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.
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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:
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- 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.
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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.
