Program Profile: Multisystemic Therapy (MST)

This is a family and community-based treatment program for adolescents with serious antisocial, delinquent, and other problem behaviors. The program is rated Effective. The treatment group had a statistically significant reduction in rearrests and number of days incarcerated, compared with a control group that received usual services. However, there were no statistically significant differences between groups in substance use outcomes.

An Effective rating implies that implementing the program is likely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial .

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination .

Program Goals/Target Population

The overriding goal of Multisystemic Therapy (MST) is to keep adolescents who have exhibited serious clinical problems (e.g., drug use, violence, severe criminal behavior) at home, in school, and out of trouble. Through intense involvement and contact with the family, MST aims to uncover and assess the functional origins of adolescent behavioral problems. It works to alter the youth’s ecology in a manner that promotes prosocial conduct while decreasing problem and delinquent behavior.

MST targets youths between the ages of 12 and 17 who present with serious antisocial and problem behavior and with serious criminal offenses. The MST intervention is used on these adolescents in the beginning of their criminal career by treating them within the environment that forms the basis of their problem behavior instead of in custody, removed from their natural ecology.

Program Components

MST typically uses a home-based model of service delivery to reduce barriers that keep families from accessing services. Therapists have small caseloads of four to six families; work as a team; are available 24 hours a day, 7 days a week; and provide services at times convenient to the family. The average treatment occurs over approximately 4 months, although there is no definite length of service, with multiple therapist–family contacts occurring each week. MST therapists concentrate on empowering parents and improving their effectiveness by identifying strengths and developing natural support systems (e.g., extended family, neighbors, friends, church members) and removing barriers (e.g., parental substance abuse, high stress, poor relationships between partners). In the family–therapist collaboration, the family takes the lead in setting treatment goals and the therapist helps them to accomplish their goals.

Key Personnel

Therapists with special MST training deal with a relatively small number of cases, due to the intensive nature of the intervention. Sessions at the home of the adolescent may occur every day or once a week, depending on the needs of the family and the stage in the program.

Program Theory

Systems and social ecological theories form the theoretical foundation of MST. As a family-based home intervention, MST identifies the practical issues that impact the youth’s serious antisocial behavior within his or her social environment. Various therapies inform the specific treatment techniques used, including behavioral, cognitive–behavioral, and the pragmatic family therapies (Henggeler and colleagues et al. 1992).

Study

The Henggeler and colleagues (1992) study reported the results of a randomized control trial of Multisystemic Therapy (MST) in South Carolina. The Family and Neighborhood Services project randomized juveniles to a treatment-as-usual ( n = 41) or the MST intervention ( n = 43). They were referred primarily on the basis of a determination by the Department of Youth Services (DYS) of their imminent risk of out-of-home placement due to their involvement in serious criminal activity. The young persons in the sample had on average 3.5 previous offenses and 9.5 weeks of previous incarceration. Fifty-four percent of the sample had at least one arrest for violent crime, with 71 percent having been previously incarcerated for at least 3 weeks. The mean age of the sample was 15.2 years, and 77 percent were male. Of the sample, 56 percent were African American, 42 percent were white, and 2 percent were Hispanic. Twenty-six percent lived with neither biological parent, and families had on average 2.7 children. There were no significant differences between groups.

The MST treatment for the 43 families lasted an average of 13.4 weeks, with 33 hours of direct contact and therapists providing 24-hour case coverage. Sessions typically lasted between 15 and 90 minutes and were held weekly or as frequently as daily, depending on the treatment stage and the severity of the crises experienced. The service-as-usual group received court orders (including curfews, school attendance, and program participation), which were monitored by probation officers who met with the youths at least once a month. Failure to comply with court orders was met with a court review, and possible referral to a DYS institution, with some receiving substantive services due to a combination of family difficulties and resistance associated with mental health issues.

The study measured participants’ criminal behavior, incarceration, self-reported delinquency, family and peer relations, social skills, and problem behaviors. Pretest and posttest surveys were administered, and archival records for arrests and incarceration were collected on average at 59.6 weeks post referral. One-way analyses of variance (or ANOVA) were used to test differences between groups in arrest and incarceration data, and one-way analyses of covariance (or ANCOVA) were used to test for differences between groups on self-reported delinquency and psychosocial measures at posttest, with pretest scores as covariates. The study authors did not conduct subgroup analyses.

Study

Borduin and colleagues (1995) examined the long-term effects of a randomized control trial of MST and an individual therapy in Missouri. Youths in the sample were eligible if they had at least two prior arrests, were living with at least one parent figure, and had no evidence of psychosis or dementia. Ninety-two juveniles were randomized to the MST condition, and 84 were randomized to a comparison individual therapy condition. The average age was 14.8 years and 67.5 percent were male. The majority (70 percent) were white; 30 percent were African American. The youths had on average 4.2 previous arrests, and all had been previously detained for at least 4 weeks. There were no significant demographic or criminal history differences between groups.

There were, however, significant differences in the duration of treatment for program completers, with MST participants averaging 23.9 hours, compared to 28.6 hours for the comparison treatment group. The study measured participant and family member psychiatric symptomatology, adolescent behavior problems (as reported by the mother), family functioning and interactions, peer relations, and criminal activity collected from State records at 3.95 years following release from probation.

