Multidimensional Family Therapy (MDFT) is a multicomponent therapeutic intervention for families with a young person between the ages of 13 and 18 years old with an identified behaviour or substance misuse problem. A qualified MDFT therapist meets with the young person and their parents up to three times a week to address issues occurring at the level of the adolescent, parent, family, and community. The length of the intervention is dependent on the family’s needs but typically lasts four to six months.
The information above is as offered/supported by the intervention provider.
12 to 19 years old
Individual
Multidimensional Family Therapy (MDFT) is a multicomponent therapeutic intervention for families with a young person between 13 and 18 years old with an identified behaviour or substance misuse problem.
A qualified MDFT therapist works with families up to three times a week over a period of four to six months to address issues occurring at the level of the adolescent, parent, family, and community. Behavioural change is facilitated through a series of conversations between the therapist and young person in individual therapy sessions, between the therapist and parents in parent sessions, in family sessions where the therapist facilitates meaningful conversations among the family members who are presented, and in sessions between the family and social systems in their community.
Treatment is organised in three stages:
Stage 1 – Build a foundation for change: Therapists create an environment in which the youth and parents feel respected and understood. Therapists meet alone with each to establish a collaborative foundation for the changes to be sought. Stage 1 goals are to develop strong therapeutic relationships, achieve a shared developmental and contextual perspective on their problems, enhance motivation for individual reflection and self-examination, and begin the change process.
Stage 2 – Facilitate individual and family change: The focus of stage 2 is on behavioural and interactional change within youth and parents in their relationships. In the adolescent domain, MDFT focuses on improving youth self-awareness, self-worth, and confidence; developing meaningful short-term and long-term goals; and improving emotional regulation, coping, problem-solving, and communication skills. In the parent domain, the focus is on strengthening parental teamwork, improving parenting skills and practices, rebuilding parent–teen emotional bonds, and enhancing parent’s individual functioning. In the family domain, MDFT works to improve family communication and problem-solving skills, strengthen emotional attachments and feelings of love and connection among family members, and improving everyday functioning of the family unit. In the community, the focus is on improving family members’ relationships with social systems including school, court, legal workplace, and neighbourhood, and building capacity to access needed resources.
Stage 3 – Solidify changes: The last few weeks of treatment strengthen the accomplishments achieved. The therapist amplifies changes and helps families create concrete plans for responding to future problems such as substance use relapse, family arguments, or any other kinds of setbacks or disappointments. Family members reflect on the changes made in treatment, acknowledge each other for the efforts they have made, see opportunities for a brighter future, and express hope for the next phase of their lives together.
Throughout the intervention, homework is given to promote out of session changes, and phone calls to youth and parents are conducted to encourage change and problem solve through difficulties.
13 to 18 years old
Adolescents who have substance misuse, behavioural, antisocial behaviour, mental health, educational/school, family mental health problems, or disorders.
Disclaimer: The information in this section is as offered/supported by the intervention provider.
Science-based assumption
Behavioural problems, substance misuse, and mental health issues during adolescence often persist into adult.
Science-based assumption
Behavioural and substance misuse problems in adolescence are often multi-determined by processes occurring at the level of the child, parent, family, and community resources (e.g. peers, school, recreation).
Science-based assumption
Adolescents who have substance misuse, behavioural, antisocial behaviour mental health, educational/school, family mental health problems or disorders.
Intervention
The young person and parents receive individual and joint therapy sessions up to three times a week.
The therapist creates a safe environment in which family members can consider the processes contributing to the young person’s issues and identify solutions and goals addressing them.
Short-term
Parenting behaviours improved
Family communication improves
The young person’s behaviour improves
The young person has more hope and optimism
Family relationships improve.
Medium-term
The young person is more engaged with school
The young person reduces or stops their substance misuse
There is reduced likelihood of an out-of-home placement
The young person has improved mental health.
Long-term
Reduced risk of the young person having future behavioural, mental health, and substance misuse problems
Improved academic performance at school
Greater life satisfaction.
Adolescents who have substance misuse, behavioural, antisocial behaviour, mental health, educational/school, family mental health problems or disorders.
MDFT is delivered by a qualified MDFT therapist. The youth-focused component of MDFT is typically delivered over the course of eight to 20 individual therapy sessions (approx. 45 to 60 minutes long). The parent-focused component of MDFT is typically delivered over the course of four to 10 sessions (approx. one to 1.5 hours long). The family-focused component of MDFT is typically delivered over the course of four to 10 sessions (approx. one to 1.5 hours long). In addition, there is a community-focused component which is delivered over four to 10 community sessions/meetings (approx. one to 1.5 hours long).
Families work with the therapist for a period typically lasting four to six months.
A therapist works individually and jointly with the young person and parents to address issues occurring at the level of the adolescent, parent, family, and community:
See model description for further information.
