Multisystemic Therapy (MST)

1  — Well-Supported by Research Evidence
Medium
1  — Well-Supported by Research Evidence
Medium
1  — Well-Supported by Research Evidence
Medium
1  — Well-Supported by Research Evidence
Medium

About This Program

Target Population: Youth, 12 to 17 years old, with possible substance abuse issues who are at risk of out-of-home placement due to antisocial or delinquent behaviors and/or youth involved with the juvenile justice system and their parents/caregivers (some other restrictions for youth exist, see the Essential Components section for more details)

For children/adolescents ages: 12 – 17

For parents/caregivers of children ages: 12 – 17

Program Overview

Multisystemic Therapy (MST) is an intensive family and community-based treatment for serious juvenile offenders with possible substance abuse issues and their families. The primary goals of MST are to decrease youth criminal behavior and out-of-home placements. Critical features of MST include: (a) integration of empirically based treatment approaches to address a comprehensive range of risk factors across family, peer, school, and community contexts; (b) promotion of behavior change in the youth's natural environment, with the overriding goal of empowering caregivers; and (c) rigorous quality assurance mechanisms that focus on achieving outcomes through maintaining treatment fidelity and developing strategies to overcome barriers to behavior change.

Program Goals

The goals of Multisystemic Therapy (MST) are:

    For youth/adolescents:

    • Eliminate or significantly reduce the frequency and severity of problem behavior(s).
    • Learn skills on how to better cope with family, peer, school, and neighborhood problems.

    For parents/caregivers:

    • Learn skills to independently address the inevitable difficulties that arise in raising children and adolescents.
    • Learn skills to help youth to cope with family, peer, school, and neighborhood problems.

Logic Model

View the Logic Model for Multisystemic Therapy (MST).

Essential Components

The essential components of Multisystemic Therapy (MST) include:

  • Target Population:
    • Delinquent or antisocial youth who are 12 to 17 years old and may also meet the following criteria:
      • Youth at Imminent risk of out-of-home placement due to criminal offenses
      • Physical aggression at home, at school, or in the community
      • Verbal aggression, verbal threats of harm to others
      • Substance abuse in the context of problems listed above
    • Programs will need to exclude:
      • Youth living independently, or youth for whom a primary caregiver cannot be identified despite extensive efforts to locate all extended family, adult friends and other potential surrogate caregivers
      • Youth who are actively suicidal, homicidal, or psychotic
      • Youths whose psychiatric problems are the primary reason leading to referral, or who have severe and serious psychiatric problems.
      • Juvenile sex offenders (sex offending in the absence of other delinquent or antisocial behavior). MST–Problem Sexual Behavior (MST-PSB), however, is an adaptation of MST that is available for youth with externalizing, delinquent behaviors, including aggressive (e.g., sexual assault, rape) and non-aggressive (e.g., molestation of younger children) sexual offenses
      • Youth with moderate to severe difficulties with social communication, social interaction, and repetitive behaviors, which may be captured by a diagnosis of autism
  • Intervention Context:
    • Services are provided in the family's home or other places convenient to them and at times convenient to the family.
    • Services are intensive, with intervention sessions being conducted from once per week to daily.
    • A 24 hour/7 day/week on-call schedule is utilized to provide round-the-clock availability of clinical services for families.
  • Therapists and Supervisors:
    • MST staff members work on a clinical team of 2-4 therapists and a supervisor.
    • MST therapists are Masters-prepared (clinical-degreed) professionals.
    • MST clinical supervisors must be at least 50% part-time and may supervise 1-2 teams only.
    • MST clinical supervisors are, at minimum, highly skilled Master's-prepared clinicians with training in behavioral and cognitive behavioral therapies and pragmatic family therapies (e.g., Structural Family Therapy and Strategic Family Therapy).
  • Application of the Intervention:
    • Interventions are developed using an analytical model that guides the therapist to assess factors that are driving the key clinical problems, and then in designing interventions that are applied to these driving factors or "fit factors."
    • All intervention techniques are evidence-based or evidence-informed.
    • Each therapist carries a maximum caseload of 6 families and case length ranges from 3 to 5 months.
  • Clinical Supervision:
    • The MST clinical supervisor conducts on-site weekly team clinical supervision, facilitates the weekly MST telephone consultation, and is available for individual clinical supervision for crises.
  • Program Monitoring and Use of Data:
    • Agencies collect data as specified by MST Services, and all data are sent to the MST Institute (MSTI) which is charged with keeping the national and international database system.
    • MSTI data reports are used to assess and guide program implementation.
    • Agencies use these reports to monitor and assure fidelity to the MST model.
  • Agency:
    • The agency must have community support for sustainability.
    • With the buy-in of other organizations and agencies, MST is able to "take the lead" for clinical decision-making on each case.
    • Stakeholders in the overall MST program have responsibility for initiating these collaborative relationships with other organizations and agencies while MST staff sustain them through ongoing, case-specific collaboration.

