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Book Forum: FORENSIC PSYCHIATRY   |    
Treating Chronic Juvenile Offenders: Advances Made Through the Oregon Multidimensional Treatment Foster Care Model
HARVEY BLUESTONE, M.D.
Am J Psychiatry 2004;161:184-184. doi:10.1176/appi.ajp.161.1.184
View Author and Article Information
New York, N.Y.

By Patricia Chamberlain. Washington, D.C., American Psychological Association, 2003, 184 pp., $39.95.

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Because multiple factors underpin juvenile delinquency, multiple factors have to be simultaneously addressed to develop an effective treatment program. The factors discussed by the author are familial, contextual, and the potent influence of peers. Since this book concerns treatment, genetic and neurophysiological factors that cannot be directly influenced by the program are not discussed.

The parent-child relationship plays a pivotal role in the development of antisocial behavior. Early onset of antisocial behavior predicts severity and chronicity. Late onset of such behavior stems substantially from interaction with delinquent peers. From this perspective, residential group care is questionable. There is a paucity of research to buttress this approach. Reviews of such research call for more scientific rigor in design and conduct of studies.

The rationale for interventions that target multiple systems is that "once a youngster becomes severely antisocial it is entirely possible that residential treatment that focuses on individual factors, family treatment or for that matter any one treatment modality alone will not turn the tide." Fostering association with delinquent peers may have a negative "iatrogenic" effect in the prevention of conduct problems and substance abuse. The popularity of group-based interventions such as "boot camps" continues to grow despite this drawback and the fact that they offer little or no contact with parents.

The Oregon Multidimensional Treatment Foster Care model takes an entirely different approach. It was developed in the early 1980s by the clinical research group at the Oregon Social Learning Center and has survived and grown over the ensuing two decades.

In 1983 five youths with multiple offenses were referred to the program as an alternate to incarceration. In 1986, Oregon state hospital made referrals for adolescents leaving that setting. The author describes the "nuts and bolts" of the program, which constitutes the nuts and bolts of this book. The recruiting, training, and supervision of foster parents is the critical element. These parents have the responsibility of only one foster child. Program staff are in daily telephone communication with these parents during the entire time of the placement and visit frequently. At the same time, a staff member is working with the public school that the youth attends. An individual skills trainer or therapist is assigned to each participant, and a family therapist is preparing the family for the child’s return. The role of each staff member in the Multidimensional Treatment Foster Care program is explicitly delineated.

Readers of the Journal will want to know what psychiatrists do in the Multidimensional Treatment Foster Care model. That too is explicitly stated:

Many youths enter the program with multiple diagnoses that include disruptive behavior disorders such as conduct disorder and attention deficit disorder as well as posttraumatic stress disorder, depression, dysthymia, bipolar disorder and obsessive compulsive disorder. Often with these diagnoses come complex medical regimens. While it is possible to refer these youths for medication evaluations in the community the ability to consult directly with a psychiatrist who is familiar with the program elements is extremely useful.

The Multidimensional Treatment Foster Care model was developed originally for boys. The specific issues of girls, who are now included in the program, are explicated. It has also been expanded to include younger children in an attempt at prevention, which still needs research validation.

Patricia Chamberlain and Philip Fisher discuss attempts to replicate this program in other jurisdictions. Given its complexity and the necessity of having a dedicated and stable staff, difficulties in so doing are formidable. However, 12 agencies throughout the United States are now using this model, as well as one in Sweden and one in Norway.

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