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Multisystemic Therapy® (MST®)

Blueprints Program Rating: Model

A juvenile crime prevention program to enhance parenting skills and provide intensive family therapy to troubled teens and delinquent teens that empower youth to cope with the family, peer, school, and neighborhood problems they encounter - in ways that promote prosocial behavior while decreasing youth violence and other antisocial behaviors.

Program Outcomes

  • Close Relationships with Parents
  • Delinquency and Criminal Behavior
  • Illicit Drug Use
  • Internalizing
  • Mental Health - Other
  • Positive Social/Prosocial Behavior
  • Violence

Program Type

  • Family Therapy
  • Juvenile Justice, Other

Program Setting

  • Home
  • Juvenile Justice Setting
  • Mental Health/Treatment Center
  • School
  • Social Services
  • Transitional Between Contexts

Continuum of Intervention

  • Indicated Prevention (Early Symptoms of Problem)

Age

  • Early Adolescence (12-14) - Middle School
  • Late Adolescence (15-18) - High School

Gender

  • Male and Female

Race/Ethnicity

  • All Race/Ethnicity

Endorsements

  • Crime Solutions: Effective
  • Blueprints: Model
  • OJJDP Model Programs: Effective
  • SAMHSA: 2.9-3.2

Program Information Contact

Marshall Swenson, MSW, MBA
MST Services, Inc.
710 J. Dodds Boulevard, Suite 200
Mount Pleasant, SC 29464
Phone: (843) 856-8226
marshall.swenson@mstservices.com
www.mstservices.com or www.mstinstitute.org

Program Developer/Owner

  • Scott W. Henggeler, Ph.D.
  • Medical University of South Carolina

Brief Description of the Program

Multisystemic Therapy® (MST®) is an intensive family- and community-based treatment that addresses the multiple causes of serious antisocial behavior in juvenile offenders. The MST program seeks to improve the real-world functioning of youth by changing their natural settings - home, school, and neighborhood - in ways that promote prosocial behavior while decreasing antisocial behavior. Therapists work with youth and their families to address the known causes of delinquency on an individualized, yet comprehensive basis. By using the strengths in each system (family, peers, school, and neighborhood) to facilitate change, MST addresses the multiple factors known to be related to delinquency across the key systems within which youth are embedded. The extent of treatment varies by family according to clinical need. Therapists generally spend more time with families in the initial weeks (daily if needed) and gradually taper their time (to as infrequently as once a week) over the 3- to 5-month course of treatment.

See: Full Description

Outcomes

Simpsonville, SC: Compared to youth receiving usual services, MST youth had:

  • Significantly lower delinquency on multiple measures: self-reported offenses, self-reported drug use, arrests, incarceration, and days incarcerated in DYS facilities.
  • Double the nonrecidivism rate by the 2.4 year follow-up.

Columbia, MO: Relative to the comparison group, MST:

  • Decreased youth behavior problems reported by mothers.
  • Led to 70% fewer arrests among recidivists, typically for less serious crimes.
  • Led to fewer arrests and convictions, and fewer days in confinement at the 13.7 year and 21.9-year follow-ups.
  • The closest sibling of the target of the MST intervention had significantly fewer arrests and convictions than the control group siblings at the 25-year follow-up.

Multisite, SC: Compared to the control group:

  • Decreased psychiatric symptomatology in youth.
  • The annualized rate of days incarcerated was 47% lower for youth in MST.

Charleston, SC: Relative to the control group, MST showed:

  • No significant treatment effects on measures of drug use, self-reported criminal activity, and arrest records.
  • A 75% reduction in convictions for aggressive crimes and higher rates of marijuana abstinence (55% versus 28%) at the 4-year follow-up.

Los Angeles, CA (Fain et al., 2014): Relative to a comparison group, MST youth improved:

  • Rates of re-arrest, incarceration, and completion of community service.
  • Improvements in arrests, incarceration, and completion of probation were only found among Hispanic youth, not African American youth.