Program Delivery

Child/Adolescent Services

Multisystemic Therapy (MST) directly provides services to children/adolescents and addresses the following:

  • Involvement in the Juvenile Justice system; youth at imminent risk of out-of-home placement due to criminal offenses; physical aggression at home, at school, or in the community; verbal aggression, verbal threats of harm to others; and substance abuse

Parent/Caregiver Services

Multisystemic Therapy (MST) directly provides services to parents/caregivers and addresses the following:

  • Difficulty managing anger, substance abuse, and barriers to effective parenting (e.g., untreated mental illness, excessive stress)

Recommended Intensity:

Service intensity varies with the needs of the youth and family. Early in treatment, the therapist may meet with the family several times a week, but as treatment progresses, the intensity tapers. Close to treatment termination, the therapist may only contact the family as needed to assure that treatment gains have been maintained by the family. Throughout treatment, contacts may range from brief check-ins either by telephone or face-to-face, up to two-hour sessions addressing specific treatment issues such as substance misuse, family communication and problem solving.

Recommended Duration:

3-5 months

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster / Kinship Care
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Multisystemic Therapy (MST) includes a homework component:

Homework may be assigned in relation to any of the following interventions:

  • Parent Management Training
  • Treatment for anger management
  • Treatment for caregiver or youth substance abuse
  • Family communication training

Languages

Multisystemic Therapy (MST) has materials available in languages other than English:

Norwegian, several other European languages, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Office space to house the team and conduct consultation and supervision is required as well as laptops and cell phones for all staff.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

  • The supervisor will benefit from an understanding of the Juvenile Justice and Child Welfare systems and needs experience with family therapy and cognitive-behavioral therapy. The supervisor must have experience in managing severe family crises that involve safety risk to the family.
  • Supervisors are, at minimum, highly skilled Master's-prepared clinicians with training in behavioral and cognitive behavioral therapies and pragmatic family therapies (i.e., Structural Family Therapy and Strategic Family Therapy).
  • At least 66% of the therapists must have a Master's degree in counseling or social work.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

All components of the quality assurance system are manualized. The treatment manual for antisocial behavior is available for purchase from Guilford Press. The other manuals are provided to MST sites. Sites are licensed through MST Services, Inc. (www.mstservices.com), which has the exclusive license for the transport of MST technology and intellectual property developed at the Medical University of South Carolina.

  • Henggeler, S. W., & Schoenwald, S. K. (1998). Multisystemic Therapy supervisory manual. The MST Institute.
  • Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic Therapy for antisocial behavior in children and adolescents (2nd ed.). Guilford Press.
  • MST Services. (2018). Multisystemic Therapy organizational manual. Author.
  • Schoenwald, S. K. (1998). Multisystemic Therapy consultation manual. The MST Institute.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

With regard to the initial 5-day training, organizations can access the training in one of two ways. New staff can come to Charleston, SC, and participate in one of the monthly open-enrollment trainings provided by the company. Alternatively, providers can elect to have the company conduct the 5-day initial training at their site when starting multiple teams at the same time. After start-up, training continues through weekly telephone consultation and on-site quarterly booster trainings for each team of clinicians.

Number of days/hours:

All trainees complete the Standard 5-day orientation. The team participates in weekly consultation with an expert on the intervention, quarterly booster training, ongoing organizational assistance, and quality assurance support through the monitoring of treatment fidelity/adherence.

After program start-up, training continues through weekly telephone consultation for each team of clinicians aimed at monitoring treatment fidelity and adherence to the treatment model, and through quarterly on-site booster trainings (1 1/2 days each). Trained experts teach the supervisor to implement a manualized supervisory protocol and collaborate with the supervisor to promote the ongoing clinical development of all team members. The intervention expert also assists at the organizational level as needed.

Additional Resources:

There currently are additional qualified resources for training:

Agencies that are licensed the parent company as Network Partner Organizations can provide the intervention's 5-day orientation training. See the list at www.mstservices.com.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Multisystemic Therapy (MST) as listed below:

The objectives of the pre-implementation assessment process are to:

  • Identify the mission, policies, and practices of the customer organization and of the community context in which it operates.
  • Specify the clinical, organizational, fiscal, and community resources needed to successfully implement MST.

