Multisystemic Therapy® (MST®)
- Close Relationships with Parents
- Delinquency and Criminal Behavior
- Illicit Drug Use
- Mental Health - Other
- Positive Social/Prosocial Behavior
- Family Therapy
- Juvenile Justice, Other
- Juvenile Justice Setting
- Mental Health/Treatment Center
- Social Services
- Transitional Between Contexts
Continuum of Intervention
- Indicated Prevention (Early Symptoms of Problem)
- Early Adolescence (12-14) - Middle School
- Late Adolescence (15-18) - High School
- Male and Female
- All Race/Ethnicity
- : Effective
- : Model
- : Effective
- : 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
www.mstservices.com or www.mstinstitute.org
- 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
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.
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.
Norweigian 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.
Program Effects on Risk and Protective Factors:
- Significantly greater family cohesion and contact with nonaggressive peers (Simpsonville, SC study).
- Improvements in family relations (increased cohesion and adaptability) and family interactions (increased supportiveness and decreased conflict/hostility) (Columbia, MO study; Borduin et al., 1995)
- Decreased psychiatric symptomatology in parents (Columbia, MO study; Weiss et al., 2013).
- A sustained increase in the percentage of adolescents in school through the 6-month follow-up (Charleston, SC study).
- Significantly better parent reports of family adaptability and caregiver depression (Canada study).
- Increased youth social competence (Norwegian study).
- Increases in positive parenting at posttest (London study) and decreases in permissive parenting (Weiss et al., 2013).
- Improvements in parental sense of competence during MST led to positive changes in parenting and improved child behavior (Dutch study, (Dekovic et al., 2012).
- Los Angeles area MST youth improved parenting skills, family relations, network of social supports, educational/vocational success, and involvement with prosocial peers from pre- to post-test (Fain et al., 2014).
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
- 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
- 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
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).
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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.
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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.
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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.