Multisystemic Therapy – Building Stronger Families (MST-BSF)
About This Program
Target Population: Families who are involved with child welfare services due to physical abuse and/or neglect plus parental substance misuse
For children/adolescents ages: 0 – 17
For parents/caregivers of children ages: 0 – 17
MST-BSF is an ecologically based treatment model for families involved with child welfare services due to physical abuse and/or neglect plus parental substance misuse. MST-BSF is designed to provide all families with intensive safety planning, Reinforcement-Based Treatment for adult substance misuse, a relapse prevention group, and clarification of the abuse or neglect. On an individualized, as-needed basis, children and adults receive treatment for clinical challenges such as posttraumatic stress disorder (PTSD), parenting, and family communication. To assure model fidelity, an array of quality assurance procedures is integrated into the model. The model is operated through a team consisting of a supervisor, a family resource specialist who focuses on basic needs, and three therapists that carry a caseload maximum of 4 families. Services are provided a minimum of 3 times per week plus there are on-call services for crises available 24 hours a day and 7 days a week. A psychiatrist is available 10-20% time. A close working relationship with child welfare services is important.
The goals of Multisystemic Therapy – Building Stronger Families (MST-BSF) are:
- Reduce mental health difficulties
- Remain or reunite with family
- Improve school performance
- Learn skills needed to have their children live in their home
- Learn problem solving skills and nonharsh discipline strategies
- Learn parenting strategies including how to provide everything needed to child
- Reduce substance misuse
- Reduce mental health difficulties
- Learn how to find natural social supports and ask when they need support
View the Logic Model for Multisystemic Therapy – Building Stronger Families (MST-BSF).
The essential components of Multisystemic Therapy – Building Stronger Families (MST-BSF) include:
- Families who are involved with child welfare services due to a physical abuse and/or neglect report having been filed within the last 180 days, plus parental substance misuse
- Families who are having serious clinical problems and are either on the verge of losing their children due to parental substance misuse or whose children were recently placed out of the home
- Families may have children in foster care or another out-of-home placement and will be reuniting with their family
- Referral Source:
- Receive all referrals from child welfare services
- Maintain close working relationships with child welfare services in support of the family
- Service Delivery:
- Conducts intervention sessions at least 3 times per week
- Provided to multiple children and adults in the family with a strong emphasis on adult treatment for substance misuse
- Individual and/or family sessions:
- Provided by a licensed MST-BSF team that consists of:
- A full-time supervisor
- 3 master’s degree level therapists
- A family resource specialist
- A part-time psychiatrist (10-20%)
- Provided in the family’s home or other places convenient to them and at times convenient to the family
- Provided in the school if the child is experiencing school difficulties
- Utilizes 24/7 on-call roster in order to provide round-the-clock crisis services for families
- Offers a relapse prevention group that parents attend
- Can be provided via telehealth when a health risk is present (e.g., COVID)
- Clinical Treatment provided by MST-BSF providers unless otherwise noted:
- Focuses on the risk factors associated with the primary clinical problems (e.g., adult trauma that is driving substance misuse)
- Engages families in intensive safety-planning throughout treatment, especially concerning substance misuse risk
- Provides Reinforcement-Based Treatment to all parents
- Requires that parents who are experiencing misuse of alcohol or opiates complete an inpatient medical detox at the beginning of treatment provided by a local community-based organization
- Engages all families in a clarification or family healing process in which the parent accepts responsibility and apologizes for the behaviors related to abuse/neglect
- Engages family members, on an as-needed basis, in research-supported treatments to reduce mental health difficulties (e.g., CBT trauma treatment, behavioral family therapy for communication and problem solving, etc.)