Using the MST Feasibility Questionnaire, an MST Program Developer will attempt to assess the needs of the future MST program site by reviewing the resources needed to operate a successful MST program.

An MST Program Developer will also provide on-site and/or telephone consultation that will include activities such as the following:

  • Meetings with the organization's leadership and clinical staff
  • Meetings with staff from agencies that influence patterns of referral, reimbursement, and/or policy affecting the customer organization's capacity to implement MST
  • Presentation of MST to the community stakeholders to assure the buy-in needed for program success after start-up
  • Assistance in designing clinical record-keeping to document treatment goals and progress
  • Assistance in developing systems to measure outcomes
  • Review of evaluation proposals
  • Consultation regarding Requests for Proposals (RFPs) relevant to the development and funding of the MST program
  • Assistance with recruiting additional staff including sample job descriptions, review of hiring advertisements, interviewing and selecting the most qualified staff

For further information about this process, please contact either: Tom Pietkiewicz, Director of Business Development, email: tom.pietkiewicz@mstservices.com, phone: 843-352-4306 or Melanie Duncan, PhD, Program Development Coordinator, email: melanie.duncan@mstservices.com, phone: 843-284-2221.

Formal Support for Implementation

There is formal support available for implementation of Multisystemic Therapy (MST) as listed below:

Implementation support is available from either MST Services or from any of the more than 20 MST training organizations, called Network Partner organizations. Contact information for MST Network Partner organizations can be found at http://www.mstservices.com/teams/network-partners.

Fidelity Measures

There are fidelity measures for Multisystemic Therapy (MST) as listed below:

Quality assurance support activities focus on monitoring and enhancing program outcomes through increasing therapist adherence to the MST treatment model. The MST Therapist Adherence Measure (TAM) and the MST Supervisor Adherence Measure (SAM) have been validated in the research on MST with antisocial and delinquent youth and are now being implemented by all licensed MST programs. Both measures are available through the MST Institute at www.mtsi.org. An overview of the Multisystemic Therapy (MST) Quality Assurance Program can be found at https://www.msti.org/mstinstitute/qa_program/. A brief review of the two MST fidelity measures is below:

  • The Therapist Adherence Measure Revised (TAM-R) is a 28-item measure that evaluates a therapist's adherence to the MST model as reported by the primary caregiver of the family. The adherence scale was originally developed as part of a clinical trial on the effectiveness of MST. The measure proved to have significant value in measuring an MST therapist's adherence to MST and in predicting outcomes for families who received treatment. More information is available at: https://www.msti.org/mstinstitute/qa_program/tam.html.
  • The Supervisor Adherence Measure (SAM) is a 43-item measure that evaluates the MST Supervisor's adherence to the MST model of supervision as reported by MST therapists. The measure is based on the principles of MST and the model of supervision presented in the MST Supervisory Manual. More information is available at: https://www.msti.org/mstinstitute/qa_program/sam.html.

Fidelity Measure Requirements:

Therapist adherence is assessed monthly during treatment using caregiver reports on the TAM-R.

Established Psychometrics:

  • Henggeler, S. W., Borduin, C. M., Schoenwald, S. K., Huey, S. J., & Chapman, J. E. (2006). Multisystemic Therapy Adherence Scale - Revised (TAM-R). Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina.
  • Schoenwald, S. K., Sheidow, A. J., Letourneau, E. J., & Liao, J. G. (2003). Transportability of Multisystemic Therapy: Evidence for multi-level influences. Mental Health Services Research, 5, 223–239. https://doi.org/10.1023/A:1026229102151
  • Schoenwald, S. K., Letourneau, E. J., & Halliday-Boykins, C. A. (2005). Predicting therapist adherence to a transported family-based treatment for youth. Journal of Clinical Child and Adolescent Psychology. 34(4), 658–670. https://doi.org/10.1207/s15374424jccp3404_8

Implementation Guides or Manuals

There are implementation guides or manuals for Multisystemic Therapy (MST) as listed below:

All components of the MST program are manualized. The treatment manuals for antisocial behavior (Multisystemic Therapy for Antisocial Behavior in Children and Adolescents) and serious emotional disturbance (Serious Emotional Disturbance in Children and Adolescents: Multisystemic Therapy) are available from Guilford Press. Additional MST-related manuals are provided to sites when they implement MST. These sites are licensed through MST Services, Inc., which has the exclusive license for the transport of MST technology and intellectual property developed at the Family Services Research Center of the Medical University of South Carolina. The following are included separately:

