Multisystemic Therapy for Child Abuse and Neglect (MST-CAN)

Scientific Rating:
2
Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
High
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) has been rated by the CEBC in the area of: Interventions for Abusive Behavior.

Target Population: Families who have come to the attention of Child Protective Services within the past 180 days due to the physical abuse and/or neglect of a child in the family between the ages of 6 and 17; where the child is still living with them or is in foster care with the intent of reunifying with the parent(s); other criteria may apply

For children/adolescents ages: 6 – 17

For parents/caregivers of children ages: 6 – 17

Brief Description

MST-CAN is for families with serious clinical needs who have come to the attention of child protective services (CPS) due to physical abuse and/or neglect. MST-CAN clinicians work on a team of 3 therapists, a crisis caseworker, a part-time psychiatrist who can treat children and adults, and a full-time supervisor. Each therapist carries a maximum caseload of 4 families. Treatment is provided to all adults and children in the family. Services are provided in the family’s home or other convenient places. Extensive safety protocols are geared towards preventing re-abuse and placement of children and the team works to foster a close working relationship between CPS and the family. Empirically-based treatments are used when needed and include functional analysis of the use of force, family communication and problem solving, Cognitive Behavioral Therapy for anger management and posttraumatic stress disorder (PTSD), clarification of the abuse or neglect, and Reinforcement Based Therapy for adult substance abuse.


Program Goals:

The goals of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) are:

  • Reduce abuse or neglect
  • Reduce out-of-home placement
  • Improve parenting (without violence, psychological aggression, or neglect)
  • Improve parent mental health functioning
  • Improve youth mental health functioning
  • Increase social support

Essential Components

The essential components of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) include:

  • Clients:
    • Youth between the ages of 6 and 17
    • Youth who have come to the attention of child protective services due to physical abuse and/or neglect and for whom the abuse report was filed within the last 180 days
    • Youth who are currently in foster care or another out-of-home placement and will be reuniting with their family
  • Intervention Context:
    • Services provided in the family’s home or other places convenient to them and at times convenient to the family
    • Intensive services, with intervention sessions being conducted from three times per week to daily
    • 24/7 on-call roster utilized to provide round-the-clock services for families
    • Treatment provided to multiple children in the family and one or both parents, with a greater emphasis on parent treatment than standard MST
  • Therapists and Supervisors
    • MST-CAN staff work on a clinical team of 3 therapists, a crisis caseworker, a part-time psychiatrist, and a full-time supervisor
    • MST-CAN supervisor must have the following criteria:
      • An understanding of the child protective services system
      • Experience with family therapy and cognitive behavioral therapy for posttraumatic stress disorder (PTSD)/trauma
      • Experience in managing severe family crises that involve safety risk to the children or entire family
      • A thorough understanding of state mandated abuse reporting laws
      • A PhD or Master’s degree in counseling, social work, or a related field
    • Supervisors must be full-time and may supervise a single team only
    • The MST-CAN therapist must have a Master’s degree in counseling, social work, or a related field
    • The MST-CAN Team must have access to an appropriate percentage of an adult and child psychiatrist’s time that has been trained in the MST and MST-CAN treatment models and is integrated into the clinical team
    • The MST-CAN team must include one full-time crisis caseworker with a Bachelors degree
  • Application of the Intervention:
    • Interventions developed along an analytical model that guides the therapist to assess factors that are driving clinical problems and then applied to the driving factors or “fit factors”
    • All interventions evidence-based or evidence-informed
    • Each therapist carries a maximum caseload of 4 families and case length is 6-9 months
  • Program Fidelity and Quality Assurance:
    • Each team member completes a 5-day MST orientation training, a 4-day MST-CAN training, and 4 days of training in adult and child trauma treatment
    • Weekly on-site group supervision
    • Weekly telephone consultation with an MST-CAN expert
    • Quarterly on-site booster trainings conducted by the MST-CAN expert
    • Measurement of model adherence through monthly phone interviews with the parent or caregiver.
  • 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 database system.
    • MSTI data reports used to assess and guide program implementation
    • Agencies use these reports to monitor and assure fidelity to the MST model
    • There must be a formal Memorandum of Agreement (MOA) in place regarding access to abuse and placement data prior to implementation