Canada Study: Compared to the control group, the MST group showed:

  • No significant differences on convictions, sentencing, and length of time in custody.
  • Significantly more open custody sentences and fewer secure custody sentences.
  • Significantly better parent reports of youths’ externalizing behavior.
  • Significantly better youth reports of internalizing symptoms.

Juvenile Sexual Offender Studies (Three Studies): Compared to the control group, MST youth had:

  • Fewer arrests and lower recidivism rates for both sexual and nonsexual crimes.
  • Significant reductions in sexual behavior problems, delinquency, substance use, externalizing symptoms, and out-of-home placements.

Midwestern State Study (Timmons-Mitchell, et al., 2006) - Independent Replication

  • MST recidivism rates (66.7%) were significantly lower than rates for those receiving treatment as usual (86.7%).
  • Youths in the treatment-as-usual group were 3.2 times more likely than MST youths to be rearrested.
  • MST showed improvement in functioning over time on four measures: school, home, work, and moods and emotions.

Norwegian Study (Ogden & Halliday-Boykins, 2004; Pgden & Hagen, 2006) - Independent Replication

  • MST decreased youth externalizing and internalizing symptoms.
  • Decreased out-of-home placements.

London Study (Butler et al. 2011) - Independent Replication:  Compared to a control group, MST produced a:

  • Significant decrease in nonviolent offenses at the 12-month follow-up assessment.
  • Decrease in aggression, delinquency, and psychopathic traits at posttest. 

U.S. School-based Study (Weiss et al., 2013) - Independent Replication
Relative to the control group, MST adolescents improved:

  • Parent and adolescent reports of externalizing behaviors.
  • Absenteeism at school.

Race/Ethnicity/Gender Details

In several studies, MST has been found effective for both genders. It has also been shown to be equally effective with youths of different age and ethnic backgrounds. Additionally, several studies included a majority sample of African Americans and one study (Fain et al., 2014) found the program to be more effective with Hispanics/Latinos than African Americans.

Risk and Protective Factors

Risk Factors
  • Individual: Early initiation of antisocial behavior, Early initiation of drug use, Rebelliousness, Substance use
  • Peer: Interaction with antisocial peers, Peer substance use
  • Family: Family conflict/violence*, Neglectful parenting, Parent history of mental health difficulties*, Parent stress, Parental attitudes favorable to antisocial behavior, Parental attitudes favorable to drug use, Poor family management*, Violent discipline
  • School: Low school commitment and attachment*, Poor academic performance
  • Neighborhood/Community: Community disorganization, Laws and norms favorable to drug use/crime, Low neighborhood attachment
Protective Factors
  • Individual: Clear standards for behavior, Problem solving skills, Prosocial involvement, Rewards for prosocial involvement, Skills for social interaction*
  • Peer: Interaction with prosocial peers*
  • Family: Attachment to parents, Non-violent discipline*, Opportunities for prosocial involvement with parents, Parent social support, Parental involvement in education, Rewards for prosocial involvement with parents
  • School: Opportunities for prosocial involvement in education, Rewards for prosocial involvement in school
  • Neighborhood/Community: Opportunities for prosocial involvement, Rewards for prosocial involvement

*Risk/Protective Factor was significantly impacted by the program.

See also: Multisystemic Therapy® (MST®) Logic Model (PDF)

Training and Technical Assistance

MST Group LLC (doing business as MST Services) offers comprehensive assistance with the full development of MST programs by providing program start-up assistance, initial and on-going clinical training and program quality assurance support services.

MST Services program development and support consists of a comprehensive package of services designed to do “what it takes” to ensure that the MST program will be successful and sustainable. These services cover four areas: 1) program start-up including initial staff training, 2) ongoing clinical support activities, 3) ongoing organization support activities, and 4) quality assurance support.