  • Multisystemic Therapy for Antisocial Behavior in Children and Adolescents - Second Edition - specifying MST clinical protocols based on the nine core treatment principles (available through the MST Stores)
  • MST Supervisory Manual - specifying the structure and processes of the weekly onsite supervisory sessions and ongoing development of therapist competences
  • MST Consultation Manual - specifying the role of the MST consultant in helping teams achieve youth outcomes and in building the competencies of team therapists and supervisors
  • MST Organizational Manual - addressing administrative issues in developing and sustaining a MST program

Implementation Cost

There have been studies of the costs of implementing Multisystemic Therapy (MST) which are listed below:

  • Dopp, A. R., Borduin, C. M., Wagner, D. V., & Sawyer, A. M. (2014). The economic impact of Mmultisystemic Therapy through midlife: A cost-benefit analysis with serious juvenile offenders and their siblings. Journal of Consulting and Clinical Psychology, 82(4), 694-705. https://doi.org/10.1037/a0036415
  • Klietz, S. J., Borduin, C. M., & Schaeffer, C. M. (2010). Cost–benefit analysis of Multisystemic Therapy with serious and violent juvenile offenders. Journal of Family Psychology, 24(5), 657–666. https://doi.org/10.1037/a0020838
  • Sheidow, A. J., Bradford, W. D., Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C., Schoenwald, S. K., & Ward, D. M. (2004). Treatment costs for youths receiving Multisystemic Therapy or hospitalization after a psychiatric crisis. Psychiatric Services, 55(5), 548–554. https://doi.org/10.1176/appi.ps.55.5.548
  • Vermeulen, K. M., Jansen, D. E. M. C., Knorth, E. J., Buskens, E., & Reijneveld, S. A. (2017). Cost-effectiveness of Multisystemic Therapy versus usual treatment for young people with antisocial problems. Criminal Behaviour and Mental Health, 27(1), 89–102. https://doi.org/10.1002/cbm.1988

Research on How to Implement the Program

Research has been conducted on how to implement Multisystemic Therapy (MST) as listed below:

  • Brunk , M. A., Chapman, J. E., & Schoenwald, S. K. (2014). Defining and evaluating fidelity at the program level in psychosocial treatments. Zeitschrift fur Psychologie, 222(1), 22–29. https://doi.org/10.1027/2151-2604/a000162
  • Halliday -Boykins, C. A., Schoenwald, S. K., & Letourneau, E. J. (2005). Caregiver-therapist ethnic similarity predicts youth outcomes from an empirically based treatment. Journal of Consulting and Clinical Psychology, 73(5), 808–818. https://doi.org/10.1037/0022-006X.73.5.808
  • Henggeler, S. W., Schoenwald, S. K., Liao, J. G., Letourneau, E. J., & Edwards, D. L. (2002). Transporting efficacious treatments to field settings: The link between supervisory practices and therapist fidelity in MST programs. Journal of Child and Adolescent Psychology, 31(2), 155–167. https://doi.org/10.1207/S15374424JCCP3102_02
  • Lange , A. M. C., van der Rijken, R. E. A., Busschbach, J. J. V., Delsing, M. J. M. H., & Scholte, R. H. J. (2017). It's not just the therapist: Therapist and country-wide experience predict therapist adherence and adolescent outcome. Child Youth Care Forum, 46, 455–471. https://doi.org/10.1007/s10566-016-9388-4
  • Lofholm, C. A., Eichas, K., & Sundell, K. (2014). The Swedish implementation of Multisystemic Therapy for adolescents: Does treatment experience predict treatment adherence?. Journal of Clinical Child & Adolescent Psychology, 43(4), 643–655. https://doi.org/10.1080/15374416.2014.883926
  • Ogden, T., Bjornebekk, G., Kjobli, J., Patras, J., Christiansen, T., Taraldsen, K., & Tollefsen, N. (2012). Measurement of implementation components ten years after a nationwide introduction of empirically supported programs – A pilot study. Implementation Science, 7, Article 49. https://doi.org/10.1186/1748-5908-7-49
  • Pantoja, R. (2015). Multisystemic Therapy in Chile: A public sector innovation case study. Psychosocial Intervention, 24(2), 97–103. https://doi.org/10.1016/j.psi.2015.07.002
  • Schoenwald, S. K., Carter, R. E., Chapman, J. E., & Sheidow, A. J. (2008). Therapist adherence and organizational effects on change in youth behavior problems one year after Multisystemic Therapy. Administration and Policy in Mental Health and Mental Health Services Research, 35, Article 379. https://doi.org/10.1007/s10488-008-0181-z
  • Schoenwald, S. K., Chapman, J. E., Henry, D. B., & Sheidow, A. J. (2012). Taking effective treatments to scale: Organizational effects on outcomes of Multisystemic Therapy for youths with co-occurring substance use. Journal of Child & Adolescent Substance Abuse, 21(1), 1–31. https://doi.org/10.1080/1067828X.2012.636684
  • Schoenwald, S. K., Chapman, J. E., Sheidow, A. J., & Carter, R. E. (2009). Long-term youth criminal outcomes in MST transport: The impact of therapist adherence and organizational climate and structure. Journal of Clinical Child and Adolescent Psychology, 38(1), 91–105. https://doi.org/10.1080/15374410802575388
  • Schoenwald, S. K., Halliday-Boykins, C. A., & Henggeler, S. W. (2003). Client-level predictors of adherence to MST in community service settings. Family Process, 42(3), 345–359. https://doi.org/10.1111/j.1545-5300.2003.00345.x
  • Schoenwald, S. K., Sheidow, A. J., & Chapman, J. E. (2009). Clinical supervision in treatment transport: Effects on adherence and outcomes. Journal of Consulting and Clinical Psychology, 77(3), 410–421. https://doi.org/10.1037/a0013788
  • Schoenwald, S. K., Sheidow, A. J., & Letourneau, E. J. (2004). Toward effective quality assurance in evidence-based practice: Links between expert consultation, therapist fidelity, and child outcomes. Journal of Child and Adolescent Clinical Psychology, 33(1), 94–104. https://doi.org/10.1207/S15374424JCCP3301_10
  • Schoenwald, S. K., Sheidow, A. J., Letourneau, E. J., & Liao, J. G. (2003). Transportability of Multisystemic Therapy: evidence for multi-level influences. Mental Health Service Research, 5(4), 22–239. https://doi.org/10.1023/A:1026229102151
  • Walsh , C., & Best, P. (2019). Practitioners' experiences of using blended models within family support: A proof of concept study involving Cognitive-Behavioural Therapy (CBT), Multisystemic Therapy (MST) and Incredible Years (IY) interventions. Journal of Family Social Work, 22(4–5), 369–388. https://doi.org/10.1080/10522158.2019.1616240
  • Welsh, B. C., & Greenwood, P. W. (2015). Making it happen: State progress in implementing evidence-based programs for delinquent youth. Youth Violence and Juvenile Justice, 13(3), 243–257. https://doi.org/10.1177/1541204014541708

Relevant Published, Peer-Reviewed Research

Child Welfare Outcomes: Permanency and Child/Family Well-Being

When more than 10 research articles have been published in peer-reviewed journals, the CEBC reviews all of the articles as part of the rating process and identifies the most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The articles chosen for Multisystemic Therapy (MST) are summarized below:

Borduin, C. M., Henggeler, S. W., Blaske, D. M., & Stein, R. (1990). Multisystemic treatment of adolescent sexual offenders. International Journal of Offender Therapy and Comparative Criminology, 35(2), 105–114. https://doi.org/10.1177/0306624X9003400204

Type of Study: Randomized controlled trial
Number of Participants: 16

Population:

  • Age — Mean=14 years
  • Race/Ethnicity — 63% White and 38% African American
  • Gender — 100% Male
  • Status — Participants were adolescent sexual offenders referred by juvenile court personnel.

Location/Institution: Columbia, Missouri; University of Missouri

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the efficacy of Multisystemic Therapy (MST) and individual therapy (IT) in the outpatient treatment of adolescent sexual offenders. Participants were randomly assigned to either MST or IT conditions. Measures utilized include juvenile court, adult court, and state police records. Results indicate that compared to youth who received IT, those in the MST condition showed significantly lower rates of re-arrest for sexual offending and other criminal offending. Limitations include the small sample size and limited generalizability due to gender and ethnicity.

Length of controlled postintervention follow-up: 3 years.

Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using Multisystemic Therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology, 60(6), 953–961. https://doi.org/10.1037//0022-006x.60.6.953

Type of Study: Randomized controlled trial
Number of Participants: 84

Population:

  • Age — Mean=15.2 years
  • Race/Ethnicity — 56% African American, 42% White, and 2% Hispanic-American
  • Gender — 77% Male
  • Status — Participants were violent juvenile criminal offenders referred by the Department of Juvenile Justice.