- Provides all families case management related to their specific practical needs (e.g., budgeting, housing, job seeking, drug-free recreation, medical and dental care)
- Treatment Model Fidelity Support:
- Provision of an MST-BSF expert to the team
- Weekly supervisor-expert case review and convergence
- Weekly group supervision led by the MST-BSF trained supervisor
- Weekly group consultation led by the MST-BSF Expert
- Audiotaping of trauma sessions with feedback provided to therapists by the MST-BSF trained supervisor with support from the MST-BSF expert
- Monthly interviews with family members by a person independent of the team to assess fidelity
Multisystemic Therapy – Building Stronger Families (MST-BSF) directly provides services to children/adolescents and addresses the following:
- Range of problems depending on the developmental level of the child, such as delays in development, tantrums, anxiety, depression, PTSD, aggression at school or home, refusal to follow family rules, self-harm, substance misuse, and school refusal
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: Extended family to support interventions and for involvement in family therapy sessions, and teachers and school staff to support school-based interventions
Multisystemic Therapy – Building Stronger Families (MST-BSF) directly provides services to parents/caregivers and addresses the following:
- Neglectful parenting, use of harsh punishment, substance misuse, PTSD, difficulty managing anger, limited problem solving and communication skills, anxiety, depression, conflicts with partner, limited knowledge of managing child misbehavior, limited ability to connect with natural social supports, need for housing, need assistance finding a job, and need assistance managing finances
Three 90-minute sessions per week plus crisis intervention as needed
This program is typically conducted in a(n):
- Birth Family Home
- Foster / Kinship Care
- Community-based Agency / Organization / Provider
- Public Child Welfare Agency (Dept. of Social Services, etc.)
- School Setting (Including: Day Care, Day Treatment Programs, etc.)
- Virtual (Online, Telephone, Video, Zoom, etc.)
Multisystemic Therapy – Building Stronger Families (MST-BSF) includes a homework component:
Homework may be assigned in relation to any of the following interventions:
- Treatment of caregiver posttraumatic stress disorder (PTSD)
- Treatment for anger management
- Treatment for caregiver substance misuse
- Family communication and problem-solving training
- Child-directed play
- Child development
Multisystemic Therapy – Building Stronger Families (MST-BSF) has materials available in languages other than English:
Dutch, German, Norwegian, Spanish, 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
- Mobile phones for all staff
- Space for the relapse prevention group
- Supplies to collect urine drug screens
Manuals and Training
Prerequisite/Minimum Provider Qualifications
MST-BSF Supervisor (full-time):
- PhD or Master’s degree in counseling, social work, marriage and family therapy or a related field
- An understanding of the child protective services system
- Experience with or knowledge about adult substance misuse
- 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
- Master’s degree in counseling, social work, marriage and family therapy, or a related field
- Preferred two years of clinical experience with children and families
- Preferred knowledge of substance misuse
- Bachelor’s degree
- Preferred experience with case management
- The training and capacity to provide services to adults and children
- Available for allotted amount of time for MST-BSF team
- Trained in the MST-BSF treatment model
- Integrated into the clinical team
There is a manual that describes how to deliver this program.
Program Manual Information:
- Swenson, C. C., Penman, J. E., Henggeler, S. W., & Rowland, M. D. (2011). Multisystemic Therapy for Child Abuse and Neglect, revised edition. Family Services Research Center, National Institute of Mental Health, and Connecticut Department of Children and Families.
- Tuten, L. M., Jones, H. E., Schaeffer, C. M., & Stitzer, M. L. (2012). Reinforcement-Based treatment for substance use disorders: A comprehensive behavioral approach. American Psychological Association.
The book on RBT is available for purchase from most bookstores. The manual is only provided to licensed teams. Both books are required for the MST-BSF model.
There is training available for this program.
Training is only available to staff who will be implementing MST-BSF in a licensed program. With regard to the initial 5-day Standard MST orientation, organizations can access the training in one of three ways. New staff can:
- Register for a scheduled virtual training at mstservices.com (during pandemic)
- Come to Charleston, SC and participate in one of the quarterly open-enrollment trainings provided by MST Services Inc.
- Providers can elect to have MST Services Inc. conduct an additional 5-day initial training at their site or virtually for their team.
Training on the MST-CAN (the core model), RBT, and the 4-day trauma training are provided virtually or on site by MST-BSF experts at this time. After start-up, training continues through weekly telephone or virtual MST-BSF consultation and virtual or on-site quarterly booster trainings for each team of MST-BSF clinicians.
Number of days/hours:
- All trainees complete the following trainings. These include:
- Standard MST 5-day orientation (35 hours)
- A 2-day (14 hours) MST-CAN (the core model) specific training
- A 2-day (14 hours) RBT training
- 4 days (28 hours) of training in adult and child trauma treatment
- An abbreviated training is open to CPS caseworkers who will be working with the MST-BSF team.
- After start-up, training continues through weekly virtual or telephone MST-BSF consultation for each team of MST-BSF clinicians aimed at monitoring treatment fidelity and adherence to the MST-BSF treatment model, and through quarterly virtual or on-site booster trainings (1 1/2 days each).
