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.
