Multisystemic Therapy (MST) (OJJDP Model Program Guide)

Office of Justice Programs, Innovation - Partnerships – Safer Neighborhoods

Office of Juvenile Justice and Delinquency Prevention (OJJDP) Serving Children, Families and Communities

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Multisystemic Therapy (MST)

Intervention:

The overriding goal of Multisystemic Therapy (MST) is to keep adolescents who have exhibited serious clinical problems (such as 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.

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.

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.

Treatment is conducted by therapists with special MST training, who 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.

Evaluation Methodology:

Study 1
The Henggeler and colleagues (1992) study reported the results of a randomized control trial of MST in South Carolina. The Family and Neighborhood Services project randomized juvenile offenders to a treatment-as-usual (n= 41) or the MST intervention (n= 43). Offenders 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 offenders 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.

Study 2
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 juvenile offenders were randomized to the MST condition, and 84 were randomized to a comparison individual therapy (IT) condition. The average age of the offenders 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.

Study 3
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, juvenile offenders 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.

Evaluation Outcome:

Study 1
Crime, Arrests, and Incarceration
Results of the first study at 59 weeks postreferral showed the MST treatment group had just more than half the number of rearrests than the usual-services comparison group. Significant differences were also found in recidivism rates, with 42 percent for the MST group and 63 percent for the comparison group. On average, MST participants spent significantly fewer days (73 days less) than the comparison group incarcerated in Department of Youth Services facilities. At 59 weeks postreferral, 20 percent of the MST group had been incarcerated, compared to 68 percent of the comparison group. At the posttest, the comparison group self-reported delinquency scale scores were nearly three times greater than the MST intervention group.

Family and Social Skills
The treatment group reported significantly higher family cohesion than the comparison group at posttest. While the comparison group’s score for family cohesion decreased from pre- to posttest, the MST group saw an improvement over the same period. Additionally, the treatment group reported significantly lower peer aggression than the comparison group at the posttest. All other measures were not significant.

Study 2
Arrests and Seriousness of Offenses
Survival analysis conducted in the second study showed significant differences between treatment and comparison groups 4 years after the end of their probation: 71.4 percent of the IT comparison group participants were arrested at least once, compared to 26.1 percent of MST participants. Further analysis showed that the number of arrests of the recidivists was significantly lower for the MST treatment group: intervention group recidivists were arrested on average 1.71 times, compared to 5.43 times in the comparison IT group.

The results also showed that the recidivists of the MST group had been arrested for significantly less-serious crimes and significantly fewer violent crimes than IT recidivists.

Family Functioning
There were significant differences between mother and father psychiatric symptomatology between treatment conditions from pre- to posttest: MST families reported a significant decrease in the symptoms they presented, while these levels did not change (or increased) in the IT sample. MST mothers also reported significantly less problem adolescent behavior than those in the comparison group. Additionally, significant differences were found between the intervention and comparison group in family cohesion and adaptability, which increased in the MST group pre- to posttest but decreased in the IT group. No significant differences were found in peer relations measures.

Study 3
Arrests
At the 18-month posttreatment follow-up, the 66.7 percent recidivism rate for the MST group was found to be significantly lower than the 86.7 percent rate for the TAU group. MST participants were also arrested and arraigned for new charges significantly fewer times (on average 1.44 times) compared to the TAU group (2.29 times). Binary logistic regression showed youths in the TAU group were 3.2 times more likely to be arrested than the MST group. While survival analysis revealed significant differences in recidivism between treatment groups, no significant differences were found between groups on the time until first arrest.

Adolescent Functioning
Both interventions improved youth functioning over time, with MST scoring significantly better on four of the six subscale areas examined. At the 6-month follow-up, the MST group showed significantly better school and work functioning than the TAU group. At posttest and 6-month follow-up, significant differences were found for the home subscale of adolescent functioning. Mean differences between the groups were significantly different at all points in time for the community scale. Further, the moods and emotions subscale showed significantly lower results for MST at 6 months. A significant trend was found in the substance use scale over time but not between groups, indicating that the MST group did not show better substance use outcomes than the comparison group.