Data was analyzed using multivariate analyses of variance (or MANOVA); survival analysis was used to assess the impact of the treatment conditions on criminal activity. The study authors conducted subgroup analyses on age, race, socioeconomic status, gender, pretreatment arrests for a violent crime, and number of pretreatment arrests.

Study

An independent randomized clinical trial of the effects of MST was conducted by Timmons–Mitchell and colleagues (2006). The study examined recidivism at 18 months and youth functioning at 6 months posttreatment. The study consisted of 93 youths who came before a family court in a Midwestern State between October 1998 and April 2001. To be included in the study, juveniles had to have a felony conviction, a suspended committal to the DYS facility, and parental consent to participate. Participants were then randomized into a treatment MST group ( n = 48) and a treatment-as-usual (TAU) group ( n = 45). The youths were all on probation or had previously been on probation at the time of the study.

The average age of the sample was 15.1 years at the time of enrollment; 22 percent of the sample was female. The participants were 77.5 percent white, 15.5 percent African American, 4.2 percent Hispanic, and 2.8 percent biracial. There were no significant differences between groups in age, racial or gender make up, or in previous criminal history (age of first offense and number of previous offenses, misdemeanors, and felonies).

The treatment group was enrolled in the MST program for an average of 144.84 days. Service delivery was provided to the 48 families with a high level of fidelity to the MST program. TAU participants’ access to services was monitored by probation officers and court services. While the TAU group did have referrals to anger management, drug and alcohol, and individual and family therapy services, records indicated that attendance was sporadic and that the group had an overall low level of service use.

Arrest data was collected for the MST group for the 19 months posttreatment. For the TAU group, who do not have a clear treatment end point, arrest data was counted if the arrest occurred between 6 and 24 months postrecruitment. For the same reason, adolescent functioning data was collected at baseline, immediately after treatment, and at a 6-month follow- up for the MST group, and at baseline, and 6 months and 12 months postrecruitment for the TAU group. The arrest data was collected from family court records. Child functioning was measured using six areas of the Child and Adolescent Functional Assessment Scale: school and work, home, community, behavior toward others, moods/emotions, and substance use. Offense data was analyzed with likelihoods and relative odd ratios using logistic regression and survival analysis. Adolescent functioning data was analyzed using general linear modeling. The study authors did not conduct subgroup analyses.

All Multisystemic Therapy (MST) programs must be licensed by MST Services. MST Services created the MST Program Development Method™ (PDM) from the successes and challenges of organizations implementing MST over more than a decade of MST dissemination. Because each organization brings a variety of strengths into this process, the PDM is rarely applied exactly the same way each time. Rather, it is an assembled set of tools that will allow the local program developer to assess the strengths, identify the weaknesses, locate the opportunities and plan for the threats unique to each organization within its own community context.

Prior to MST training, an Expert MST Program Developer provides on-site and/or telephone consultation regarding the development and implementation of a successful MST program. The program start-up services include technical assistance and materials designed to produce a program description, projected budget, and implementation timeline. Key critical elements include review of funding proposal documents and/or responses, clear articulation of the target population definition and prioritization process, referral and discharge criteria and processes, development of program-specific policies and procedures, recommendations regarding clinical record keeping practices and initial program evaluation planning.

More information can be found on the website for MST: https://www.mstservices.com/ .

Subgroup Analysis

Borduin and colleagues (1995) conducted subgroup analyses on age, race, socioeconomic status, gender, pretreatment arrests for a violent crime, and number of pretreatment arrests. They found that Multisystemic Therapy (MST) had no statistically significant impacts on any of the moderator variables.

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

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

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

Formal System Processing for Juveniles

The practice of using traditional juvenile justice system processing in lieu of alternative sanctions to deal with juvenile criminal cases. The practice is rated Ineffective for reducing recidivism compared to the youth that were diverted from the system. Test

Evidence Ratings for Outcomes

Crime & Delinquency - Multiple crime/offense types

Family-based Treatment for Adolescent Delinquency and Problem Behaviors

In general family-based treatment practices consist of a wide range of interventions that are designed to change dysfunctional family patterns that contribute to the onset and maintenance of adolescent delinquency and other problem behaviors. This practice is rated Effective for reducing recidivism, and Promising for reducing antisocial behavior and substance use, and improving psychological functioning and school performance.

Evidence Ratings for Outcomes

	Crime & Delinquency - Multiple crime/offense types
	Mental Health & Behavioral Health - Externalizing behavior
	Drugs & Substance Abuse - Multiple substances
	Mental Health & Behavioral Health - Psychological functioning
	Education - Academic achievement/school performance

Psychosocial Interventions for Antisocial Behavior of Juveniles

This practice involves the use of psychosocial interventions to reduce antisocial behavior in juveniles. Psychosocial interventions consist of both preventive and therapeutic interventions but share the common goal of improving psychosocial functioning. The practice is rated Effective for the reduction of antisocial behavior.

Evidence Ratings for Outcomes

Juvenile Problem & At-Risk Behaviors - Antisocial behaviors

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