Program

Multisystemic Therapy

Jan 06, 2012

OVERVIEW

The
Multisystemic Therapy (MST) approach to the prevention of criminal behavior and
violent offending is designed to improve key family correlates of antisocial
behavior and ameliorate adjustment problems. Multisystemic therapy focuses on
the multiple determinants of antisocial behavior. Therapy is delivered in the
youth’s natural environment. The multisystemic therapy approach to serious
juvenile offenders was tested in the Missouri Delinquency Project, as well as
the Simpsonville, South Carolina Study and the Charleston, South Carolina Study.
These assessments of MST found that MST was more effective than individual
therapy or usual services in improving family correlates of antisocial behavior
and ameliorating adjustment problems, including decreasing post-treatment
criminal activity. In a separate evaluation of adolescents arrested for sexual
offenses, there were significant impacts on family, peer, and academic outcomes.
In addition, at the nine year follow-up, there were significant impacts on the
number of reported arrests for sexual crimes, other crimes, and the number of
days incarcerated. In an evaluation used to determine whether MST could serve
as an alternative to hospitalization for youths in psychiatric crisis, MST
significantly decreased externalizing symptoms and improved family functioning
and school attendance.

DESCRIPTION
OF PROGRAM

Target
population:
Serious juvenile offenders and their families

The MST approach
uses an action-oriented and present-focused therapeutic method to treat and
prevent behavior problems in adolescents. MST addresses intrapersonal and
systematic factors of antisocial behavior and targets the specific factors in
each youth’s and family’s ecology (family, peer, school, neighborhood, and
support network) that contribute to the behavior. The therapy is individualized
based on the juvenile and his/her family’s needs. The interventions are
pragmatic, goal-oriented, and emphasize development of family strengths. MST is
consistent with family preservation models of service delinquency. Sessions are
typically held in the family’s home, school, or other community locations. The
average duration of treatment is about four months, including approximately 50
hours of face-to-face therapy. MST focuses on providing parents with the skills
and resources necessary to address difficulties of raising delinquent
adolescents.

The Washington State Public Policy Group, which assessed the “bottom-line” of
crime reduction programs, found that taxpayers receive more than $31,000 in
subsequent criminal justice cost savings for each MST program participant, and
the benefit-to-cost ratio was estimated to be more than $28 for each dollar
spent.

EVALUATIONS
OF PROGRAM

Study 1:
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.

Evaluated population: A total of 126
families completed pretreatment and post treatment assessments. Families were
referred to the program if their child had at least two arrests, was currently
living with at least one parent figure, and showed no evidence of psychosis or
dementia.

Approach:
Families were randomly assigned to MST or individual therapy. MST was provided
by three female and three male graduate students in clinical psychology. The
researchers collected data using a multiagent, multimethod assessment battery.
Individually, parents and children were assessed for psychiatric and behavior
problems. Family and children were also assessed on perceived family
functioning, observed family interactions, peer relations, and criminal
activity. Analyses were conducted to examine differences at pretreatment and
posttreatment of those in MST and individual treatment. The ultimate outcome was
based on arrest data collected during the follow-up.

Results:
There was a significant decrease in psychiatric symptamology for mothers and
fathers in the MST group. Mother in the MST group also reported a significant
decrease in adolescent behavior problems. MST families reported significant
increases in family cohesion, adaptability, and supportiveness, and a
significant decrease in conflict-hostility. Participants in the MST group were
at significantly lower risk of arrest at follow-up than those in the IT group.
In addition, recidivists who had completed MST had significantly fewer arrests
and for significantly less serious crimes at follow-up compared to the IT
group. MST participants were significantly less likely to be arrested for
violent crimes than were those in the IT group.

Study 2:
Henggeler, S. W., Mihalic, S. F., Rone, L., Thomas, C., & Timmons-Mitchell, J.
(Eds.). (1998). Multisystemic Therapy (Vol. 6). Boulder, CO: Institute of
Behavioral Science, University of Colorado at Boulder.

Evaluated
population:
The Simpsonville study included 84 violent and chronic juvenile
offenders, over half of whom had been arrested for violent crimes. Participants
were 77 percent male and 26 percent lived with neither of their biological
parents. Fifty-six percent were African American with the remaining 44 percent
being white. The average age was 15.22 years.

