The information in this program outline is provided by the program representative and edited by the CEBC staff. The Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) program has been rated by the CEBC in the area of: Sexual Behavior Problems in Adolescents, Treatment of.

• Types of Maltreatment: Does not target any specific kind of maltreatment
• Target Population: Youth (and their families) when the youth has engaged in sexually abusive behavior toward others. The offending youth must be between 10 and 17.5 years of age. Many of these youth will have been seen by the courts, although this is not an inclusionary requirement.

Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) is a clinical adaptation of Multisystemic Therapy (MST) that has been specifically designed and developed to treat youth (and their families) for problematic sexual behavior. Building upon the research and dissemination foundation of standard MST, the MST-PSB model represents a practice uniquely developed to address the multiple determinants underlying problematic juvenile sexual behavior.

MST-PSB is delivered in the community, occurs with a high level of intensity and frequency, incorporates treatment interventions from MST, and places a high premium on approaching each client and family as unique entities. Treatment incorporates intensive family therapy, parent training, cognitive-behavioral therapy, skills building, school and other community system interventions, and clarification work. Ensuring client, victim, and community safety is a paramount mission of the model.

Each youth/family has uniquely and collaboratively designed individual treatment plans, and each treatment site is encouraged to conjointly develop locally defined outcomes that suit community needs. As a program, MST-PSB always identifies the following as minimally desired goals at discharge and at designated post discharge intervals.

• Youth is currently living at home.
• Youth is attending school (is not truant) or vocational training; youth may have a job if of a legally appropriate age not to attend school.
• Youth has not been arrested for an offense since the beginning of MST-PSB treatment.
• Youth has demonstrated an absence of any problem sexual behavior and no sexually related arrests or substantiated child abuse investigations.

MST for Problem Sexual Behavior (MST-PSB) is an adaptation of MST that was developed for 10- to 17.5-year-old youth with sexually related externalizing delinquent behaviors, including aggressive (e.g., sexual assault, rape) and non-aggressive (e.g., molestation of younger children) sexual offenses. Youth may also exhibit the following characteristics:

• At imminent risk of out-of-home placement due to criminal offenses.
• Physical aggression at home or school or in the community.
• Verbal aggression and threats of harm to others.
• Substance abuse in the context of the 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 referred primarily due to concerns related to suicidal, homicidal, or psychotic behaviors.
• Youth with pervasive developmental delays.

Intervention Context:

• Services are provided in the family’s home or other convenient places and at times convenient to the family.
• Services are intensive, with intervention sessions conducted from once a week to every day.
• A 24 hour/7 day per week on-call schedule is utilized to provide round-the-clock availability of clinical services for families.

Therapists and Supervisors:

• MST-PSB staff members work on a clinical team of 2-4 therapists and a supervisor.
• MST-PSB therapists are Master’s-prepared (clinical-degreed) professionals.
• MST-PSB clinical supervisors must be allocate at least 50% of their time to each MST-PSB team and may supervise 1-2 teams only.
• MST-PSB clinical 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).

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.”
• Each therapist carries a maximum caseload of 4 families and case length ranges from 5 to 7 months.

Clinical Supervision:

• The MST-PSB clinical supervisor conducts on-site weekly team clinical supervision, facilitates the weekly MST-PSB 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/MST Associates, and all data are sent to the MST Institute (MSTI), which is charged with keeping the national 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-PSB model.

Agency:

• The agency must have community support for sustainability.
• With the buy-in of other organizations and agencies, MST-PSB staff is able to “take the lead” for clinical decision-making on each case.
• Stakeholders in the overall MST-PSB program have responsibility for initiating these collaborative relationships with other organizations and agencies while MST-PSB staff sustains them through ongoing, case-specific collaboration.

Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) was designed with a child component that addresses the following presenting problems and symptoms:

• Sexually related externalizing, delinquent behaviors, including aggressive (e.g., sexual assault, rape) and non-aggressive (e.g., molestation of younger children) sexual offenses are the primary target behavior.  Other externalizing behaviors such as verbal and physical nonsexual aggression, substance abuse, truancy, and criminal activity that interfere with youth/family functioning and/or may result in the youth being placed outside of the home are also addressed.

Age range: 10 – 17

Developmental Delays:

This program was not developed for children with developmental delays, and has not been tested for children with developmental delays.

Treatment Involves Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Family therapy (using a Structural and/or Strategic Family Therapy approach) is a primary treatment modality within MST-PSB, and the vast majority of treatment sessions focus on the family system. As an in-home, community- based model that focuses on all elements of the youth’s natural ecology, the family is engaged as a central change agent for the youth’s behavior. Extended family members are often engaged in treatment interventions along with nuclear family members. Long-term outcomes and generalization of acquired skills are hoped to be enhanced by this strength-based, ecological approach in which caregivers are supported in managing youth behaviors across the systemic elements of their ecology (e.g., school, community, peer relationships).

Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

• Denial, minimization, and or victim blaming. Plus general presenting problems/symptoms:  Difficulty managing anger, substance abuse, and barriers to effective parenting (e.g., untreated mental illness, excessive stress). 

Recommended Intensity:

Frequency and intensity of treatment are dependent on the unique needs of the youth and family. In general, families receive three or more contacts per week with the average contact lasting 1-2 hours. However, if the family is in crisis or urgent needs arise, the amount of contact will likely be even greater. During the latter stages of treatment, session frequency may lessen to promote more autonomy and generalization of treatment effects.

Recommended Duration:

5-7 months

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Foster Home
• School

Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) includes a homework component:

A number of the core treatment principles in MST support the concept of youth and family work between sessions. Youth and caregiver interventions are designed to require continuous effort, increase client responsibility, require action oriented behaviors, and promote generalization of skills through practice. Thus weekly goals are collaboratively developed with the family that, for example, support the acquisition of newly learned behaviors, the monitoring of interventions to gauge effectiveness, and tracking behavioral baselines.

Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) has materials available in languages other than English:

Danish, Dutch, Japanese, Norwegian, 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).

The typical resources for implementing the program are:

Office space to house the team and conduct consultation and supervision is required. All team members must also have cell phones and access to computers. Each team must have at least one video camera (for training and quality assurance purposes).

The supervisor must have an understanding of the juvenile justice system, experience with family therapy and cognitive-behavioral therapy, and experience in managing severe family crises that involve safety risk to the family.

Supervisors are, at a 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).

Therapists must have a Master's degree in a mental health-related field.

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

Training Contact:

• Richard J. Munschy, PsyD, Director of Clinical Training
  MST Associates
  www.mstpsb.com
  Munschy@mstpsb.com
  phone: (860) 348-1938
  fax: (860) 225-4776

Training is obtained:

With regard to the standard MST orientation 5-day training, organizations can obtain the training in one of three ways. New staff can come to Charleston, SC, and participate in one of the quarterly open-enrollment trainings provided by the Multisystemic Therapy Services (MSTS). Or, organizations can send staff to any 5-day trainings provided by Licensed MST Network Partners (see a list of licensed Network Partners at www.mstservices.com). Alternatively, providers can elect to have MSTS conduct the 5-day initial training at the provider site.

MST-PSB specific 2-day orientation training can only be obtained via MST Associates (the sole dissemination agent for MST-PSB). Initial training for new MST-PSB teams is delivered on site as an integrated component of program start up. Training for subsequent hires typically occurs off site. Contact the MST-PSB Director of Clinical Training for further information.

Number of days/hours:

All trainees must first complete the standard MST 5-day orientation. An additional 2 day orientation training covering the unique aspects and augmentations of the MST-PSB clinical model is then required.

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. Experts also assist at the organizational level as needed.

Since Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) is highly rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being