The program start-up services include technical assistance and materials designed to produce a program description, projected budget, and implementation timeline. Key critical elements include clear articulation of the target population definition and prioritization process, referral and discharge criteria and processes, recommendations regarding clinical record-keeping practices, and initial program evaluation planning. The MST Program Developer will visit the community to provide an overview presentation and meet with community stakeholders to assure the buy-in needed for program success after start-up. Next, staff recruitment assistance includes sample job descriptions, help with advertising, interviewing and selecting staff most qualified to implement MST successfully. Finally, all selected initial staff will complete the 5-day MST Orientation Training.

The ongoing MST clinical support is provided to replicate the characteristics of training, clinical supervision, consultation, and monitoring provided in the successful clinical research trials of MST. This program implementation protocol has been refined through extensive experience with communities and providers in numerous sites in the U.S. and internationally. After start-up, training continues through weekly telephone MST consultation for each team of MST clinicians aimed at monitoring treatment fidelity and adherence to the MST treatment model, and through quarterly on-site booster trainings (1 ½ days each). Fully trained MST Experts will teach the on-site MST supervisor to implement a manualized MST supervisory protocol and collaborate with the supervisor to promote the ongoing clinical development of all team members. The MST Expert will also assist at the organizational level.

Ongoing organizational assistance aims to overcome barriers to achieving successful clinical outcomes through services that may include business planning, promotion of the MST program within the broader service community, and developing program-level interventions designed to increase referrals, reduce staff attrition, or restructure program funding mechanisms to increase sustainability.

Quality assurance support activities focus on monitoring and enhancing program outcomes through increasing therapist and supervisor adherence to the MST treatment model. The research on MST has consistently indicated that adherence to the model is critical to achieving reduced rates of recidivism and incarceration. The MST Therapist Adherence Measure (TAM) and the MST Supervisor Adherence Measure (SAM) were validated in the research on MST with antisocial and delinquent youth and are now being implemented by all licensed MST programs. Additionally, new measures of supervisor practices, organizational, and broader systems-level influences on client outcomes are under development and are available to interested MST sites.

Successful programs require an economic environment that promotes the excellence of the services as well as the financial health of the provider organization. MST Services offers assistance to funding organizations to assure that funding structures are sufficient and the funder’s program requirements are compatible with MST program standards. Examples of this type of assistance include providing materials and technical assistance to help with developing practice standards, writing a Request for Proposals (RFP), and reviewing provider responses if requested. At the funding organization’s discretion, MST Services will provide technical assistance to organizations responding to funding RFP’s to assure that selected proposals contain the necessary elements and address or remove barriers to implementation.

MST Services assists interested programs in conducting a feasibility study at no cost to determine if MST is the best choice given the community needs and provider organization interests. Program development costs cover all activities that prepare the MST team to accept clients and initiate program operations. The cost of ongoing program support services is based on an all-inclusive annual per-team fee within provider organizations. Those organizations wishing to take on MST Services’ supporting role within their organization may be considered for Network Partner status. Consideration is based on the organization’s MST Program size and growth plan, its staff demonstrating high treatment fidelity and adherence to the MST model, its administration committing to execute the required quality assurance responsibilities, and their community stakeholders’ commitment to financially supporting this added element.

Training Certification Process

Administratively, training certification relationships are structured as a license agreement for MST between the Medical University of South Carolina (MUSC) and the provider/implementing organization/agency. MUSC holds the intellectual property rights to MST, and MST Services is the MUSC-affiliated organization that grants license agreements and provides program development and training services for MST worldwide. Certification, in the form of MST Licensure, is not available on an individual basis but is rather granted to an organization that is fully committed to supporting the adherent implementation through all levels of implementation, from staff selection, agency practices and policies, support of the model at the agency Executive level, and by championing the model as necessary with funding and referral sources across time as system-level issues put pressure on the agency and clinicians to modify practices in ways that may not be consistent with the MST model.