Approach:
Participants were randomly assigned to the MST condition (n=43) or usual
services provided by the Department of Juvenile Justice (n=41), such as
court-ordered curfews, school attendance, or referrals to other agencies.
Treatment lasted thirteen weeks on average. Standardized measurement
instruments were administered both before and after treatments. Post-referral
follow-ups were conducted for up to 2.4 years after the treatment.

Results:
MST was more effective than usual services in reducing criminal activity and
institutionalization. Participants receiving MST had significantly fewer
arrests on average than those receiving usual services (0.87 vs. 1.52) and spent
fewer weeks incarcerated (5.8 vs. 16.2). Families receiving MST also reported
increased cohesion and decreased adolescent aggression with peers, while these
behaviors decreased or remained the same for families receiving usual services.

Study 3:
Henggeler, S. W., Mihalic, S. F., Rone, L., Thomas, C., & Timmons-Mitchell, J.
(Eds.). (1998). Multisystemic Therapy (Vol. 6). Boulder, CO: Institute of
Behavioral Science, University of Colorado at Boulder.

Evaluated
Population: 
The Charleston study included 118 juvenile offenders meeting
the DSM-III-R criteria for substance abuse or dependence.

Approach:
Participants were randomly assigned to either MST or usual community services.

Results:
Based on self-report measures, MST reduced drug use at post-treatment for both
soft-drug and hard-drug use. MST also reduced incarceration by 46 percent and
reduced re-arrests by 25 percent.

Study 4:
Henggeler, S.W., Brondino, M.J., Melton, G.B., 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(5), 821-833.

Evaluated
Population:
The study included 155 violent or chronic juvenile offenders
between 11 to 17 years of age and their primary caregivers. Nearly 82 percent
were male. Roughly 81 percent were African-American and 19 percent were
Caucasian, and the group averaged 3.07 prior arrests. The caregivers were
predominantly female, and many had not completed high school. Only half of the
juveniles lived in two-parent households, and the median family income was
between $5,000-10,000 per year.

Approach:
Participants were randomly assigned to Multisystemic Therapy or the usual
juvenile justice services. However, a youth was only placed in the treatment
group with the judge’s consent. Ten therapists were trained in MST, and
families met with therapists on average, 122.6 days and 116.6 days in site 1 and
site 2, respectively. A 1.7-year follow-up was also conducted to examine arrest
and incarceration rates. 9.7 percent of the families dropped out of the study
because they moved out of South Carolina, died, or voluntarily withdrew from the
study.

Data were
collected on (a) caregiver and adolescent psychological distress; (b) adolescent
behavior problems; (c) criminal activity; (d) family relations; (e) parental
monitoring; and (f) peer relations. Treatment adherence was also measured.

Results:
Of the 155 participants, 140 completed the intervention and followed-up. MST
youth reported significantly reduced psychiatric symptomatology. Although MST
resulted in lower rates of rearrest and incarceration, these findings were not
statistically significant. Family relations appeared to worsen, becoming less
structured and less cohesive. Low adherence to MST principles on the part of
the therapists and/or families and youth may have affected the results. Parent
and adolescent reports of MST adherence predicted low rates of rearrest, and
therapist reports of MST adherence and treatment engagement predicted decreased
self-reported index offenses and low probability of incarceration,
respectively.

Study 5:
Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., & Pickrel, S. G. (2002).
Four-year follow-up of Multisystemic Therapy with substance-abusing and
substance-dependent juvenile offenders. Journal of the American Academy of
Child & Adolescent Psychiatry, 41
(7), 868-874.

Evaluated
population:
In 1999, 118 substance-abusing or dependent juvenile offenders
and their families were evaluated. Seventy-nine percent of the adolescents were
male, 50 percent were African American, 47 percent were white, and the average
age was 15.7 years. The median family income was between $15,000 and $20,000.

At the four-year
follow-up, 80 adolescents remained in the study. Seventy-six percent of the
subjects were male, 60 percent were African-American, 40 percent were white, and
the average age was 19.6 years. Forty-eight percent of the sample did not
obtain a high school diploma or GED, and12 percent completed college or
technical education after high school.