Child/Adolescent Services

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) directly provides services to children/adolescents and addresses the following:

  • Physical abuse and/or neglect for which the report to child protective services was filed within the last 180 days, youth aggression, anxiety and trauma/PTSD, substance abuse, difficulty managing anger, safety risks, difficulties with family problem solving, negative family communication, physical force in parenting, neglectful parenting, parental psychological aggression, low social support, parental blame of the child for the abuse/neglect, and school difficulties

Parent/Caregiver Services

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) directly provides services to parents/caregivers and addresses the following:

  • Has a child who experienced physical abuse and/or neglect for which the report to CPS was filed within the last 180 days, anxiety and trauma/PTSD, depression, substance abuse, difficulty managing anger, safety risks, difficulties with family problem solving, negative family communication, physical force in parenting, neglectful parenting, parental psychological aggression, low social support, parental blame of the child for the abuse/neglect, and difficulties maintaining housing or jobs
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Direct treatment services provided to familyCollaboration with other supportive individuals, including them as part of the treatment team

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster/Kinship Care
  • School

Homework

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) includes a homework component:

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

  • Parent Management Training
  • Treatment of caregiver posttraumatic stress disorder (PTSD)
  • Treatment for anger management
  • Treatment for caregiver substance abuse
  • Family communication training

Languages

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) has materials available in languages other than English:

Dutch, Swiss German

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 mobile phones for all staff.

Minimum Provider Qualifications

MST-CAN Supervisor:

  • Must be assigned to MST-CAN 100%.
  • Must have a Master's degree in counseling, social work, or a related field
  • Must be independently licensed.
  • May only supervise a single team
  • May not carry their own caseload
  • Must have an understanding of the child welfare system
  • Must have experience in managing severe family crises that involve safety risk to the children and/or entire family
  • Must have a thorough understanding of state and national mandated abuse reporting laws
  • Should have experience implementing Standard MST or MST-CAN
  • Should have knowledge and experience in the MST-CAN Supervision Model
  • Should have experience with family therapy and Cognitive-Behavioral Therapy (CBT) for Post-traumatic Stress Disorder (PTSD)

MST-CAN Therapist:

  • Must be assigned to a single MST-CAN team 100%
  • Must have a Master's degree in counseling, social work, or a related field
  • Should have a background in child development
  • Should have an understanding of family violence
  • Should have skills in engaging families reluctant to participate
  • Should have experience in crisis intervention where homicidal or suicidal risk is present
  • Should have knowledge of the child welfare system.

MST-CAN Crisis Caseworker:

  • Must be assigned to a single MST-CAN team 100%
  • Must have a minimum of a Bachelor’s degree
  • Should have knowledge, of interventions related to practical life skills such as employment seeking, budgeting, and housing
  • Should have experience in the child welfare system
  • Should have knowledge of child development

MST-CAN Psychiatrist:

  • Must be available to team at least 8 hours per week
  • MD or DO, board certification eligibility in Child and Adolescent Psychiatry
  • Must be trained in the MST treatment model and the MST-CAN adaptations by MST, Inc.
  • Must have a thorough understanding of state and national mandated abuse reporting laws
  • Should have a thorough understanding of existing ethical guidelines and laws concerning clinical situations that may occur in crisis treatment (i.e., restraints, commitments, reporting abuse or neglect)
  • Should have experience with both child and adult populations
  • Should have experience in trauma treatment for youth and adults
  • Should have experience working in local organizations and systems

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Training is only available to staff who will be implementing MST-CAN in a licensed program. With regard to the initial 5-day MST orientation, organizations can access the training in one of two ways. New staff can come to Charleston, SC and participate in one of the quarterly open-enrollment trainings provided by MST Services Inc. Alternatively, providers can elect to have MST Services Inc. conduct an additional 5-day initial training at their site. MST-CAN training and the 4-day trauma training are provided on site by MST-CAN experts at this time. After start-up, training continues through weekly telephone MST-CAN consultation and on-site quarterly booster trainings for each team of MST-CAN clinicians.

