The behavioral health crisis among adolescents is not a new story. For decades, clinicians, researchers, and policymakers have watched the statistics accumulate: an estimated 80 to 90% of adult substance use disorders have their roots in adolescence; half of all lifetime mental health conditions begin by age 14; and youth involved with the child welfare system carry disproportionate burdens of trauma, adversity, and co-occurring behavioral health challenges that, without effective intervention, compromise their development well into adulthood.1
Left to right: Howard Liddle, Cynthia Rowe, Adhar Mohamed, and Gayle Dakof at the 2026 Joint Meeting for Youth Prevention Treatment and Research (JMYPTR).
What is relatively new, and what has not yet received the attention it deserves, is the policy and funding infrastructure now in place to address this crisis. Over the past decade, a convergence of federal legislation, evidence-based practice guidelines, and funding mechanisms has created a clearer pathway for states to finance and sustain treatments that work for young people and their families. Understanding this infrastructure is essential for anyone working to improve behavioral health services in their agency or region.
The Clearinghouse System: What It Is and Why It Matters
The federal Title IV-E Prevention Services Clearinghouse, operated by the U.S. Department of Health and Human Services (DHHS), is arguably one of the most consequential policy tools in adolescent behavioral health. It reviews research on programs and services designed to support children and families and prevent foster care placements, and assigns ratings based on the strength and rigor of the evidence. Programs are categorized as promising, supported, or well-supported.2
These designations are not merely scholarly or honorary. They are directly tied to federal dollars.
The California Evidence-Based Clearinghouse for Child Welfare (CEBC) serves a parallel function, maintaining one of the most rigorous scientific rating systems for child welfare–related mental health and substance use treatments in the country.3 Together, these clearinghouses have become the primary reference points through which states evaluate and select programs for funding.
The Title IV-E Prevention Clearinghouse recently gave Multidimensional Family Therapy (MDFT) its highest effectiveness rating of “Well-Supported,” recognizing its proven effectiveness in reducing substance use, violence, and mental health symptoms among adolescents. MDFT holds the distinction of receiving the highest rating by both the Title IV-E Clearinghouse and the California Evidence-Based Clearinghouse (CEBC). That dual rating reflects nearly four decades of research and positions MDFT among the most rigorously validated treatment approaches available to states serving youth and families today. 2,3
For practitioners and advocates, the takeaway is this: the clearinghouse ratings system has shifted the conversation about treatment selection from professional preference and anecdotal success to verifiable evidence standards. This is a meaningful policy achievement, yet it is only effective if states utilize it.
Family First: Connecting Ratings to Reimbursement
The Family First Prevention Services Act, signed into law in 2018, fundamentally changed the federal funding calculus for child welfare and behavioral health services.4 Under Family First, states can now claim 50% federal reimbursement for prevention services, including mental health and substance use treatment, provided to children and youth at imminent risk of foster care placement.
Beginning October 1, 2026, the federal reimbursement rate for Title IV-E prevention services shifts from a flat 50% to each state’s Federal Medical Assistance Percentage (FMAP). As a result, certain states will receive an even higher federal match. Under the most recent published FMAP figures, for example, Arizona’s rate is 64.34%, South Carolina’s is 69.53%, and New Mexico’s is 71.66%.
This is a significant departure from how Medicaid and Title IV-E funding have historically operated. Prevention has long been the underfunded stepchild of the child welfare and behavioral health systems, with the bulk of federal dollars flowing to placement and residential care rather than to services that could keep families together and avoid the trauma of removal in the first place.
Family First changes the equation, but with an important condition. To qualify for the enhanced federal reimbursement, states must adopt programs rated as promising, supported, or well-supported by the Title IV-E Clearinghouse. States are also required to direct at least half of their Family First prevention funding toward programs rated well-supported, the highest tier.5
This is where clearinghouse ratings translate into real-world benefits for youth and families. A well-supported designation is not simply a mark of scientific credibility; it is a funding qualification. States using well-supported programs can claim federal reimbursement at a rate that would otherwise be unavailable.
What “Well-Supported” Actually Requires
It is worth focusing on what the well-supported designation requires, because it sets a genuinely high bar. The Clearinghouse does not award its top rating based on a single promising study or a program developer’s own research. A well-supported rating requires multiple rigorous studies, typically randomized controlled trials, conducted by independent research teams, that demonstrate sustained positive outcomes across a range of relevant domains.
For substance use and behavioral health programs serving youth, the clearinghouse examines outcomes including reductions in substance use, delinquent behavior, and mental health symptoms, as well as improvements in family functioning, school performance, and placement stability. Programs must demonstrate not only that they produce these outcomes, but that the effects are durable, with gains that hold over time across diverse populations. Utilizing these rigorously validated programs with federal funding allows states to significantly improve treatment outcomes for youth and families across the country.
MDFT’s well-supported rating reflects exactly this standard. Backed by nearly four decades of research, including multinational randomized controlled trials conducted by independent teams6,7, MDFT has documented outcomes in substance use reduction, delinquency, mental health symptoms, family functioning, and school performance, with effects sustained across diverse youth populations. It is also one of the few evidence-based treatments with documented outcomes for adolescent opioid use disorder and co-occurring mental health conditions. The durability of the model in real-world settings is reflected in a striking implementation statistic: 87% of MDFT programs are sustained for five years or more.8
Gayle A. Dakof, PhD, is President, Adhar B. Mohamed, MEd, is Assistant Director, and Cynthia L. Rowe, PhD, is Director of Training at Multidimensional Family Therapy (MDFT) International, Inc. For more information, contact [email protected], (786) 668-2088 ext. 1, or visit www.MDFT.org.
References
- Substance Abuse and Mental Health Services Administration. (2023). Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health. HHS Publication No. PEP23-07-01-006.
- U.S. Department of Health and Human Services, Administration for Children and Families. Title IV-E Prevention Services Clearinghouse. https://preventionservices.acf.hhs.gov
- California Evidence-Based Clearinghouse for Child Welfare. https://www.cebc4cw.org/program/multidimensional-family-therapy/
- Family First Prevention Services Act, Pub. L. No. 115-123 (2018).
- Child Welfare Information Gateway. (2021). Family First Prevention Services Act. U.S. Department of Health and Human Services, Children’s Bureau. https://www.childwelfare.gov/topics/systemwide/laws-policies/federal/family-first/
- Rigter, H., Pelc, I., Tossmann, P., Phan, O., Grichting, E., Hendriks, V., & Rowe, C. (2010). INCANT: a transnational randomized trial of Multidimensional Family Therapy versus treatment as usual for adolescents with cannabis use disorder. BMC Psychiatry, 10, 28. https://doi.org/10.1186/1471-244X-10-28
- Liddle, H.A. (2016). Multidimensional Family Therapy: Evidence base for transdiagnostic treatment outcomes, change mechanisms, and implementation in community settings. Family Process, 55(3), 558–576. https://doi.org/10.1111/famp.12243
- Dakof, G.A., Ricardo, M.M., Rowe, C., Henderson, C., Rigter, H., & Liddle, H.A. (2022). Sustainment rates and factors for Multidimensional Family Therapy in Europe and North America. Global Implementation Research and Applications, 2, 132–140. https://doi.org/10.1007/s43477-022-00043-6
