Multisystemic Therapy (MST)

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
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 (MST) has been rated by the CEBC in the areas of: Disruptive Behavior Treatment (Child & Adolescent), Substance Abuse Treatment (Adolescent) and Behavioral Management Programs for Adolescents in Child Welfare.

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 (some other restrictions exist, see the Essential Components section for more details)

For children/adolescents ages: 12 – 17

For parents/caregivers of children ages: 12 – 17

Brief Description

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:

  • Eliminate or significantly reduce the frequency and severity of the youth’s referral behavior(s)
  • Empower parents with the skills and resources needed to:
    • Independently address the inevitable difficulties that arise in raising children and adolescents
    • Empower youth to cope with family, peer, school, and neighborhood problems

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.

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)

Delivery Settings

This program is typically conducted in a(n):

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

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.

Minimum Provider Qualifications

  • The supervisor must have an understanding of the Juvenile Justice system, and 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.

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:

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

Since Multisystemic Therapy (MST) 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 (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: Marshall E. Swenson, MSW, MBA, Vice President & Manager of New Program Development, email: marshall.swenson@mstservices.com, phone: 843-284-2215 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. 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.

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

Research on How to Implement the Program

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

  • 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.
  • 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, 345-359.
  • 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), 223-239.
  • 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, 94-104.
  • 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, 808-818.
  • 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, 379-394.
  • 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, 410-421.
  • 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, 91-105.
  • 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, 1-31.
  • 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(49). doi:10.1186/1748-5908-7-49

Relevant Published, Peer-Reviewed Research

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 program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

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

Show relevant research...

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 10 most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The 10 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, 105-114.

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

Population:

  • Age — Mean=14 years
  • Race/Ethnicity — 62.5% White and 37.5% 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 comparison groups, outcomes, measures, notable limitations)
This study compared the efficacy of Multisystemic Therapy (MST) and individual therapy (IT) in the outpatient treatment of adolescent sexual offenders. Sixteen adolescent sexual offenders were randomly assigned to either MST or IT conditions. Youths in the MST and IT conditions received an average of 37 and 45 hours of treatment, respectively. Recidivism data were collected on all subjects at an approximately 3-year follow up. 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 small sample size and limited generalizability due to gender and ethnicity.

Length of 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, 953-961.

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 and juvenile criminal offenders referred by the Department of Juvenile Justice.

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

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Multisystemic Therapy (MST) delivered through a community health center was compared to usual services delivered by the Department of Juvenile Justice in the treatment of 84 serious juvenile offenders and their families. Offenders were assigned randomly to treatment conditions. Pretreatment and posttreatment assessment batteries evaluated family relations (as measured by the Family Adaptability and Cohesion Evaluation Scales), peer relations (as evaluated by the Missouri Peer Relations Inventory), behavioral symptomology and social competence (as measured by the Revised Behavior Problem Checklist), criminal offending based on self-reports, and arrest/incarceration records through 59 weeks post-referral. 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 for this study.

Length of postintervention follow-up: 59 weeks; a subsequent publication provided a 2.4 year follow-up with outcomes favoring the MST condition.

*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.

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 — 67.5% Male
  • Status — Participants were adolescent offenders referred by juvenile court personnel.

Location/Institution: Missouri

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Youth were randomly assigned to receive Multisystemic Therapy (MST) or individual therapy (IT). Participants and family members were assessed prior to treatment and approximately one week after treatment using the same measurement procedure. A follow-up using police and court records was conducted for 4 years after completion of treatment. Outcome measures included self-reports on the Symptom Checklist—90 and the Revised Behavior Problem Checklist. Family functioning was assessed with the Family Adaptability and Cohesion Evaluation Scales (FACES-II), and observers evaluated family interactions using the Unrevealed Differences Questionnaire. Finally, peer relations, through parent and teacher perceptions, were evaluated with the Missouri Peer Relations Inventory. Post-treatment 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 lack of expected improvement on participants’ peer relations. Therapists in the MST condition may also have differed in motivational factors from those in the IT condition.

Length of 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, 821-833.

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

Population:

  • Age — Mean=15.2 years
  • Race/Ethnicity — 80.6% African American and 19.4% White
  • Gender — 81.9% Male
  • Status — Participants were violent and juvenile criminal offenders youth referred to the study by juvenile court personnel.

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

Summary: (To include comparison groups, outcomes, measures, notable limitations)
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 were examined. Across 2 public-sector mental health sites, 155 youths and their families were randomly assigned to MST versus usual juvenile justice probation services with high rates of incarceration. Youth emotional adjustment and adolescent behavior problems were measured by the Global Severity Index of the Brief Symptom Inventory. Criminal activity was measured by the Self-Report Delinquency Scale as well as Department of Juvenile Justice arrest records. Family relations were measured by the Family Adaptability and Cohesion Evaluation Scales and peer relations were measured by the Missouri Peer Relations Inventory. 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 generaliability due to ethnicity and gender of participants.

Length of 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.

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 delinquents youth referred to the study by juvenile court personnel.

