacy of Multidimensional Treatment Foster Care for Adolescents (MTFC-A) compared with usual care for young people at risk in foster care in England.
Method:
A two-arm single (assessor) blinded randomised controlled trial (RCT) embedded within an observational quasi-experimental case-control study involving 219 young people aged 11-16 years (trial registration: ISRCTN 68038570). The primary outcome was the Child Global Assessment Scale (CGAS). Secondary outcomes were ratings of educational attendance, achievement and rate of offending.
Results:
The MTFC-A group showed a non-significant improvement in CGAS outcome in both the randomised cohort (n = 34, adjusted mean difference 1.3, 95% CI -7.1 to 9.7, P = 0.75) and in the trimmed observational cohort (n = 185, adjusted mean difference 0.95, 95% CI -2.38 to 4.29, P = 0.57). No significant effects were seen in secondary outcomes. There was a possible differential effect of the intervention according to antisocial behaviour.
Conclusions:
There was no evidence that the use of MTFC-A resulted in better outcomes than usual care. The intervention may be more beneficial for young people with antisocial behaviour but less beneficial than usual treatment for those without.
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