Brief Evaluation Methodology

Twenty-five evaluations of MST have been published, and 22 of these used randomized designs. The majority of these studies were conducted with serious juvenile offenders and juvenile offenders, including violent offenders, substance abusing offenders, and juvenile sex offenders. Multimethod (self-report, parent report, biological, and archival) assessment strategies have been used to examine the effects of the MST program on criminal behavior and incarceration, family relations, peer relations, psychiatric symptomatology, and drug use. Several randomized trials in the U.S. and Europe were conducted without direct oversight by the model developers. MST has also been adapted and tested for conditions other than delinquency, for instance, obesity, diabetes, child abuse and neglect, and serious emotional disturbances (these studies are written separately).

References

Borduin, C. M., Henggeler, S. W., Blaske, D. M., & Stain, R. J. (1990). Multisystemic treatment of adolescent sexual offenders. International Journal of Offender Therapy and Comparative Criminology, 35, 105-114.

Borduin, C. M., Mann, B. J., Cone, L. T., Henggeler, S. W., Fucci, B. R., Blaske, D. M. & Williams, R. A. (1995). Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence. Journal of Consulting and Clinical Psychology, 63, 569-578.

Borduin, C.M., Schaeffer, C.M. & Heiblum, N.  (2009).  A randomized clinical trial of Multisystemic Therapy with juvenile sexual offenders: Effects on youth social ecology and criminal activity. Journal of Consulting and Clinical Psychology, 77(1), 26-37.

Brown, T. L., Henggeler, S. W., Schoenwald, S. K., Brondino, M. J., & Pickrel, S. G. (1999). Multisystemic treatment of substance abusing and dependent juvenile delinquents: Effects on school attendance at posttreatment and 6-month follow-up. Children's Services: Social Policy, Research, and Practice, 2(2), 81-93.

Butler, S., Baruch, G., Hickey, N., & Fonagy, P. (2011). A randomized controlled trial of Multisystemic Therapy and a statutory therapeutic intervention for young offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 50(12), 1220-1235.

Camp, G. M. & Camp, C. G. (1993). The Corrections Yearbook. South Salem, N. Y.: Criminal Justice Institute.

Dekovic, M., Asscher, J. J., Manders, W. A., Prins, P. J. M., & van der Laan, P. (2012). Within-intervention change: Mediators of intervention effects during Multisystemic Therapy. Journal of Consulting and Clinical Psychology, 80(4), 574-587.

Fain, T., Greathouse, S. M., Turner, S. F., & Weinberg, H. D. (2014). Effectiveness of Multisystemic Therapy for minority youth: Outcomes over 8 years in Los Angeles County. Journal of Juvenile Justice, 3(2), 24-37.

Henggeler, S. W., Borduin, C. M., Melton, G. B., Mann, B. J., Smith, L. A., Hall, J. A., Cone, L., & Fucci, B. R. (1991). Effects of multisystemic therapy on drug use and abuse in serious juvenile offenders: A progress report from two outcome studies. Family Dynamics of Addiction Quarterly, 1(3), 40-51.

Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., & Pickrel, S. G. (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), 868-874.

Henggeler, S.W., Letourneau, E.J., Chapman, J.E., Borduin, C.M., Schewe, P.A., & McCart, M.R. (2009). Mediators of change for multisystemic therapy with juvenile sexual offenders. Journal of Consulting and Clinical Psychology, 77(3), 451-462.

Henggeler, S. W., Melton, G. B., Brondino, M. J., Scherer, D. G., & Hanley, J. H. (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, 821-833.

Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology6, 953-961.

Henggeler, S. W., Melton, G. B., Smith, L. A., Schoenwald, S. K., & Hanley, J. H. (1993). Family preservation using multisystemic treatment: Long-term followup to a clinical trial with serious juvenile offenders. Journal of Child and Family Studies, 2, 283-293.

