MULTISYSTEMIC THERAPY (MST)

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.

 EVALUATION(S) 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

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

For additional information about cost effectiveness, please visit: http://www.mstservices.com/cost_effectiveness.php

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.

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.