Multisystemic Therapy (MST) for diabetes is an intensive home- and community-based, multi-level intervention that aims to increase regimen adherence in children and adolescents with poorly controlled diabetes. Experimental studies of this intervention have shown a significant impact on adherence, diabetes-related stress, hospitalizations for diabetic ketoacidosis, and metabolic control at post-treatment when compared with a control group. Long-term outcomes are less consistent, with one study showing maintained impacts on adherence and metabolic control, and another study showing no long term impacts for these outcomes.
DESCRIPTION OF PROGRAM
Target Population: Children and adolescents (aged 10-18) with diabetes and their families.
Originally designed to treat antisocial behavior, Multisystemic Therapy (MST) [LINK TO MULTISYSTEMIC THERAPY WRITE UP] is an intensive home- and community-based family intervention. MST has been adapted to treat regimen adherence difficulties in children with chronic diseases, like diabetes. MST interventions target the child, the family, the school, and the broader community. This broad-based approach is particularly well-suited for treating regimen adherence difficulties, as this can be caused by many different factors. MST for diabetes aims to increase regimen adherence, decrease diabetes related stress, and improve metabolic control. MST is individualized for each child, utilizes empirically support treatments, and promotes behavior change within a child’s natural environment. MST is administered in home, school or community settings by trained therapists. At the individual level, MST for diabetes focused on increasing motivation for diabetes care compliance and improving self-care skills. At the family level, this intervention aims to increase parent knowledge of diabetes care, develop parenting skills, improve family routines related to diabetes care, and enhance caregivers’ communication skills about care needs. MST for diabetes includes a school-level intervention focused on improving family-school communication regarding diabetes are and helping school personnel develop strategies to support regimen adherence. MST for diabetes also targets the healthcare system by helping families resolve barriers to appointment attendance, and promoting a positive relationship between families and healthcare providers. In this adaptation of MST, therapists typically meet with children, families, schools, or healthcare providers for at least 2 hours a week total. The intervention typically lasts about 6 months, but is flexible based on individual need.
EVALUATION OF PROGRAM
Study 1: Ellis, D. A., Frey, M. A., Naar-King, S., Templin, T., Cunningham, P. B., & Cakan, N. (2005). The effects of multisystemic therapy on diabetes stress among adolescents with chronically poorly controlled type 1 diabetes: Findgs from a randomized controlled trial. Pediatrics, 116, e826-e832. Doi:10.1542/peds.2005-0638
Evaluated Population: This sample consisted of 127 adolescents with Type I diabetes and chronically poor metabolic control and their families. Participants were recruited from an endocrinology clinic at a children’s hospital in a large city in the Midwest. Participants were eligible for the study if they were 10-17 years old, were diagnosed with Type I diabetes for at least a year, had chronically poor metabolic control, and spoke English. The sample was 49 percent male, 63 percent Black, 26 percent White, and 11 percent other. The average age was 13.3 years.
Approach: Adolescents were individually randomized to multisystemic therapy or to the standard care control condition, Participants in the intervention completed about 6 months of MST targeting the adolescent’s regimen adherence, and continued to receive standard medical care. Those in the control condition continued to receive standard medical care. Outcomes of interest, measured at baseline and post-treatment, were diabetes-related stress, adherence to regimen, and metabolic control. Diabetes-related stress was measured via adolescent self-report. Adherence to regimen was measured as the frequency of blood glucose testing, as indicated on the adolescent’s blood glucose meter. Metabolic control was measured through blood draws to calculate HbA1c. The only statistically significant difference between groups at baseline was that more male subjects were randomly assigned to the intervention group.
Results: Adolescents in the MST intervention group reported significantly lower diabetes-related stress at post-treatment compared with the control group. MST also had a significant impact on regimen adherence, with adolescents in the intervention group showing greater adherence than those in the control group. The intervention did not have a significant direct impact on metabolic control.
Study 2: Ellis, D. A., Templin, T., Naar-King, A., Frey, M. A., Cunningham, P. B., Podolski, C., & Cakan, N. (2007). Multisystemic therapy for adolescents with poorly controlled type I diabetes: Stability of treatment effects in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 75, 168-174. doi:10.1037/0022-006C.75.1.168
Evaluated Population: See Study 1 (above).