Henggeler, S. W., Pickrel, S. G., & Brondino, M. J. (1999). Multisystemic treatment of substance-abusing and dependent delinquents: Outcomes, treatment fidelity, and transportability. Mental Health Services Research, 1(3), 171-184.

Henggeler, S. W., Rodick, J. D., Borduin, C. M., Hanson, C. L., Watson, S. M., & Urey, J. R. (1986). Multisystemic treatment of juvenile offenders: Effects on adolescent behavior and family interaction. Developmental Psychology, 22, 132-141.

Henggeler, S. W., Schoenwald, S .K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (1998). Multisystemic Treatment of Antisocial Behavior in Children and Adolescents. New York: Guilford.

Henggeler, S. W., Schoenwald, S .K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic therapy for antisocial behavior in children and adolescents (2nd ed.). New York: Guilford Press.

Huey, S.J., Henggeler, S.W., Brondino, M.J., & Pickrel, S.G. (2000). Mechanisms of change in multisystemic therapy: Reducing delinquent behavior through therapist adherence and improved family and peer functioning. Journal of Consulting and Clinical Psychology, 68(3), 451-467.

Leschied, A. & Cunningham, A. (2002). Seeking Effective Interventions for Serious Young Offenders: Interim Results of a Four-Year Randomized Study of Multisystemic Therapy in Ontario, Canada. London, Canada: Centre for Children and Families in the Justice System.

Letourneau, E.J., Henggeler, S.W., Borduin, C.M., Schewe, P.A., McCart, M.R., Chapman, J.E., & Saldana, L.  (2009).  Multisystemic Therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial. Journal of Family Psychology, 23(1), 89-102.

Ogden, T. & Halliday-Boykins, C. A. (2004). Multisystemic treatment of antisocial adolescents in Norway: Replication of clinical outcomes outside of the US. Child and Adolelscent Mental Health, 9(2), 77-83.

Ogden, T. & Hagen, K.A.  (2009).  What works for whom? Gender differences in intake characteristics and treatment outcomes following Multisystemic Therapy.  Journal of Adolescence, 32, 1425-1435.

Ogden, T. & Hagen, K.A.  (2006). Multisystemic Therapy of serious behaviour problems in youth: Sustainability of therapy effectiveness two years after intake. Journal of Child and Adolescent Mental Health, 11, 142-149.

Sawyer, A.M, & Borduin, C.M. (2011). Effects of Multisystemic Therapy through midlife: A 21.9-year follow-up to a randomized clinical trial with serious and violent juvenile offenders. Journal of Consulting and Clinical Psychology, 79(5), 643–652.

Schaeffer, C. M. & Borduin, C. M. (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), 445-453.

Schoenwald, S. K., Ward, D. M., Henggeler, S. W., Pickrel, S. G., & Patel, H. (1996). Multisystemic Therapy treatment of substance abusing or dependent adolescent offenders: Costs of reducing incarceration, inpatient, and residential placement. Journal of Child and Family Studies, 5(4), 431-444.

Timmons-Mitchell, J., Bender, M., Kishna, M.A., & Mitchell, C. (2006). An independent effectiveness trial of Multisystemic Therapy with juvenile justice youth. Journal of Clinical Child and Adolescent Psychology35(2), 227-236.

Wagner, D. V., Borduin, C. M., Sawyer, A. M., & Dopp, A. R. (2014). Long-Term Prevention of Criminality in Siblings of Serious and Violent Juvenile Offenders: A 25-Year Follow-Up to a Randomized Clinical Trial of Multisystemic Therapy. Journal of Consulting and Clinical Psychology, 82(3), 492-499.

Weiss, B., Han, S., Harris, V., Catron, T., Ngo, V. K., Caron, A., Gallop, R., & Guth, C. (2013). An independent randomized clinical trial of Multisystemic Therapy with non-court-referred adolescents with serious conduct problems. Journal of Consulting and Clinical Psychology, 81(6), 1027-1039.