Interview: Implementing Multidimensional Family Therapy for Teens in the Justice System

Multidimensional Family Therapy (MDFT) is an evidence-based practice for working with adolescents struggling with substance abuse – the manual can be downloaded from SAMHSA for free. (SAMHSA is the Substance Abuse and Mental Health Services Administration.) One of five treatment protocols developed and tested in the past decade by SAMHSA, it has been shown to be clinically and cost-effective.
As it happens, the creator of MDFT, Dr. Howard A. Liddle, Ed.D., will be doing a webinar for us on family engagement on April 30, 2011, at 11 am PST / 12 pm CST / 2 pm EST. You can learn more and register for it on our webinars page.
Dr. Liddle told me recently that there was an MDFT program operating in Portland, Oregon, where I live, so I set up an interview with Deena Corso, who is a clinical supervisor in the Juvenile Treatment Services unit at the Department of Community Justice (DCJ) in Multnomah County, Oregon. (Deena and I were co-workers when I was employed there between 2000 and 2007.)
 

Benjamin: What are the top reasons to implement MDFT?
Deena: We picked MDFT as our treatment model because it's an evidence-based practice, effective at reducing substance abuse and delinquent behavior for populations that looked like ours. We’d had a Multi-Systemic Therapy [MST] program for many years with good outcomes, but budget cuts forced us to look for an alternative, and once we looked at the research, we decided on MDFT. 

We like MDFT because it uses cognitive behavioral therapy – the treatment of choice for delinquent youth – and it is also multidimensional and relational. The model requires clinicians to understand drug use and delinquency in a multidimensional way, and also aims to improve the relationship between the teen and the parent.

Not only does MDFT help parents hold their kids accountable, but it adds an extra dimension: “I’m giving you these consequences because I love you, care about you, and want you to have a good future.” It’s a relational lens we like, rather than a “Behave, and you get treats; misbehave, and you get sanctions” sort of approach. It’s more engaging for the kids.

There’s an art to it, though, because you do one-on-one sessions with both the parent and the youth, who are generally at odds with each other, and you have to be able to make them both feel that you totally get them and support them, and are in it 100% for them – that takes a lot of work and skill.

What do staff require to implement it effectively?
Most therapists need to have at least a master's degree, and two to three years of experience. Having experience with drug-using, law-breaking youth is critical for us, and some experience working with family systems is very helpful. It requires a lot of consistent clinical supervision as well, and staff have to be willing to do case management-type interventions as well as clinical ones.

Start-up costs are high, and getting certified is an arduous process – it takes about a year -- but once you’re certified, it gets less expensive to maintain. Clinicians get re-certified annually and MDFT can provide booster trainings or other technical support as needed.

Do staff like doing MDFT?
They do.

One shift for our program has been that a lot of the work happens here, in a clinical setting, as opposed to happening at the family’s home. That’s a plus, actually, because we can get so much more accomplished when the phone's not ringing, the TV's not on, the doorbell’s not ringing, the dog's not barking, and so on. We were initially worried that the clients wouldn’t come in, but they do.

In addition to minimizing distractions, it is also nice to be able to structure the sessions a little more. For example, when the kid and/or parents are highly agitated or emotional, we can separate family members pretty easily. It can be hard on a home visit to say to the teen, “Okay, I'm going to spend 15 minutes alone with your mom, and then I’ll spend 15 minutes alone with you,” and actually make that happen in a way that feels confidential and safe.

How big are your caseloads?
Well, the model suggests 5 to 10 cases for a full-time therapist. Our caseloads are around five to six, because our cases are tough. We serve high-risk, "alternative-to-residential-placement" adolescents, as opposed to more traditional outpatient kids.

What are your outcomes like?
It’s too early to say. We had our initial training in November 2009. The first cohort of clients didn’t finish until June 2010. (The treatment is projected to last for five months, but it can go six.) We will be able to begin to collect our first set of 12-month recidivism data by the end of June 2011.
 

Deena Corso is a Licensed Professional Counselor with 21 years of experience working with delinquent and at-risk adolescents and their families.  Deena obtained her Masters Degree in Counseling Psychology from the University of Oregon in 1990 and has been employed by Multnomah County's Department of Community Justice (DCJ) since 1991.  She is currently a Clinical Supervisor for DCJ's Juvenile Treatment Services and manages an outpatient treatment program. Deena has extensive training in evidence-based treatment approaches, including Multi-Systemic Therapy (MST) and Multi-Dimensional Family Therapy (MDFT). She is also certified as a local trainer for the Global Appraisal of Individual Needs (GAIN) and is a recent graduate of the American Probation and Parole Association's (APPA) Leadership Institute.