- Trained MST-BSF experts will teach the MST-BSF 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-BSF expert will also assist at the organizational level as well as needed.
There are pre-implementation materials to measure organizational or provider readiness for Multisystemic Therapy – Building Stronger Families (MST-BSF) as listed below:
MST Services, the company that disseminates MST, MST-CAN, and MST-BSF has developed site assessment tools that have been used since the inception of all three models. 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. Importantly, for MST-BSF there are inclusion criteria that must be met to receive a referral. The screening process is reviewed with the provider. 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-BSF program.
Formal Support for Implementation
There is formal support available for implementation of Multisystemic Therapy – Building Stronger Families (MST-BSF) as listed below:
Each team is assigned an MST-BSF expert who assists with hiring to find team members who are a good fit for the model. Throughout the course of implementation, the MST-BSF expert works with the team to set and attain professional development goals and to learn the model through weekly consultation in which all cases are reviewed. Weekly case convergence is conducted with the supervisor who will then provide a very structured group supervision. The expert visits the team on-site (or virtually if on-site work is not possible) to conduct a booster training in areas of clinical need. Monthly to quarterly stakeholder meetings are held to review implementation. Every six months the MST-BSF expert works with the supervisor to conduct a program implementation review in which family and program outcomes are reviewed. The program needs that surface in these reviews are analyzed to understand the needs and then targeted for change.
There are fidelity measures for Multisystemic Therapy – Building Stronger Families (MST-BSF) as listed below:
- Adherence Rating for Therapists-Revised (ART-R): Is used to capture model adherence for MST-BSF. It is an adaptation of the Therapist Adherence Measure-Revised (TAM-R), an objective, standardized instrument that evaluates a therapist’s adherence to the MST model as reported by the primary caregiver of the family. The ART-R is comprised of the TAM-R questions plus additional questions related to substance misuse treatment. The TAM-R 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 ART-R is administered during the second week of treatment and every four weeks thereafter by an interviewer independent from the team. Data are entered onto an on-line database managed by the MST Institute and aggregated results are reviewed by the MST-BSF Supervisor and Therapist. The ART-R is available through MST Services but is used only for MST-BSF programs (www.mstservices.com).
- Supervisor Adherence Measure (SAM): This measure evaluates the MST-BSF clinical supervisor’s adherence to the MST model of supervision. This 10- to 15-minute measure is completed by MST-BSF therapists, who are prompted to complete the SAM every two months and enter their responses directly onto an on-line database. Results are shared with the MST-BSF expert, who then shares a summary of the feedback with the MST-BSF 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 CAM consists of 23 items that measure consultation behavior in three domains. The estimated time commitment required is 10 to 15 minutes per respondent for each administration. MST-BSF therapists and MST-BSF supervisors are responsible for completing this questionnaire. Times will be scheduled one month after completion of the first SAM, and every two months thereafter. The CAM is available through MST Services but is used only for MST programs (www.mstservices.com).
Fidelity Measure Requirements:
Fidelity measures are required to be used as part of program implementation.
Implementation Guides or Manuals
There are implementation guides or manuals for Multisystemic Therapy – Building Stronger Families (MST-BSF) as listed below:
The MST Consultation Manual clearly outlines in detail site assessment and program launch processes. Each site receives step-by-step instructions and support for the complete assessment and implementation process from an MST-BSF expert. Ongoing program implementation is guided by the MST Organizational Manual and informed by the six-month Program Implementation Reports. Implementation guides and manuals are only available for programs implementing MST-BSF.
There are no studies of the costs of Multisystemic Therapy – Building Stronger Families (MST-BSF).
Research on How to Implement the Program
Research has not been conducted on how to implement Multisystemic Therapy – Building Stronger Families (MST-BSF).
Relevant Published, Peer-Reviewed Research
Schaeffer, C. M., Swenson, C. C., Tuerk, E. H., & Henggeler, S. W. (2013). Comprehensive treatment for co-occurring child maltreatment and parental substance abuse: Outcomes from a 24-month pilot study of the MST-Building Stronger Families program. Child Abuse & Neglect, 37(8), 596–607. https://doi.org/10.1016/j.chiabu.2013.04.004
Type of Study:
Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 25 mother–youth dyads
- Age — Parents: Mean=37.8–39.8 years; Children: Mean=10.8–12.8 years
- Race/Ethnicity — Parents: 79% White/Non-Hispanic, 16% Hispanic, and 5% Black/Non-Hispanic; Children: 65% White/Non-Hispanic, 14% Hispanic, 14% Biracial, 5% Black/Non-Hispanic, and 2% Other
- Gender — Parents: 100% Female; Children: 44% Female
- Status — Participants were individuals involved in the child welfare system.