This intervention is delivered by an MDFT Therapist with a master’s qualification or higher in family therapy, social work, or psychology.
Therapists have 65 hours of intervention training. Booster training of practitioners is recommended.
It is recommended that practitioners are supervised by a host-agency supervisor with 15 to 20 hours of intervention training.
Intervention fidelity is maintained through the following processes:
Contact person: Gayle A. Dakof
Email address: info@mdft.org
Website: http://www.mdft.org
*Please note that this information may not be up to date. In this case, please visit the listed intervention website for up to date contact details.
MDFT’s most rigorous evidence comes from three RCTs consistent with Foundations’ Level 3 evidence strength criteria. One of these studies has evidence of a long-term impact, meaning that MDFT has evidence consistent with Foundations’ Level 4 criteria.
The first study was conducted in the United States and observed statistically significant reductions in MDFT young persons’ reports of substance misuse and cannabis dependence a year after treatment compared to young people not receiving the intervention.
The second study was conducted with young people across Belgium, France, Germany, Netherlands and Switzerland, and observed statistically significant reductions in MDFT young persons’ use of cannabis and other substances, as well as improvements in their behaviour a year following treatment in comparison to youth who did not receive the intervention.
The third study was conducted in the United States and observed statistically significant reductions in MDFT young persons’ reports of antisocial behaviour, as well as fewer felony arrests 18 months following intervention completion in comparison to young people not receiving the intervention.
MDFT can be described as evidence-based: it has evidence from at least two rigorously conducted evaluations (RCT/QED) demonstrating positive impacts across populations and environments lasting a year or longer.
Reduced externalising symptoms
A year later
Improvement index
Interpretation
Study
Reduced externalising symptoms
A year and a half later
Improvement index
Interpretation
Study
Reduced delinquency
A year and a half later
Improvement index
Interpretation
Study
Reduced felony arrests
A year and a half later
Improvement index
Interpretation
Study
Reduced substance use problem severity
Six months later
Improvement index
Interpretation
Study
Reduced substance use problem severity
A year later
Improvement index
Interpretation
Study
Reduced other drug use
A year later
Improvement index
Interpretation
Study
Increased drug abstinence
A year later
Improvement index
Interpretation
Study
Reduced cannabis dependence symptoms
A year later
Improvement index
Interpretation
Study
| Identified in search | 15 |
| Studies reviewed | 15 |
| Meeting the L2 threshold | 0 |
| Meeting the L3 threshold | 3 |
| Contributing to the L4 threshold | 0 |
| Ineligible | 12 |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 224 drug-using adolescents between the ages of 12 and 17.5 years old (mean = 15). |
| Race, ethnicities, and nationalities |
|
| Population risk factors |
|
| Timing |
|
| Child outcomes |
|
| Other outcomes | None |
| Study rating | 3 |
| Citations | Liddle, H. A., Dakof, G. A., Turner, T. M., Henderson, C. E., Greenbaum & P. E. (2008) Treating adolescent drug abuse: A randomized trial comparing multidimensional family therapy and cognitive behavior Therapy. Addiction. 103, 1660–1670. |
| Study design | RCT |
| Country | Belgium, France, Germany, Netherlands, Switzerland |
| Sample characteristics | 450 adolescents between ages of 13 and 18 years old, all with recently diagnosed cannabis use disorder. |
| Race, ethnicities, and nationalities | Not reported |
| Population risk factors |
|
| Timing |
|
| Child outcomes | Study 2a:
Study 2b:
|
| Other outcomes | None |
| Study rating | 3 |
| Citations | Study 2a: Rigter, H., Henderson, C. E., Pelc, I., Tossmann, P., Phan, O., Hendriks, V. & Rowe, C. L. (2013) Multidimensional family therapy lowers the rate of cannabis dependence in adolescents: A randomised controlled trial in Western European outpatient settings. Drug and Alcohol Dependence. 130, 85–93. Study 2b: Schaub, M. M., Henderson, C. E., Pelc, I., Tossmann, P., Phan, O., Hendricks V., Rowe, C. L. & Rigter, H. (2014) Multidimensional family therapy decreases the rate of externalising behavioural disorders symptoms in cannabis abusing adolescents: Outcomes of the INCANT trial. BMC Psychiatry. 14, 26. |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 112 adolescents between the ages of 13 and 19 years old diagnosed with substance abuse problems or dependency. |
| Race, ethnicities, and nationalities |
|
| Population risk factors |
|
| Timing |
|
| Child outcomes |
|
| Other outcomes | None |
| Study rating | 3 |
| Citations | Dakof, G. A., Henderson, C. S., Rowe, C. L, Boustani, M., Greenbaum, P., Wang, W., Hawes, S., Linares, C. & Liddle, H. A. (2015) A randomized controlled trial of multidimensional family therapy in juvenile drug court. Journal of Family Psychology. 29, 232–241. |
The following studies were identified for this intervention but did not count towards the intervention’s overall evidence rating. An intervention receives the same rating as its most robust study or studies.
