Peer-reviewed article

The effects of multidimensional treatment foster care for maltreated children and adolescents: A systematic review and meta-analysis

Andrea Krishnapillai, Lindsay Oad, Taylar Cassidy, Melissa Kimber, Nancy A. Santesso · 2 May 2025

Abstract

A significant proportion of youth in foster care have a history of child maltreatment (CM) exposure, which contributes to their elevated risk for experiencing emotional and behavioural disorders. To update a previously published systematic review and meta-analysis examining the effects of Multidimensional Treatment Foster Care (MTFC) on the well-being of maltreated youth in foster care. Children between 3-17 years of age exposed to any type of CM by their birth parents. Systematic searches across five databases retrieved randomized controlled trials (RCTs) evaluating the impact of MTFC. We assessed risk of bias using the Cochrane Risk of Bias Tool and certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach. Eight RCTs were included. Meta-analyses indicated that MTFC may have little to no greater effect on internalizing symptoms at 5-6 months but may slightly reduce externalizing symptoms at 3-12 months compared to usual care. MTFC’s long-term effects on these outcomes is still uncertain. There is very little and uncertain evidence regarding the difference in effects of MTFC compared to usual care interventions on suicide attempts or ideation, involvement with authority, and positive parent-child interactions. MTFC may have no additional benefits for children exposed to maltreatment. Decision makers must balance these findings with costs, resources, and training required to provide MTFC to this population compared to usual care. Quality RCTs that measure long-term outcomes, and which integrate the perspectives of children who receive MTFC, are needed. • Certainty in evidence for MTFC for youth exposed to maltreatment remains low. • MTFC may not improve youth well-being more than usual care. • Randomized controlled trials measuring long-term outcomes are needed.