The practice of placing children and adolescents with severe antisocial behavior and delinquency in residential and group home settings is common place in most communities in the United States, yet little research exists on the short- or long-term effectiveness of such placements. Furthermore, recent evidence suggests that there are potentially damaging effects from placement in congregate care settings that relate to negative influences that problem youth who are placed together tend to have on each other. The Oregon Multidimensional Treatment Foster Care (MTFC) model was developed as an alternative to group and residential care for youth with delinquency and severe emotional and behavioral problems. The central features of the Oregon MTFC model are described, evidence on the efficacy of the model is reviewed, and practical aspects relating to dissemination are discussed along with conditions that act to facilitate or create barriers to implementation.