Location/Institution: Simpsonville, SC; SC Department of Mental Health

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Multisystemic Therapy (MST) delivered through a community health center to usual services delivered by the Department of Juvenile Justice. Participants were randomly assigned to either MST or usual services. Measures utilized include the Family Adaptability and Cohesion Evaluation Scales, the Missouri Peer Relations Inventory, and the Revised Behavior Problem Checklist. Results indicate that in comparison with youth who received usual juvenile justice services (high rates of incarceration), youths who received MST showed improved family cohesion, improved peer relations, decreased recidivism (43%), and decreased incarceration (64%). Limitations include high attrition rate, lack of alternative treatment control, and length of follow-up.

Length of controlled postintervention follow-up: 59 weeks.

Borduin, C. M., Mann, B. J., Cone, L. T., Henggeler, S. W., Fucci, B. R., Blaske, D. M., & Williams, R. A. (1995). Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence. Journal of Consulting and Clinical Psychology, 63(4), 569–578. https://doi.org/10.1037/0022-006X.63.4.569

Type of Study: Randomized controlled trial
Number of Participants: 176

Population:

  • Age — Mean=14.8 years
  • Race/Ethnicity — 70% White and 30% African American
  • Gender — 68% Male
  • Status — Participants were adolescent offenders referred by juvenile court personnel.

Location/Institution: Missouri

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the long-term effects of Multisystemic Therapy (MST) vs. individual therapy (IT) on the prevention of criminal behavior and violent offending on juvenile offenders at high risk for committing additional serious crimes. Participants were randomly assigned to receive MST or individual therapy (IT). Measures utilized include the Symptom Checklist–90, the Revised Behavior Problem Checklist, the Family Adaptability and Cohesion Evaluation Scales (FACES-II), the Unrevealed Differences Questionnaire, and the Missouri Peer Relations Inventory. Results indicate that posttreatment measures found improved parent-reported psychiatric symptoms, levels of behavior problems, and observed family functioning for the MST group, while the IT group reported increased problems in these areas. By the end of the 4-year observation, 71.4% of the IT youth had been arrested compared with 26.1% of the MST group. The MST group also had significantly fewer arrests for violent crimes. Limitations include the lack of expected improvement on participants' peer relations and therapists in the MST condition may have differed in motivational factors from those in the IT condition.

Length of controlled postintervention follow-up: 4 years.

Henggeler, S. W., Melton, G. B., Brondino, M. J., Scherer, D. G., & Hanley, J. H. (1997). Multisystemic Therapy with violent and chronic juvenile offenders and their families: The role of treatment fidelity in successful dissemination. Journal of Consulting and Clinical Psychology, 65(5), 821–833. https://doi.org/10.1037/0022-006X.65.5.821

Type of Study: Randomized controlled trial
Number of Participants: 155

Population:

  • Age — Adolescents: Mean=15.2 years; Caregivers: Mean=41.30 years
  • Race/Ethnicity — Adolescents: 81% African American and 19% White; Caregivers: 81% African American
  • Gender — Adolescents: 82% Male; Caregivers: 92% Female
  • Status — Participants were violent or chronic juvenile offenders and their primary caregivers.

Location/Institution: Orangeburg and Spartanburg, SC; Medical University of South Carolina

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effects of Multisystemic Therapy (MST) in treating violent and chronic juvenile offenders and their families in the absence of certain aspects of the MST quality assurance protocol. Participants were randomly assigned to MST versus usual juvenile justice probation services. Measures utilized include the Global Severity Index of the Brief Symptom Inventory, the Self-Report Delinquency Scale, the Family Adaptability and Cohesion Evaluation Scales, the Missouri Peer Relations Inventory, and Department of Juvenile Justice arrest records. Results indicate that MST decreased adolescent externalizing and internalizing symptoms at post treatment, decreased incarceration at a 1.7-year follow-up and decreased recidivism. Analysis of parent, adolescent, and therapist reports of MST treatment adherence (as measured by the MST Treatment Adherence Measure) indicated that outcomes were substantially better in cases where MST treatment fidelity was high. Limitations include possible lack of therapists' adherence to the MST treatment protocol and limited generalizability due to ethnicity and gender of participants.

Length of controlled postintervention follow-up: 1.7 years.

Henggeler, S. W., Pickrel, S. G., & Brondino, M. J. (1999). Multisystemic treatment of substance abusing and dependent delinquents: Outcomes, treatment fidelity, and transportability. Mental Health Services Research, 1, 171–184. https://doi.org/10.1023/A:1022373813261

Type of Study: Randomized controlled trial
Number of Participants: 118

Population:

  • Age — Mean=15.7 years
  • Race/Ethnicity — 50% Black, 47% White, 1% Asian, 1% Indicating some Hispanic Ethnicity, and 1% Native American
  • Gender — 79% Male
  • Status — Participants were substance abusing and substance dependent delinquent youth referred to the study by juvenile court personnel.