Other Information:

Costs: The Washington State Institute for Public Policy published a report with detailed analysis of fiscal year 2008 costs associated with providing State-funded evidence-based programs in the Washington State juvenile courts (Barnoski 2009). Cost information on Multisystemic Therapy was included in the report. Total cost per youth in Washington State for MST was $7,076, which included service, quality assurance, administrative overhead, transportation, court oversight, court referral/coordination, case management, and additional court services. The benefits of this program, which included benefits to both crime victims and taxpayers, were calculated to be $23,856 per youth.

Implementation: All Multisystemic Therapy programs must be licensed by MST Services. MST Services created the MST Program Development Method™ (PDM) based on previous experience with implementation. Because each organization is unique, the PDM is rarely applied exactly the same way each time. Rather, the emphasis is on allowing 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 the MST program. The program start-up services include technical assistance and materials designed to produce a program description, projected budget, and implementation timeline. Key elements include review of funding proposal documents and/or responses, 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. Additional information is available by visiting the MST Services Web site or by contacting MST Services directly: http://www.mstservices.com

References:

Barnoski, Robert. 2009. Providing Evidence-Based Programs With Fidelity in Washington State Juvenile Courts: Cost Analysis (Document No. 09–12–1201). Olympia, Wash.: Washington State Institute for Public Policy.

Borduin, Charles M., Barton J. Mann, Lynn T. Cone, Scott W. Henggeler, Bethany R. Fucci, David M. Blaske, and Robert A. Williams. 1995. “Multisystemic Treatment of Serious Juvenile Offenders: Long-Term Prevention of Criminality and Violence.” Journal of Consulting and Clinical Psychology 63(4):569–78.

Borduin, Charles M., Cindy M. Schaeffer, and Naamith Heiblum. 2009. “A Randomized Clinical Trial of Multisystemic Therapy With Juvenile Sexual Offenders: Effects on Youth Social Ecology and Criminal Behavior.” Journal of Consulting and Clinical Psychology 77(1):26–37.

Curtis, Nicola M., and Kevin R. Ronan. 2004. “Multisystemic Treatment: A Meta-Analysis of Outcome Studies.” Journal of Family Psychology 18(3):411–19.

Henggeler, Scott W. 1997. “Treating Serious Antisocial Behavior in Youth: The MST Approach.” Juvenile Justice Bulletin. Washington, D.C.: Office of Juvenile Justice and Delinquency Prevention.

Henggeler, Scott W., W. Glenn Clingempeel, Michael J. Brondino, and Susan G. Pickrel. 2002. “Four-Year Follow-Up of Multisystemic Therapy With Substance-Abusing and Substance-Dependent Juvenile Offenders.” Journal of the American Academy of Child and Adolescent Psychiatry 41(7):868–74.

Henggeler, Scott W., Phillippe B. Cunningham, Susan G. Pickrel, Sonja K. Schoenwald, and Michael J. Brondino. 1996. “Multisystemic Therapy: An Effective Violence Prevention Approach for Serious Juvenile Offenders.” Journal of Adolescence 19(1):47–61.

Henggeler, Scott W., Elizabeth Letourneau, Jason E. Chapman, Charles M. Borduin, Paul A. Schewe, and Michael R. McCart. 2009. “Mediators of Change for Multisystemic Therapy With Juvenile Sexual Offenders.” Journal of Consulting and Clinical Psychology 77(3):451–62.

Henggeler, Scott W., Gary B. Melton, Michael J. Brondino, David G. Scherer, and Jerome H. Hanley. 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):821–33.

Henggeler, Scott W., Gary B. Melton, and Linda A. Smith. 1992. “Family Preservation Using Multisystemic Therapy: An Effective Alternative to Incarcerating Serious Juvenile Offenders.” Journal of Consulting and Clinical Psychology 60(6):953–61.

Henggeler, Scott W., Gary B. Melton, Linda A. Smith, Sonja K. Schoenwald, and Jerome H. Hanley. 1993. “Family Preservation Using Multisystemic Treatment: Long-Term Follow-Up to a Clinical Trial With Serious Juvenile Offenders.” Journal of Child and Family Studies 2:283–93.

Henggeler, Scott W., Sharon F. Mihalic, Lee Rone, Christopher R. Thomas, and Jane Timmons–Mitchell. 1998. Blueprints For Violence Prevention, Book 6: Multisystemic Therapy. Boulder, Colo.: Center for the Study and Prevention of Violence.