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

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The effectiveness and transportability of Multisystemic Therapy (MST) were examined in a study that included 118 juvenile offenders meeting the Diagnostic and Statistical Manual, Third Edition, Revised (DSM-III-R) criteria for substance abuse or dependence and their families. Participants were randomly assigned to receive MST versus usual community services. Outcome measures assessed drug use (as measured by the Personal Experience Inventory and urine drug screens), criminal activity (measured by the Self-Report Delinquency Scale as well as Department of Juvenile Justice arrest records), and days in out-of-home placement at post treatment and at a 6-month post-treatment follow-up. Also, treatment adherence (as measured by the MST Treatment Adherence Measure) was examined from multiple perspectives. Results showed a reduction in drug use, decreased days in out-of-home placement, and decreased recidivism. 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 postintervention follow-up: 1 year; a 4-year follow-up was subsequently published with results favoring the MST condition.

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, 34(4), 658-670.

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 to the study by juvenile justice authorities.

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

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Over a 1-year period, a four-treatment condition randomized design evaluated the outcomes for 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 (as measured by self-report and urine screens) , criminal behavior (as measured by the Self-Report Delinquency Scale and arrest records), symptomatology (as measured by the Child Behavior Checklist), and days in out-of-home placement (as documented in criminal justice records). In general, results showed 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 included the relatively short follow-up.

Length of postintervention follow-up: Approximately 8 months.

*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.

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

Population:

  • Age — Mean=15 years
  • Race/Ethnicity — Not specified – 99% of caregivers had a Norwegian background
  • Gender — 64% Male
  • Status — Participants were youth referred for treatment for serious antisocial behavior.

Location/Institution: 3 sites in Norway

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The aim of this study was to examine the effectiveness of Multisystemic Therapy (MST) compared to “regular services” (RS) two years after intake to treatment 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 reliability of self-reporting measures.

Length of 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.

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

Population:

  • Age — Mean=15.1 years
  • Race/Ethnicity — 77.5% European American, 15.5% African American, 4.2% American Hispanic, and 2.8% Biracial
  • Gender — 78% Male
  • Status — Participants were youth who had appeared before a family court.

Location/Institution: Midwestern U.S.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Families were randomly assigned to Multisystemic Therapy (MST) or to treatment as usual (TAU). In their introduction, the authors note that this study is unusual in that it does not involve the original MST developers and was conducted in a more naturalistic setting than some previous trials. Youth functioning was measured using the Child and Adolescent Functional Assessment Scale (CAFAS), which focuses on school/work, home, community, behavior towards others, emotions, self-harming and risky behavior and thinking. Youth recidivism was also measure using family court records. 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 relatively little information about services used in the TAU condition. Available information suggested that use of services was low by families in the TAU group.

Length of 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.

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

Population:

  • Age — Mean=14 years
  • Race/Ethnicity — 72.9% White, 27.1% Black, and 2.1% Hispanic
  • Gender — 95.8% Male
  • Status — Participants were youth referred to the study by juvenile court personnel.

Location/Institution: Midwestern U.S.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Youth were included in the study if the reason for their arrest included a serious sexual offense and if they had subsequently been referred for sexual offender counseling. Participants were randomly assigned to receive Multisystemic Therapy (MST) or usual community services (UCS). Measures of individual adjustment include the Global Severity Index of the Brief Symptom Inventory and the Revised Behavior Problem Checklist. Family relations were assessed with the Family Adaptability and Cohesion Scale (FACES-II) and peer relations with the Missouri Peer Relations Inventory. Researchers also measured self-report of delinquent behavior and arrests and incarcerations. Improvement was shown for the MST group in individual adjustment, family and peer relations, with comparable decreases over time for the comparison group. MST recipients also have 84% fewer arrests for sexual crimes and 70% fewer arrests of other crimes. Limitations include lack of randomization of therapists to treatments and lack of data about possible crimes committed in other states.

Length of postintervention follow-up: 8.9 years on average (arrest and incarceration data only).

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.

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

Population:

  • Age — 11-17 years
  • Race/Ethnicity — 54% Black and 44% White with 31% indicating some Hispanic ethnicity
  • Gender — 97.6% 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 comparison groups, outcomes, measures, notable limitations)
Youth recommended for sexual offender treatment were randomly assigned to receive either Multisystemic Therapy (MST) or treatment as usual (TAU), specific to juvenile sexual offenders. Outcome measures assessed problem sexual behavior using the Adolescent Sexual Behavior Inventory; substance abuse, using the Personal Experience Inventory; and delinquency, using the National Youth Survey’s self-report delinquency scale. Parents also reported mental health issues using the Child Behavior Checklist (CBCL) and out-of-home placements were monitored. 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 lack of long-term follow-up and lack of adequate validation for self-report measures of criminal sexual behaviors.

Length of postintervention follow-up: Not specified.

References

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.). New York: Guilford Press.

Contact Information

Name: Marshall Swenson, MBA
Agency/Affiliation: MST Services
Website: www.mstservices.com
Email:
Phone: (843) 284-2215
Fax: (843) 856-8227

Date Research Evidence Last Reviewed by CEBC: March 2015

Date Program Content Last Reviewed by Program Staff: October 2016

Date Program Originally Loaded onto CEBC: June 2009