Location/Institution: Charleston, South Carolina; Medical University of South Carolina

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness and transportability of Multisystemic Therapy (MST). Participants were randomly assigned to receive MST versus usual community services. Measures utilized include the Personal Experience Inventory, the MST Treatment Adherence Measure, the Self-Report Delinquency Scale, urine drug screens, and Department of Juvenile Justice arrest records. Results indicate that there was a reduction in alcohol, marijuana, and other drug use, a decrease in days in out-of-home placement by 50%, and decreased criminal activity. Treatment adherence was linked with long-term outcomes, and analyses suggested that the modest results of MST were due, at least in part, to difficulty in transporting this complex treatment model from the direct control of its developers. Increased emphasis on quality assurance mechanisms to enhance treatment fidelity may help overcome barriers to transportability. Limitations include limited treatment fidelity and small sample size.

Length of controlled postintervention follow-up: 6-months.

Henggeler, S. W., Halliday-Boykins, C. A., Cunningham, P. B., Randall, J., Shapiro, S. B., & Chapman, J. E. (2006). Juvenile drug court: Enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology, 74(1), 42–54. https://doi.org/10.1037/0022-006X.74.1.42

Type of Study: Randomized controlled trial
Number of Participants: 161

Population:

  • Age — Mean=15.2 years
  • Race/Ethnicity — 67% White, 31% African American, and 2% Biracial
  • Gender — 83% Male
  • Status — Participants were substance abusing and substance dependent juvenile offenders referred by juvenile justice authorities.

Location/Institution: Charleston SC, Medical University of South Carolina

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of juvenile drug court to determine whether the integration of evidence-based practices enhanced the outcomes of juvenile drug court. Participants were randomly assigned to four-treatment conditions: family court with usual services, drug court with usual services, drug court with Multisystemic Therapy (MST), and drug court with MST enhanced with contingency management for adolescent substance use. Measures utilized include the Self-Report Delinquency Scale, the Child Behavior Checklist, criminal behavior, urine screens, arrest records, and criminal justice records. Results indicate that MST enhanced substance use outcomes and drug court was more effective than family court at decreasing self-reported substance use and criminal activity. Possibly due to the greatly increased surveillance of youths in drug court, however, these relative reductions in antisocial behavior did not translate to corresponding decreases in re-arrest or incarceration. Limitations include generalizability to other juvenile drug courts, timing of assessments might have favored certain treatment conditions, and did not include a follow up for drug court conditions.

Length of controlled postintervention follow-up: None.

Ogden, T., & Hagen, K. A. (2006). Multisystemic treatment of serious behavior problems in youth: Sustainability of effectiveness two years after intake. Child and Adolescent Mental Health, 11(3), 142–149. https://doi.org/10.1111/j.1475-3588.2006.00396.x

Type of Study: Randomized controlled trial
Number of Participants: 75

Population:

  • Age — Adolescents: Mean=15.07 years; Caregivers: Not specified
  • Race/Ethnicity — Adolescents: Not specified; Caregivers: 99% Norwegian
  • Gender — Adolescents: 48 Male and 27 Female; Caregivers: Not specified
  • Status — Participants were youth referred for treatment for serious antisocial behavior.

Location/Institution: Three sites in Norway

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of Multisystemic Therapy (MST) compared to regular services (RS) to investigate whether MST was successful at preventing placement out of home, and to examine reductions in behavior problems in multi-informant assessments. Participants were randomly assigned to MST or RS treatment conditions. Measures utilized include the Child Behavior Checklist (CBCL), the Youth Self-Report (YSR), the Teacher's Report Form (TRF), and the Self-Report Delinquency Scale (SRD). Results indicate that MST was more effective than RS in reducing out-of-home placement and behavioral problems. Limitations include missing data and the reliability of self-reporting measures.

Length of controlled postintervention follow-up: Approximately 18 months.

Timmons-Mitchell, J., Bender, M. B., Kishna, M. A., & Mitchell, C. C. (2006). An independent effectiveness trial of Multisystemic Therapy with juvenile justice youth. Journal of Clinical Child and Adolescent Psychology, 35(2), 227–236. https://doi.org/10.1207/s15374424jccp3502_6

Type of Study: Randomized controlled trial
Number of Participants: 93

Population:

  • Age — Mean=15.1 years
  • Race/Ethnicity — 78% European American, 16% African American, 4% American Hispanic, and 3% Biracial
  • Gender — 78% Male
  • Status — Participants were youth who had appeared before a family court.

