Program Profile: Multisystemic Therapy–Family Integrated Transitions (MST-FIT)

Program Goals

The Multisystemic Therapy–Family Integrated Transitions (MST–FIT) program provides integrated individual and family services to juveniles who have co-occurring mental health and chemical dependency disorders. Services are provided during a juvenile’s transition from incarceration back into the community. The overall goal of MST–FIT is to provide necessary treatment to youth, thereby reducing recidivism. The program also seeks to connect youth and their families to appropriate community supports, achieve youth abstinence from alcohol and other drugs, improve youth mental health, and increase youth prosocial behavior.

The program was developed after the Washington State Legislature initiated a pilot rehabilitation program for juveniles with co-occurring substance abuse and mental health disorders who had received sentences to enter a state Juvenile Rehabilitation Administration (JRA) institution.

Target Population

To be eligible to participate in MST–FIT, a youth must be:

• Younger than 17½ years old.
• In a JRA institution and scheduled to be released to 4 or more months of parole/supervision.
• Have a substance abuse or dependence disorder and any of the following: any Axis 1 disorder, currently prescribed psychotropic medication, or demonstrated suicidal behavior within the past 3 months.

Youth must also reside in King, Pierce, Snohomish, Kitsap, Thurston, Mason, Yakima, Benton, or Kittitas counties, where the MST–FIT program is currently available.

Program Components

The MST–FIT program begins in a youth’s final 2 months in a residential facility and continues for 4 to 6 months during parole supervision. MST–FIT is based on components of three programs: Multisystemic Therapy (MST), Dialectical Behavior Therapy (DBT), and Motivational Enhancement Therapy (MET). The overarching framework of the program is derived from MST, a family-based preservation model for community-based treatment. MST provides the foundation of the intervention, while the other intervention strategies are delivered within the MST framework. MST tailors treatment goals to a youth’s individual risk and protective factors within his or her natural environment (i.e., family, school, and community). This treatment component uses therapists to coach caregivers in establishing productive partnerships with schools, community supports, parole, and other systems, and to help caregivers develop skills to be effective advocates for those in their care.

Although the MST component concentrates on the extent to which the youth’s surrounding environments support prosocial behavior, MST–FIT incorporates elements of DBT to address individual-level characteristics in both youth and caregivers by replacing maladaptive emotional and behavioral responses with more effective and skillful responses. The skills training component of DBT targets emotional dysregulation that underlies problems youth with co-occurring disorders have, such as anger, impulse control, and moodiness. Throughout the intervention, coaches look for opportunities to encourage youth to apply the skills they learn in real-world settings.

Finally, MST–FIT uses aspects of MET to engage youths and their families in treatment, with the objective of increasing their commitment to change. MST–FIT therapists use MET techniques to develop the initial engagement of all parties and to maintain their commitment throughout treatment.

Relapse prevention/community reinforcement is also used to increase the youth's and family’s awareness of issues such as substance use and high-risk situations. A range of effective coping strategies are provided, and a plan is established for youth to resume treatment, should they relapse.

Key Personnel

The MST–FIT team consists of contracted therapists with backgrounds in children’s mental health, family therapy, and chemical dependency. The team serves four to six families at any given time. Service delivery occurs in the families’ homes and communities, and services are available 24 hours a day, 7 days a week.

The following outcomes were considered in the study, but CrimeSolutions Study Reviewers determined the evidence was insufficient for a rating to be assigned:

• Overall recidivism
• Violent felony recidivism
• Misdemeanor recidivism

Aos (2004) conducted an outcome evaluation and cost-benefit analysis of the Multisystemic Therapy–Family Integrated Transitions (MST–FIT) program in Washington State. The outcome evaluation showed results similar to those found in the study by Trupin and colleagues (2011). A cost-benefit analysis of the MST–FIT program indicated that for every $1 spent on FIT, $3.15 is saved in criminal justice expenses and avoided criminal victimization (a link to the 2004 study by Aos is available under Additional References).

The program used master’s-level clinicians who worked in small teams that included two to four coaches, a supervisor, a Ph.D.-level consultant, and a psychiatrist. While the study authors did not specify formal certification or training requirements, treatment fidelity for the Multisystemic Therapy (MST) component was monitored using the Therapist Adherence Measure (TAM), with average scores meeting the established threshold. No validated fidelity tools were available for the other components of the program (Trupin et al. 2011).

These sources were used in the development of the program profile:

Anderson, Carol, and Karen Bogenschneider. 2007. A Policymaker’s Guide to Effective Juvenile Justice Programs: How Important Are Family Approaches? Madison, Wis.: Policy Institute for Family Impact Seminars.

https://trestlelink.org/wp-content/uploads/2024/02/fia_brchapter_25c03.pdf

Aos, Steve. 2004. Washington State’s Family Integrated Transitions Program for Juvenile Offenders: Outcome Evaluation and Benefit-Cost Analysis. Olympia, Wash.: Washington State Institute for Public Policy.

http://www.wsipp.wa.gov/rptfiles/04-12-1201.pdf

Barnoski, Robert. 2009. Providing Evidence-Based Programs With Fidelity in Washington State Juvenile Courts: Cost Analysis . Olympia, Wash.: Washington State Institute for Public Policy.

http://www.wsipp.wa.gov/rptfiles/09-12-1201.pdf

Lee, Terry, and Megan DeRobertis. 2006. “Overview of the FIT Treatment Model.” Focal Point 20(2):17–19.

http://pathwaysrtc.pdx.edu/pdf/fpS0606.pdf

Public Behavioral Health and Justice Policy. 2008. “Juvenile Rehabilitation Administration: Family Integrated Transitions™ (FIT™) Overview.” Accessed July 17, 2012.

Following are CrimeSolutions-rated programs that are related to this practice:

Treatment in Secure Corrections for Serious Juveniles Who Have Committed Serious or Multiple Offenses

This practice includes interventions targeting serious (violent and chronic) juveniles sentenced to serve time in secure corrections. The overall goal is to decrease recidivism rates when juveniles are released and return to the community. The practice is rated Effective for reducing general recidivism and serious recidivism of violent and chronically offending juveniles.

Evidence Ratings for Outcomes

	Crime & Delinquency - Serious recidivism
	Crime & Delinquency - Multiple crime/offense types

Juvenile Reentry Programs

This practice consists of reintegrative programs and services designed to prepare juveniles, who were placed out of their homes, for reentry into the community. The overall goal is to reduce the recidivism rate of juveniles released from out-of-home placements. The practice is rated Promising. There was a statistically significant decrease in the recidivism rates of juveniles who participated in the reentry programs, compared with juveniles in the comparison groups.

Evidence Ratings for Outcomes

Crime & Delinquency - Multiple crime/offense types

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?