Approach: See Study 1 (above). This study included an examination of the longitudinal impact of MST, by measuring metabolic control, treatment adherence, and hospitalizations for diabetic ketoacidosis (DKA) at a 6-month follow-up.
Results: At the 6-month follow-up assessment, treatment adherence and metabolic control were not significantly different between the MST and control groups. However, moderation analyses revealed that for adolescents in two-parent households, MST had a significant impact on adherence at post-treatment (effect size: 0.67) and at follw-up (effect size: 0.53). MST also had a significant impact on DKA hospital admissions during the intervention (effect size: 0.67) and for the six months following (effect size: 0.53).
Study 3: Ellis, D. A.., Naar-King, A., Chen, X., Molt, K., Cunningham, P. B., & Idalski-Carcone, A. (2012). (2012). Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: Findings from a randomized controlled trial. Annals of Behavioral Medicine, published online May 30. Doi:10.1007/s12160-012-9378-1
Evaluated Population: This sample consisted of 146 adolescents with types 1 or 2 diabetes and their families who were recruited from an endocrinology clinic at a university-affiliated children’s hospital in the Midwest. To be eligible for this study, participants had to be 10-18 years old, have a diagnosis of diabetes that required insulin treatment for at least a year, have a certain level of metabolic functioning, be living in a home setting, not have a diagnosis of mental retardation or psychosis, and speak English. The sample was 77 percent African-American, 20 percent white, and 4 percent other racial/ethnic category. The average age of the sample was 14.2 years.
Approach: Participants were stratified based on baseline metabolic control and weight status. They were then randomized to intervention (n=74) or telephone support control (n=72) groups. The intervention was tailored for each individual, but generally lasted about 6 months. The telephone support control condition involved weekly half hour phone calls with a trained therapist, and was designed to control for the attention, support, and expectation of improvement components of the intervention. At baseline, post-intervention, and 6-month follow-up, trained research assistants collected measures of metabolic control and regimen adherence. Metabolic control (HbA1c) was measured via blood draw and height and weight measurements. Parents and youth completed a questionnaire to measure regimen adherence. There were no significant differences between the intervention and control groups at baseline.
Results: Controlling for baseline features, participants in the MST intervention had significantly greater reductions in HbA1c (indicating greater metabolic control) at post-intervention (effect size 0.36) and follow-up (effect size: 0.24) when compared with the control group, Parent-reported regimen adherence was significantly better in the intervention group at post-intervention (effect size: 0.29) and follow-up (effect size: 0.28). Youth-reported regimen adherence was not significantly different between the groups at any time point.
SOURCES FOR MORE INFORMATION
Ellis, D. A., Frey, M. A., Naar-King, S., Templin, T., Cunningham, P. B., & Cakan, N. (2005). The effects of multisystemic therapy on diabetes stress among adolescents with chronically poorly controlled type 1 diabetes: Findgs from a randomized controlled trial. Pediatrics, 116, e826-e832. Doi:10.1542/peds.2005-0638
Ellis, D. A., Templin, T., Naar-King, A., Frey, M. A., Cunningham, P. B., Podolski, C., & Cakan, N. (2007). Multisystemic therapy for adolescents with poorly controlled type I diabetes: Stability of treatment effects in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 75, 168-174. doi:10.1037/0022-006C.75.1.168
Ellis, D. A.., Naar-King, A., Chen, X., Molt, K., Cunningham, P. B., & Idalski-Carcone, A. (2012). (2012). Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: Findings from a randomized controlled trial. Annals of Behavioral Medicine, published online May 30. Doi:10.1007/s12160-012-9378-1
Deborah A. Ellis, Ph.D.
Department of Psychiatry and Behavioral Neurosciences
9-B University Health Center
4201 St. Antoine
Detroit, MI 48201
KEYWORDS: Children (3-11), Adolescents (12-17), Youth (16+), Young Adults (18-24), Males and Females (Co-ed), Home-based, Skills Training, Physical Health Other, Social/Emotional Health Other
Program information last updated on 12/21/12.