Multisystemic Therapy

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 that individual therapy or usual services in improving family correlates of antisocial behavior and ameliorating adjustment problems, including decreasing post-treatment criminal activity.

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. The therapy is individualized based on the juvenile and his or her family's needs. MST is consistent with family preservation models of service delinquency. Sessions are held in the family's home. MST focuses on providing parents with the skills and resources necessary to address the difficulties of raising delinquent adolescents.

EVALUATION(S) OF PROGRAM

STUDY 1: 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.

Evaluated population: 104 families completed pretreatment and posttreatment assessments. Families were randomly assigned to MST or individual therapy. 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. MST was provided by three female and three male graduate students in clinical psychology.

Approach: 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: After 4 years, youth in the MST treatment group were less likely to be arrested for violent crimes than those in the individual therapy. MST was also more effective in improving key family correlates of antisocial behavior than individual therapy.

Results of this study could be furthered by measurement of a broader range of factors. This would enhance understanding outcomes of those who dropped out of the program. Furthermore, future studies could tap relevant peer relations constructs to determine how strongly peer relations influence delinquency.

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.

Simpsonville Study:

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% male, 26% percent lived with neither biological parents, 56% were African American with the remaining 44% being white, and the average age was 15.22 years.

Approach: Participants were randomly assigned to the MST condition (n=43) or usual services provided by DJJ (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: Charleston, South Carolina Study:

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% and reduced re-arrests by 25%.

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 11-17 years of age, and their primary caregivers.  Nearly 82 percent were male.  Roughly 81 percent were African American and 19 percent 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: MST youth reported reduced psychiatric symptomatology.  Although MST resulted in lower rates of reatrrest 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. 

SOURCES FOR MORE INFORMATION

Link to program curriculum: http://www.mstservices.com/

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.

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.

Program categorized in this guide according to the following:

Evaluated participant ages: 14-19, / Program age ranges in the Guide:  12-14, 15-21

Program components: home visiting; parent or family component

Measured outcomes: social/emotional component, behavioral problems, positive citizenship

KEYWORDS: Adolescence (12-17), Young Adulthood (17-24), Home-based, Adolescents (12-17), Youth (16+), Young adults (18-24), Home Visitation, Delinquency, High-Risk, Juvenile Offenders, High School.

Program information last updated 2/10/2009.