Henggeler, Scott W., J. Douglas Rodick, Charles M. Borduin, Cindy L. Hanson, Sylvia M. Watson, and Jon R. Urey. 1986. “Multisystemic Treatment of Juvenile Offenders: Effects on Adolescent Behavior and Family Interactions.” Development Psychology 22(1):132–41.

Henggeler, Scott W., Sonja K. Schoenwald, Charles M. Borduin, Melisa D. Rowland, and Phillippe B. Cunningham. 2009. Multisystemic Therapy for Antisocial Behavior in Children and Adolescents (Second Edition). New York, N.Y.: Guilford Press.

Letourneau, Elizabeth J, Scott W. Henggeler, Charles M Borduin, Paul A. Schewe, Michael R. McCart, and Jason E. Chapman. 2009. “Multisystemic Therapy for Juvenile Sexual Offenders: 1-Year Results From a Randomized Effectiveness Trial.” Journal of Family Psychology 23(1):89-102.

Mitchell–Herzfeld, Susan, Therese A. Shady, Janet Mayo, Do Han Kim, Kelly Marsh, Vajeera Dorabawila, and Faye Rees. 2008. Effects of Multisystemic Therapy (MST) on Recidivism Among Juvenile Delinquents in New York State. New York, N.Y.: The New York State Office of Children and Family Services.

Ogden, Terje, and Kristine Amlund Hagen. 2006. “Multisystemic Therapy of Serious Behavior Problems in Youth: Sustainability of Therapy Effectiveness 2 Years After Intake.” Child and Adolescent Mental Health 11(3):142–49.

Ogden, Terje, and Colleen A. Halliday–Boykins. 2004. “Multisystemic Treatment of Antisocial Adolescents in Norway: Replication of Clinical Outcomes Outside of the United States.” Child and Adolescent Mental Health 9:76–82.

Schaeffer, Cindy M., and Charles M. Borduin. 2005. “Long-Term Follow-Up to a Randomized Clinical Trial of Multisystemic Therapy With Serious and Violent Juvenile Offenders.” Journal of Consulting and Clinical Psychology 73(3):445–53.

Timmons–Mitchell, Jane, Monica B. Bender, Maureen A. Kishna, and Clare C. Mitchell. 2006. “An Independent Effectiveness Trial of Multisystemic Therapy With Juvenile Justice Youth.” Journal of Clinical Child and Adolescent Psychology 35:227–36.

Program Specification:

New Rating:

Effective

Re-reviewed Date:

June 2011

Program Type:

Cognitive Behavioral Treatment

Family Therapy

Parent Training

Ethnicity:

Other Ethnicity

African American

Hispanic or Latino (of any race)

White

Gender:

Both

Age:

12 - 17

Special Populations:

Less Serious Offender

Serious Offenders

Target Settings:

Rural

Suburban

Urban

Problem Behaviors:

Aggression/Violence

Alcohol,Tobacco and Other Drug Use

Family Functioning

Risk & Protective Factors:

Risk

Protective

Additional Information:

OJJDP: Blueprints

SAMHSA: NREPP

OJJDP/CSAP: Strengthen Families

HHS: Surgeon General

Status:

Program is in operation at this time.

Performance Measures:

Suggested OJJDP Performance Measures for the Program Types(s):

Delinquency Prevention
Family Therapy
Logic Model: PDF
Performance Matrix:PDF
Mental Health Services
Family Therapy
Logic Model: PDF
Performance Matrix:PDF
Delinquency Prevention
Parent Training
Logic Model: PDF
Performance Matrix:PDF
Mental Health Services
Parent Training
Logic Model: PDF
Performance Matrix:PDF
Mental Health Services
Cognitive Behavioral Treatment
Logic Model: PDF
Performance Matrix:PDF

Contact Information:

Program Developer:
Scott W. Henggeler
Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
326 Calhoun Street
Charleston, SC 29425
Phone: 843.876.1800
Email: Click Here
Website: Click Here

Training & TA Provider:
Marshall E. Swenson
Manager of New Program Development MST Services
710 Johnnie Dodds Blvd.
Mount Pleasant, SC 29464
Phone: 843.856.8226
Fax: 843.856.8227
Email: Click Here
Website: Click Here