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Researchers Assess Sustainability of Multidimensional Family Therapy

Two faculty members of the Department of Public Health Sciences (DPHS) at the University of Miami Miller School of Medicine, Howard Liddle, Ed.D., Professor, and Cynthia Rowe, Ph.D., Clinical Associate Professor, took part in a retrospective non-experimental study that assessed the sustainability of 137 evidence-based treatment programs for youth behavioral problems across Europe and North America.

The study, titled “Sustainment Rates and Factors for Multidimensional Family Therapy in Europe and North America,” was recently published in the Global Implementation Research and Applications journal.

“MDFT is an all-encompassing, evidence-based treatment for youth substance abuse, delinquency, mental health, and other behavioral problems,” said Dr. Liddle, who has developed MDFT in numerous studies based in Miami/UM since 1996 alongside Dr. Rowe, and Gayle Dakof, Ph.D., Senior Author.

“Several randomized clinical trials with young people ranging in ages 12 to 25 and their families have demonstrated the model's efficacy,” he added.

Countless child and adolescent interventions that focus on a wide range of disorders have been created and extensively researched over the last 30 years. This has resulted in the identification of numerous strong evidence-based practices (EBP). Despite this significant achievement, researchers and program managers are worried about the sustainability of research-based interventions in non-research, usual-care clinical settings.

The study had two main goals:

  • Examine short-term (2-year) and longer-term (5-year and 8-year) MDFT sustainment rates in Europe and North America.
  • Investigate potential factors associated with MDFT sustainment, as well as the implications for behavioral health EBPs more broadly.

The study surveyed MDFT sustainment rates and factors among 137 MDFT programs in Europe (72) and North America (65). All programs received standardized training and quality assurance services from one of two certified MDFT training entities. Trainers conducted the initial MDFT clinical training, with ongoing fidelity monitoring, and yearly clinical boosters to maintain adherence and competence to the model.

“All data used in the current study were part of standard administrative data collection conducted by the two organizations which routinely keep records on the start and end of programs, sources of funding, location of programs, level of care of services provided, and provider-reported reasons for discontinuation,” said Dr. Liddle.

According to the study’s findings, very few MDFT programs were terminated within its first 2 years. An impressive 90% of the 137 programs continued for at least 2 years. Over 5 years 87% of the programs were sustained, and over 8 years 70% of the programs were sustained. “These findings support the viability of MDFT adoption by clinicians serving diverse populations in a wide range of clinical settings, including standard outpatient clinics, juvenile justice programs, intensive home-based services, and residential programs,” Dr. Rowe explained.  

Findings indicated no significant difference in sustainment rates between European and North American programs, location, or level of care. Being part of a multi-site network with other MDFT programs was associated with longer-term sustainment at eight years or more but not at two- or five-year sustainment periods.

Programs that were funded from time-limited grants were more likely to discontinue: 37% of programs with time-limited grant funding were discontinued during the five-year period, whereas only six percent of those with ongoing funding and 10% of those relying on mixed financing discontinued during this same period. 53% of the discontinued programs reported a lack of adequate funding as the primary reason for discontinuation, 31% reported that provider internal restructuring issues led to discontinuation, and only 16% reported that their MDFT programs closed because of clinician issues. Dr. Rowe stated, “these findings really point to the need for financial and administrative support to help programs maintain EBPs beyond initial training.”

The sustainment rates for MDFT compare favorably to rates from previous research on the sustainment of evidence-based interventions. “For example, MDFT's two-year sustainment at 90% compares favorably with the average two-year sustainment of EBPs of approximately 50%, ranging from a low of 25% to a high of 88%,” said Dr. Liddle.

Although few studies in behavioral health examine longer-term sustainment, some notable exceptions provide guidance. The National Implementing Evidence-Based Practices Project studied 49 programs providing a variety of interventions including employment and family psychoeducation. While 79% of the programs sustained for at least four years, only 47% sustained for eight years.

In another study of 67 behavioral interventions in Pennsylvania, only 45% were sustained for five years. “In comparison, of the 137 MDFT programs in North America and Europe that participated in this study, there were relatively high rates of longer-term sustainability, with 88% of the programs sustaining for at least five years and 70% for at least eight years,” said Dr. Liddle.

The authors note: “Given that funding alone is not the only factor, and few programs cited clinician factors for discontinuation, perhaps the nature and quality of the MDFT training, consultation, and fidelity and outcome monitoring contribute to its sustainability. Studies have revealed that implementation is very difficult if the EBP training and ongoing consultations are not perceived as worthwhile by therapists and supervisors who are tasked with administering the EBP.”

Written by Deycha Torres Hernández
Published on January 31, 2023