Multisystemic Therapy (MST)
This program was part of a cost-benefit analysis completed by the Washington State Institute for Public Policy on several violence prevention and reduction programs, including six Blueprints programs: Watching the Bottom Line: Cost-Effective Interventions for Reducing Crime in Washington.
Program Summary
Multisystemic Therapy (MST) is an intensive family- and community-based treatment that addresses the multiple determinants of serious antisocial behavior in juvenile offenders. The multisystemic approach views individuals as being nested within a complex network of interconnected systems that encompass individual, family, and extrafamilial (peer, school, neighborhood) factors. Intervention may be necessary in any one or a combination of these systems.
Program Targets:
MST targets chronic, violent, or substance abusing male or female juvenile offenders, ages 12 to 17, at high risk of out-of-home placement, and the offenders' families.
Program Content:
MST addresses the multiple factors known to be related to delinquency across the key settings, or systems, within which youth are embedded. MST strives to promote behavior change in the youth's natural environment, using the strengths of each system (e.g., family, peers, school, neighborhood, indigenous support network) to facilitate change.
The major goal of MST is to empower parents with the skills and resources needed to independently address the difficulties that arise in raising teenagers and to empower youth to cope with family, peer, school, and neighborhood problems. Within a context of support and skill building, the therapist places developmentally appropriate demands on the adolescent and family for responsible behavior. Intervention strategies are integrated into a social ecological context and include strategic family therapy, structural family therapy, behavioral parent training, and cognitive behavior therapies.
MST is provided using a home-based model of services delivery. This model helps to overcome barriers to service access, increases family retention in treatment, allows for the provision of intensive services (i.e., therapists have low caseloads), and enhances the maintenance of treatment gains. The usual duration of MST treatment is approximately 60 hours of contact over four months, but frequency and duration of sessions are determined by family need.
Program Outcomes:
Evaluations of MST have demonstrated for serious juvenile offenders:
- reductions of 25-70% in long-term rates of rearrest,
- reductions of 47-64% in out-of-home placements,
- extensive improvements in family functioning, and
- decreased mental health problems for serious juvenile offenders.
Program Costs:
MST has achieved favorable outcomes at cost saving in comparison with usual mental health and juvenile justice services, such as incarceration and residential treatment. At a cost of $4,500 per youth, a recent policy report concluded that MST was the most cost-effective of a wide range of intervention programs aimed at serious juvenile offenders.
The information for this fact sheet was excerpted from:
Henggeler, S.W., Mihalic, S.F., Rone, L.,Thomas, C., & Timmons-Mitchell, J. (1998). Multisystemic Therapy: Blueprints for Violence Prevention, Book Six. Blueprints for Violence Prevention Series (D.S. Elliott, Series Editor). Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado.
1998 (Updated 08/2006)
Program Background
Multisystemic Therapy (MST) was developed in the late 1970s. It addresses several limitations of existing mental health services for serious juvenile offenders which include minimal effectiveness, low accountability of service providers for outcomes, and high cost.
Treatment efforts, in general, have failed to address the complexity of youth needs, being individually-oriented, narrowly focused, and delivered in settings that bear little relation to the problems being addressed (e.g., residential treatment centers, outpatient clinics). Given overwhelming empirical evidence that serious antisocial behavior is determined by the interplay of individual, family, peer, school, and neighborhood factors, it is not surprising that treatments of serious antisocial behavior have been largely ineffective. Restrictive out-of-home placements, such as residential treatment, psychiatric hospitalization, and incarceration, fail to address the known determinants of serious antisocial behavior and fail to alter the natural ecology to which the youth will eventually return. Furthermore, mental health and juvenile justice authorities have had virtually no accountability for outcome, a situation that does not enhance performance. The ineffectiveness of out-of-home placement, coupled with extremely high costs, have led many youth advocates to search for viable alternatives. MST is one treatment model that has a well-documented capacity to address the aforementioned difficulties in providing effective services for juvenile offenders.