Approach:
Adolescents were randomly assigned to receive the MST treatment condition, as
described in the description section above, or usual community services.
Adolescents were assessed on self-reported delinquency and criminal convictions;
self-reported and biologically assessed marijuana and cocaine use; and
externalizing and internalizing symptoms.

The 38 study
dropouts from the baseline did not significantly differ from the subjects that
remained in the study on treatment condition, gender, race, internalizing and
externalizing disorders, or substance use and dependence.

Results:
At the four-year follow-up, there was a significant reduction in convictions for
aggressive crimes and self-reported aggressive crimes for the MST group when
compared with the control group. There was no significant difference between
the groups on property crimes.

Based on
biological measures, the MST group had significantly higher rates of marijuana
abstinence when compared with the control group. There were no significant
differences between the groups on self-reported marijuana and cocaine use and
biologically reported cocaine use.

There were no
significant differences between groups on measures of internalizing and
externalizing behavior.

Study 6:
Borduin CM, Schaeffer CM, Heiblum N. (2009). A randomized clinical trial of
Multisystemic Therapy with juvenile sexual offenders: Effects on youth social
ecology and criminal cctivity. Journal of Consulting and Clinical Psychology,
77(1):26-37.

Evaluated
population:
A total of 48 adolescents and their families were enrolled in
the study. All adolescents included in this study were arrested for serious
sexual offenses such as rape, sexual assault, or molestation of younger
children. The mean age of participants was 14 years. Approximately 96 percent of
participants were boys. In addition, 73 percent were White, 27 percent were
Black, and 2 percent of participants also reported being of Latino origin.
Approximately one-third of participants (31 percent) lived with one parental
figure, and 55 percent of families were of a lower socioeconomic status.
Participants averaged approximately four prior arrests for sexual and nonsexual
felonies.

Approach:
Adolescents and their families were randomly assigned to either the MST
intervention group (n=24) or the control (n=24). As with previous MST
interventions, adolescents enrolled in the current MST intervention group
received services in the home, school, and/or community setting. Adolescents and
their families received multiple contacts each week–approximately three hours of
intervention sessions. Therapists were available to respond to clinical problems
24-hours a day, seven days a week. Adolescents in the control group received
cognitive-behavioral group and individual treatments through their local
juvenile court system.

Participants
were assessed at baseline as well as post-intervention, along with a follow-up
at approximately nine years after the intervention. Adolescents were assessed on
individual adjustment (self- and parent-report), family relations such as
cohesion and adaptability (self- and parent-report), peer relations such as
emotional bonding, aggression, and social maturity (self-, parent-, and
teacher-report), school grades (parent- and teacher-report), criminal activity
such as person and property, arrests for sexual crimes and other crimes, and
incarceration. Criminal arrest and incarceration reports were obtained from
official records. Follow-up occurred approximately nine years after the
intervention.

Results:
There were statistically significant decreases in mother- (ES=.35), father-
(ES=.31), and adolescent- (ES=.30) reported psychiatric symptoms among those in
the intervention group. However, these symptoms significantly increased among
those in the control group. There were significant increases in parent- and
adolescent-report cohesion (ES=.41) and adaptability (ES=.45) among those in the
intervention group. However, there was a significant decrease among those in
the control group. There was a statistically significant decrease in parent
repots of youth behavior problems (ES=.46) in the intervention group; however,
these symptoms significantly increased among those in the control goup.

There were
significant increases in parent- and teacher-report for emotional bonding
(ES=.22) and social maturity (ES=.37). There was a significant decrease in
aggression (ES=.18) among those in the intervention group, whereas in the
control group, there was a significant increase in aggression. There also were
significant increases in adolescent-report for emotional bonding (ES=.18) and
social maturity (ES=.14) among those in the intervention group, whereas with
those in the control group, there was a significant decrease. There were no
significant differences between the two study groups for aggression.

There were
significant increases in school grades (ES=.33) for parent- and teacher-report
among those in the intervention group. However in the control group, there was
a significant decrease. There also were significant decreases in self-report
person (ES=.39) and property (ES=.38) criminal activity among the intervention
group, whereas in the control group, there was a significant increase.

At the nine year
follow-up, there were significant decreases in the number of reported arrests
for sexual crimes (ES=.16) and other crimes (ES=.04) and the number of days
incarcerated (ES=.09) among those in the intervention group compared with the
control group.