Location/Institution: New Britain Area Office of the Connecticut Department of Children and Families (DCF)
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to present outcomes from a pilot study of Multisystemic Therapy-Building Stronger Families (MST-BSF). Participants received MST-BSF and were compared to 18 families with similar demographic and case characteristics who received Comprehensive Community Treatment (CCT). Measures utilized include the Addiction Severity Index–Fifth Edition (ASI), the Beck Depression Inventory (BDI-II), the 54-item Trauma Symptom Checklist for Children (TSCC), the Conflict Tactics Scale (CTS), and reabuse and placement data were obtained from archival DCF records. Results indicate that at posttreatment, mothers who received MST-BSF showed significant reductions in alcohol use, drug use, and depressive symptoms; they also significantly reduced their use of psychological aggression with the youth. Youth reported significantly fewer anxiety symptoms following MST-BSF treatment. Relative to families who received CCT, mothers who received MST-BSF were three times less likely to have another substantiated incident of maltreatment over a follow-up period of 24 months postreferral. The overall number of substantiated reabuse incidents in this time frame also was significantly lower among MST-BSF families, and youth who received MST-BSF spent significantly fewer days in out-of-home placements than did their CCT counterparts. Limitations include lack of randomization of participants, lack of generalizability to other ethnic populations, and small sample size.
Length of controlled postintervention follow-up: Not clear – CWS outcomes were examined 24 months after referral, but length of treatment is not specified.
Schaeffer, C. M., Swenson, C. C., & Powell, J. S. (2021). Multisystemic Therapy - Building Stronger Families (MST-BSF): Substance misuse, child neglect, and parenting outcomes from an 18-month randomized effectiveness trial. Child Abuse & Neglect, 122, Article 105379. https://doi.org/10.1016/j.chiabu.2021.105379
Type of Study:
Randomized controlled trial
Number of Participants: 98 families
- Age — Not specified
- Race/Ethnicity — Parents: 64% White, 24% Other, 9% Black, 4% American Indian, and 2% refused; Children: 64% White, 18% Other, 14% Black, 2% American Indian, 2% Asian or Pacific Islander, and 2% Refused
- Gender — Parents: 88% Female; Children: 48% Female
- Status — Participants were families who had an open case with child protective services.
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report outcomes from a randomized clinical trial examining the effectiveness of the Multisystemic Therapy – Building Stronger Families (MST-BSF) treatment model with families involved with child protective services due to physical abuse and/or neglect plus parental substance misuse. Families were randomly assigned to MST-BSF or Comprehensive Community Treatment (CCT). Measures utilized include the Addiction Severity Index – Fifth Edition (ASI), the Conflict Tactics Scale (CTS-PC), and the 42-item Alabama Parenting Questionnaire (APQ). Results indicate that MST-BSF was significantly more effective than CCT in reducing parent self-reported alcohol and opiate use and in improving child-reported neglectful parenting. Although means were in predicted directions, new incidents of abuse across 18 months did not differ between groups. Limitations include small sample size, sample was primarily Caucasian and Latinx, unable to assess treatment dosage (i.e., number of hours of services) for either study arm, and lack of follow-up.
Length of controlled postintervention follow-up: None.
Schaeffer, C. M., Swenson, C. C., Penman, J. E., & Tuten, L. M. (2014). Implementing Reinforcement-Based Treatment (RBT) for substance use disorders within child protective service systems in Europe. International Journal of Prevention and Treatment of Substance Use Disorders, 1(2), 38–52. https://doi.org/10.4038/ijptsud.v1i2.7692
Swenson, C. C., Schaeffer, C. M., Tuerk, E. H., Henggeler, S. W., Tuten, M., Pan-zarella, P., Lau, C., Remmele, L., Foley, T., Cannata, E., & 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, 17, 3-8. https://www.civicresearchinstitute.com/online/article_abstract.php?pid=5&iid=105&aid=673
Date Research Evidence Last Reviewed by CEBC: April 2022
Date Program Content Last Reviewed by Program Staff: November 2022
Date Program Originally Loaded onto CEBC: December 2022