Dennis, M., Godley, S. H., Diamond, G., Tims, F. M., Babor, T., Donaldson, J. & Funk, R. (2004) The Cannabis Youth Treatment (CYT) study: Main findings from two randomized trials. Journal of Substance Abuse Treatment. 27, 197–213.
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(6), 919.
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 Clinical Psychology. 78, 885–897.
Henderson, C. E., Rowe, C. L., Dakof, G. A., Hawes, S. W. & Liddle, H. A. (2009) Parenting practices as mediators of treatment effects in an early-intervention trial of multidimensional family therapy. American Journal of Drug and Alcohol Abuse. 35, 220–226.
Liddle, H. A., Dakof, G. A., Henderson, C. E. & Rowe, C. L. (2011) Implementation outcomes of multidimensional family therapy detention to community (DTC): A re-entry program for drug using juvenile detainees. International Journal of Offender Therapy and Comparative Criminology. 55, 587–604.
Liddle, H. A., Dakof, G. A., Parker, K., Diamond, G. S., Barrett, K. & Tejeda, M. (2001) Multidimensional Family Therapy for adolescent drug abuse: Results of a randomized clinical trial. American Journal of Drug and Alcohol Abuse. 27 (4), 651–688.
Liddle, H. A., Rowe, C. L., Dakof, G. A., Henderson, C. E. & Greenbaum, P. E. (2009) Multidimensional family therapy for young adolescent substance abuse: twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology. 77 (1), 12.
Liddle, H. A., Rowe, C. L., Dakof, G. A., Ungaro, R. A. & Henderson, C. E. (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, 49–63.
Liddle, H. A., Rowe, C. L., Gonzalez, A., Henderson, C. E., Dakof, G. A. & Greenbaum, P.E. (2006) Changing provider practices, program environment and improving outcomes by transporting Multidimensional Family Therapy to an adolescent drug treatment setting. The American Journal of Addictions. 15, 102–112.
Marvel, F., Rowe, C. L., Colon‐Perez, L., DiClemente, R. J. & Liddle, H. A. (2009) Multidimensional Family Therapy HIV/STD risk‐reduction intervention: An integrative family‐based model for drug‐involved juvenile offenders. Family Process. 48 (1), 69–84.
Rowe, C. L., Alberga, L., Dakof, G. A., Henderson, C. E., Ungaro, R. & Liddle, H. A. (2016) Family-based HIV and sexually transmitted infection risk reduction for drug-involved young offenders: 42-month outcomes. Family Process. 55 (2), 305–320.
Schmidt, S. E., Liddle, H. A. & Dakof, G. A. (1996) Changes in parenting practices and adolescent drug abuse during Multidimensional Family Therapy. Journal of Family Psychology. 10, 12–27.
Note on provider involvement: This provider has agreed to Foundations’ terms of reference (or the Early Intervention Foundation's terms of reference), and the assessment has been conducted and published with the full cooperation of the intervention provider.
Rated 1: Set up and delivery is low cost, equivalent to an estimated unit cost of less than £100.
Rated 2: Set up and delivery is medium-low cost, equivalent to an estimated unit cost of £100–£499.
Rated 3: Set up and delivery is medium cost, equivalent to an estimated unit cost of £500–£999.
Rated 4: Set up and delivery is medium-high cost, equivalent to an estimated unit cost of £1,000–£2,000.
Rating 5: Set up and delivery is high cost. Equivalent to an estimated unit cost of more than £2,000.
Set up and delivery cost is not applicable, not available, or has not been calculated.
Click here for more information.
Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus.
Supporting children’s mental health and wellbeing: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing child maltreatment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Enhancing school achievement & employment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing crime, violence and antisocial behaviour: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing substance abuse: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing risky sexual behaviour & teen pregnancy: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing obesity and promoting healthy physical development: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Rated 2: Has preliminary evidence of improving a child outcome from a quantitative impact study, but there is not yet evidence of causal impact.
Rated 2+: Meets the level 2 rating and the best available evidence is based on a study which is more rigorous than a level 2 standard but does not meet the level 3 standard.
Rated 3: Has evidence of a short-term positive impact from at least one rigorous study.
Rated 3+: Meets the level 3 rating and has evidence from other studies with a comparison group at level 2 or higher.
Rated 4: Has evidence of a long-term positive impact through at least two rigorous studies.
Rated 4+: Meets the level 4 rating and has at least a third study contributing to the Level 4 rating, with at least one of the studies conducted independently of the intervention provider.
Rating has a *: The evidence base includes mixed findings i.e., studies suggesting positive impact alongside studies, which on balance, indicate no effect or negative impact.
Click here for more information.