Study 7:
Henggeler, S.W., Rowland, M.D., Randall, J., Ward, D.M., Pickrel, S.G.,
Cunningham, P.B., Miller, S.L., Edwards, J., Zealberg, J.J., Hand, L.D., Santos,
A.B. (1999). Home-based multisystemic therapy as an alternative to the
hospitalization of youths in psychiatric crisis: Clinical outcomes. Journal
of the American Academy of Child Adolescent Psychiatry, 38
(11), 1331-1339.

Evaluated
Population: 
In total, 113 children and adolescents aged 10 to 17 (average 13
years) years living in Charleston County, South Carolina were evaluated.
Sixty-five percent of participants were male, and 64 percent were
African-American. All participants were approved by an independent source for
emergency psychiatric hospitalization at the Medical University of South
Carolina and had symptoms of suicidal ideation, homicidal ideation, psychosis,
or threat of harm to self or others due to mental illness severe enough to
warrant hospitalization. Participants had Medicaid-funded or no health
insurance and a noninstitutional residence.

Approach: After referral by personnel from the community’s child service agencies,
crisis caseworkers were called by the professional at the youth’s emergency
assessment to meet with the family to determine study eligibility. Participants
were then randomly assigned to receive MST or psychiatric hospitalization at
Medical University of South Carolina Youth Division Psychiatric Inpatient Unit
with aftercare. Two families dropped out immediately after randomization.
Assessments were conducted within 24 hours of consent, shortly after control
group participants were released from the hospital (with MST intervention group
assessed at same time) and after completion of MST home-based services (with
control group assessed at same time). As a consequence of the severity of
presenting problems, 44 percent of youths in the MST intervention group were
hospitalized at some point during the MST services. Therefore, this study
compared MST combined with other community services (including hospitalization)
with hospitalization followed by usual treatment.

Results:
Participants in the MST group had fewer externalizing symptoms than hospitalized
participants at the completion of MST services. However, those in the
hospitalization group reported significantly improved self-esteem compared with
the MST condition. At hospital release, families in the MST group had become
significantly more structured, while those in the hospitalization group became
significantly less structured. Family cohesion significantly increased for MST
participants and significantly decreased for hospitalization participants at
time of completion of MST services. School attendance and treatment
satisfaction were significantly higher in the MST condition upon time of
hospital release.

SOURCES FOR
MORE INFORMATION

References

Borduin, C. M.,
Mann, B. J., Cone, L. T., Henggeler, S. W., Fucci, B. R., Blaske, D. M., et al.
(1995). Multisystemic treatment of serious juvenile offenders: Long-term
prevention of criminality and violence. Journal of Consulting and Clinical
Psychology, 63
(4), 569-578.

Borduin CM,
Schaeffer CM, 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.

Henggeler, S.
W., Mihalic, S. F., Rone, L., Thomas, C., & Timmons-Mitchell, J. (Eds.). (1998).
Multisystemic Therapy (Vol. 6). Boulder, CO: Institute of Behavioral
Science, University of Colorado at Boulder.

Henggeler, S.W.,
Brondino, M.J., Melton, G.B., 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(5), 821-833.

Henggeler, S.W.,
Rowland, M.D., Randall, J., Ward, D.M., Pickrel, S.G., Cunningham, P.B., Miller,
S.L., Edwards, J., Zealberg, J.J., Hand, L.D., Santos, A.B. (1999). Home-based
multisystemic therapy as an alternative to the hospitalization of youths in
psychiatric crisis: Clinical outcomes. Journal of the American Academy of
Child Adolescent Psychiatry, 38
(11), 1331-1339.

For a link to
the program curriculum, please visit:
http://www.mstservices.com/

For additional
information about cost effectiveness, please visit:

http://mstservices.com/proven-results/cost-effectiveness

KEYWORDS:
Adolescents (12-17), Youth (16+), Home-based, Home Visitation, High-Risk, High
School, Juvenile Offenders, Counseling/Therapy, Aggression, Parent/Family
Component, Any Substance Use, Marijuana/Illicit/Prescription Drugs, Manual,
Cost, Other Behavior Problems

Program
information last updated 1/6/12.

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