Theoretical Rationale/Conceptual Framework
Consistent with social-ecological models of behavior and findings from causal modeling studies of delinquency and drug use, MST posits that youth antisocial behavior is multidetermined and linked with characteristics of the individual youth and his or her family, peer group, school, and community contexts. As such, MST interventions aim to attenuate risk factors by building youth and family strengths (protective factors) on a highly individualized and comprehensive basis. The provision of home-based services circumvents barriers to service access that often characterize families of serious juvenile offenders. An emphasis on parental empowerment to modify the natural social network of their children facilitates the maintenance and generalization of treatment gains.
Brief Description of Intervention
MST is a pragmatic and goal-oriented treatment that specifically targets those factors in each youth's social network that are contributing to his or her antisocial behavior. Thus, MST interventions typically aim to:
- improve caregiver discipline practices;
- enhance family affective relations;
- decrease youth association with deviant peers;
- increase youth association with prosocial peers;
- improve youth school or vocational performance;
- engage youth in prosocial recreational outlets; and
- develop an indigenous support network of extended family, neighbors, and friends to help caregivers achieve and maintain such changes.
Specific treatment techniques used to facilitate these gains are integrated from those therapies that have the most empirical support, including cognitive behavioral, behavioral, and the pragmatic family therapies.
MST services are delivered in the natural environment (e.g., home, school, and community). The treatment plan is designed in collaboration with family members and is, therefore, family driven rather than therapist driven. The ultimate goal of MST is to empower families to build an environment, through the mobilization of indigenous child, family, and community resources, that promotes health. The typical duration of home-based MST services is approximately four months, with multiple therapist-family contacts occurring each week, determined by family need.
Although MST is a family-based treatment model that has similarities with other family therapy approaches, several substantive differences are evident:
- MST places considerable attention on factors in the adolescent and family's social networks that are linked with antisocial behavior. Hence, for example, MST priorities include removing offenders from deviant peer groups, enhancing school or vocational performance, and developing an indigenous support network for the family to maintain therapeutic gains.MST programs have an extremely strong commitment to removing barriers to service access (e.g., the home-based model of service delivery).
- MST services are more intensive than traditional family therapies (e.g., several hours of treatment per week vs. 50 minutes).
- Most importantly, MST has well-documented long-term outcomes with adolescents presenting serious antisocial behavior and the adolescents' families.
The strongest and most consistent support for the effectiveness of MST comes from controlled studies that focused on violent and chronic juvenile offenders. Importantly, results from these studies showed that MST outcomes were similar for youth across the adolescent age range (i.e., 12-17 years), for males and females, and for African American as well as White youth and families.
Evidence of Program Effectiveness
The first controlled study of MST with juvenile offenders was published in 1986, and three randomized clinical trials with violent and chronic juvenile offenders have been conducted since then. In these trials, MST has demonstrated long-term reductions in criminal activity, drug-related arrests, violent offenses, and incarceration. This success has led to several randomized trials and quasi-experimental studies aimed at extending the effectiveness of MST to other populations of youth presenting serious clinical problems and their families.
The information for this fact sheet was excerpted from:
Henggeler, S.W., Mihalic, S.F., Rone, L.,Thomas, C., & Timmons-Mitchell, J. (1998). Blueprints for Violence Prevention, Book Six: Multisystemic Therapy. Boulder, CO: Center for the Study and Prevention of Violence.
Video Segment
Contact MST
MULTISYSTEMIC THERAPY (MST) |
| For information about program development, contact: |
| Marshall Swenson, MSW, MBA MST Services, Inc. 710 J. Dodds Boulevard Mount Pleasant, SC 29464 Phone: (843) 856-8226 Fax: (843) 856-8227 Email: marshall.swenson@mstservices.com Website: www.mstservices.com or www.mstinstitute.org |
| For information about program research, contact: |
| Scott W. Henggeler, Ph.D. Family Services Research Center Department of Psychiatry and Behavioral Sciences Medical University of South Carolina 171 Ashley Avenue Charleston, SC 29425-0742 Phone: (843) 876-1800 Fax: (843) 876-1808 Email: henggesw@musc.edu Website: www.musc.edu |