Location/Institution: Midwestern U.S.

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of an evidence-based practice, Multisystemic Therapy (MST), conducted in a real-world mental health setting. Participants were randomly assigned to MST or to treatment as usual (TAU). Measures utilized include the Child and Adolescent Functional Assessment Scale (CAFAS) and family court records. Results indicate that the MST group showed a significantly lower recidivism rate. Both groups showed functional improvements, with MST showing particular improvements in the areas of home, school, and community. Limitations include the sample size was insufficient to allow for investigation of possible mediators, measures were restricted to key outcomes, and lack of better information on the actual services received by the usual services group.

Length of controlled postintervention follow-up: 6 months.

Borduin, C. M., Schaeffer, C. M., & Heiblum, N. (2009). A randomized clinical trial of Multisystemic Therapy with juvenile sexual offenders: Effects on youth social ecology and criminal activity. Journal of Consulting and Clinical Psychology, 77(1), 26–37. https://doi.org/10.1037/a0013035

Type of Study: Randomized controlled trial
Number of Participants: 48 families

Population:

  • Age — Mean=14.0 years
  • Race/Ethnicity — 73% White, 27% Black, and 2% Hispanic
  • Gender — 96% Male
  • Status — Participants were juvenile sexual offenders at high risk of committing additional serious crimes

Location/Institution: Midwestern U.S.

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of Multisystemic Therapy (MST) versus usual community services (UCS). Participants were randomly assigned to receive MST or UCS. Measures utilized include the Global Severity Index of the Brief Symptom Inventory, the Revised Behavior Problem Checklist, the Family Adaptability and Cohesion Scale (FACES-II), and the Missouri Peer Relations Inventory. Results indicate that there was improvement for the MST group in individual adjustment, family, and peer relations, with comparable decreases over time for the comparison group. MST recipients also had 84% fewer arrests for sexual crimes and 70% fewer arrests for other crimes. Limitations include the lack of randomization of therapists to treatments and a lack of data about possible crimes committed in other states.

Length of controlled postintervention follow-up: Approximately 8.9 years.

Letourneau, E. J., Henggeler, S. W., Borduin, C. M., Schewe, P. A., McCart, M. R., Chapman, J. E., & Saldana, L. (2009). Multisystemic Therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial. Journal of Family Psychology, 23(1), 89–102. https://doi.org/10.1037/a0014352

Type of Study: Randomized controlled trial
Number of Participants: 127

Population:

  • Age — 11–17 years
  • Race/Ethnicity — 54% Black and 44% White with 31% indicating some Hispanic ethnicity
  • Gender — 98% Male
  • Status — Participants were youth referred by the County State's Attorney after being charged with a sexual offense.

Location/Institution: Chicago, IL

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Multisystemic Therapy (MST) adapted for juvenile sexual offenders with services that are typical of those provided to juvenile sexual offenders. Participants were randomly assigned to receive either MST or treatment as usual (TAU). Measures utilized include the Adolescent Sexual Behavior Inventory, the Personal Experience Inventory, the National Youth Survey, and the Child Behavior Checklist (CBCL). Results indicate that relative to the TAU group, those receiving MST showed reductions in sexual behavior problems, delinquency, externalizing behaviors on the CBCL, substance use, and out-of-home placements. Limitations include a lack of long-term follow-up and the lack of adequate validation for self-report measures of criminal sexual behaviors.

Length of controlled postintervention follow-up: 1 year.

Additional References

Henggeler, S. W., & Schaeffer, C. M. (2019). Multisystemic Therapy: Clinical procedures, outcomes, and implementation research. In B. H. Friese (Ed.), APA Handbook of contemporary family psychology: Vol. 3. Family therapy and training. American Psychological Association.

MST Services. (2019, Nov. 15). How does MST really work? [Video]. https://www.youtube.com/watch?v=GUhcojAeC9E

MST Services. (2018). What makes MST such an effective intervention? https://info.mstservices.com/mst-effective-intervention-whitepaper

Contact Information

Tom Pietkiewicz
Title: Director of Business Development
Agency/Affiliation: MST Services
Website: www.mstservices.com
Email:
Phone: (843) 352-4306

Date Research Evidence Last Reviewed by CEBC: March 2024

Date Program Content Last Reviewed by Program Staff: May 2024

Date Program Originally Loaded onto CEBC: June 2009