Number of days/hours:

All trainees complete the Standard MST 5-day orientation. Then each team member completes a 4-day MST-CAN specific training and 4 days of training in adult and child trauma treatment. All training is open to CPS caseworkers who will be working with the MST-CAN team.

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

Additional Resources:

There currently are additional qualified resources for training:

Agencies that are licensed by MST Services Inc. as Network Partner Organizations can provide the MST 5-day orientation training.

At this time all MST-CAN trainings are provided by MST-CAN experts affiliated with MST Services or the Medical University of South Carolina.

Implementation Information

Since Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

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

MST Services, the company that disseminates MST and MST-CAN has developed site assessment tools that have been used for the last 15 years with standard MST and for the last 5 years with MST-CAN. The tools include a review of the feasibility of the program, goals, and guidelines for implementation and implementation and program practice requirements that must be met. Furthermore, each site must pass a formal Site Readiness Review conducted on site. These tools are not available to the general public and are only used when a site is moving forward with implementation of an MST-CAN program.

Formal Support for Implementation

The program representative did not provide information about formal support for implementation of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN).

Fidelity Measures

There are fidelity measures for Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) as listed below:

Therapist Adherence Measure-Revised (TAM-R): This is an objective, standardized instrument that evaluates a therapist’s adherence to the MST-CAN model as reported by the primary caregiver of the family. It has been shown to have significant value in measuring Therapist adherence to MST principles and predicting treatment outcomes. The TAM-R has been validated in clinical trials with serious, chronic, juvenile offenders, and is now implemented by all licensed MST programs. The TAM-R is available through MST Services but is used only for MST programs (www.mstservices.com).

MST-CAN Therapist Adherence Measure-Revised (MST-CAN TAM-R): This measure is the TAM-R plus additional items that measure adherence to the MST-CAN model. The MST-CAN TAM-R takes 10 to 15 minutes to complete. It is administered during the second week of treatment and every four weeks thereafter. A MST-CAN interviewer with the Family Services Research Center of the Medical University of South Carolina will contact the family in person or by phone to complete the measure. Data are entered onto an on-line database managed by the MST Institute, and results are reviewed by the MST-CAN Supervisor and Therapist. The full MST-CAN TAM-R is entered into a database housed at the Family Services Research Center of the Medical University of South Carolina. The MST-CAN TAM-R is not available to the general public at this time as it is considered a research instrument.

Supervisor Adherence Measure (SAM): This measure evaluates the MST-CAN Clinical Supervisor’s adherence to the MST model of supervision. This 10 to 15 minute measure is completed by MST-CAN Therapists, who are prompted to complete the SAM every two months and enter their responses directly onto the on-line database. Results are shared with the MST-CAN Consultant, who then shares a summary of the feedback with the MST-CAN Clinical Supervisor during a consultation meeting. The SAM is available through MST Services but is used only for MST programs (www.mstservices.com).

Consultant Adherence Measure (CAM)
: The MST-CAN Therapists and MST-CAN Supervisors are responsible for completing this questionnaire. Times will be scheduled one month after completion of the first SAM, and every two months thereafter. It is estimated that the time commitment required will be 10 to 15 minutes per respondent for each administration. The CAM consists of 23 items that measure consultation behavior in three domains. The CAM is available through MST Services but is used only for MST programs (www.mstservices.com).

Implementation Guides or Manuals

There are implementation guides or manuals for Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) as listed below:

MST Services has developed manuals for training supervisors and consultants and for teams to follow to prepare weekly treatment plans. These tools are not available to the general public.

Research on How to Implement the Program

The program representative did not provide information about research conducted on how to implement Multisystemic Therapy for Child Abuse and Neglect (MST-CAN).

Relevant Published, Peer-Reviewed Research

This program is rated a "2 - Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least one rigorous randomized controlled trial with a sustained effect of at least 6 months. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 6 months has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

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

Show relevant research...

*Swenson, C. C., Schaeffer, C. M., Henggeler, S. W., Faldowski, R., & Mayhew, A. (2010). Multisystemic Therapy for Child Abuse and Neglect: A randomized effectiveness trial. Journal of Family Psychology, 24, 497-507.

Type of Study: Randomized controlled trial
Number of Participants: 86

Population:

  • Age — 10-17 years
  • Race/Ethnicity — 69% African American, 22% Caucasian, and 9% Other
  • Gender — 56% Female and 44% Male
  • Status — Participants were physically abused youth at a public sector mental health center referred through child protective services (CPS).

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) in a sample of physically abused youth. Participants were randomly assigned to an MST-CAN treatment group or to an Enhanced Outpatient Treatment (EOT) comparison group. Participants were assessed at intake, 2 months, post-intervention, and at 10- and 16-month post-intervention follow-ups using the Child Behavior Checklist (CBCL), Trauma Symptom Checklist or Children (TSCC), Social Skills Rating System, Global Severity Index (GSI), Brief Symptom Inventory (BSI), Conflict Tactics Scale (CTS), and the Interpersonal Support Evaluation List (ISEL). Results indicated that MST-CAN was significantly more effective than EOT in reducing youth mental health symptoms, parent psychiatric distress, parenting behaviors associated with maltreatment, youth out-of-home placements, and changes in youth placement. MST-CAN was significantly more effective at improving natural social support for parents. MST-CAN was not significantly more effective at reducing incidents of re-abuse. Limitations include relatively small sample size and reliance on parent self-report.

Length of postintervention follow-up: 1 year.

The following studies were not included in rating MST-CAN on the Scientific Rating Scale...

Brunk, M., Henggeler, S. W., & Whelan, J. P. (1987). Comparison of Multisystemic Therapy and parent training in the brief treatment of child abuse and neglect. Journal of Consulting and Clinical Psychology, 55, 171-178.

Note: This study examined the usual format of Multisystemic Therapy (MST) applied to child abuse and neglect, as opposed to MST-CAN. Results may not be applicable to MST-CAN. The study evaluated the efficacy of MST in a sample of families with histories of child maltreatment and neglect. Participants were randomly assigned to an MST intervention group or to a parent training comparison group. Participants were assessed at intake and at 1-week post-intervention follow-up using the Symptom Checklist-90 (SCL-90), Behavior Problem Checklist (BPC), Family Environment Scale (FES), Family Inventory of Life Events and Changes (FILE), and the Treatment Outcome Questionnaire (TOQ). Results indicated that families who received either treatment showed decreased parental psychiatric symptomology, reduced overall stress, and a reduction in the severity of identified problems. Analyses revealed that MST was more effective than parent training at restructuring parent-child relations, but parent training was more effective than MST at reducing identified social problems. Study limitations include relatively small sample size and lack of a long-term post-intervention follow-up.

References

Swenson, C. C., & Schaeffer, C. M. (2011). Multisystemic Therapy for Child Abuse and Neglect. In A. Rubin & D. Springer (Eds.), Programs and Interventions for Maltreated Children and Families at Risk (pp. 31-42). Hoboken, NJ: Wiley.

Swenson, C. C., Schaeffer, C. M., Tuerk, E. H., Henggeler, S. W., Tuten, M., Panzarella, P., ... Guillorn, A. (2009). Adapting Multisystemic Therapy for co-occurring child maltreatment and parental substance abuse: The building stronger families project. Emotional and Behavioral Disorders in Youth, W, 3-8.

Swenson, C. C., Penman, J. E., Henggeler, S. W., & Rowland, M. D. (2011). Multisystemic Therapy for Child Abuse and Neglect, revised edition. Charleston, SC: Family Services Research Center, National Institute of Mental Health, and Connecticut Department of Children and Families.

Contact Information

Name: Joanne Penman, M.Ed, LMSW
Agency/Affiliation: MST Services
Website: www.mstcan.com
Email:
Phone: (843) 284-2222
Fax: (843) 856-8227

Date Research Evidence Last Reviewed by CEBC: August 2016

Date Program Content Last Reviewed by Program Staff: March 2016

Date Program Originally Loaded onto CEBC: February 2012