Mutlisystemic Therapy
Multisystemic therapy (MST) is a family- and community-based treatment system devised address and treat the factors within a juvenile's family, peer and school networks which encourage that individual to commit offensive acts. MST relies on decades of research to address the known determinants of serious antisocial behavior in youths. Compared to usual juvenile justice services, MST results in significantly reduced rates of incarceration and rearrest among violent and chronic juvenile offenders.
MST takes the view that individuals function within a complex nest of interconnected systems
encompassing:
Intervention in one or more of these areas may be necessary to modify the juvenile's behavior. A crucial aspect of MST is that it promotes behavior change within the youth's natural environment. Specific strengths and weaknesses vary widely for delinquent and substance-abusing youths and their families. Each typically demonstrates several problem areas. MST also takes into consideration the individual's childhood development background.
Intervention in one or more of these areas may be necessary to modify the juvenile’s behavior. A crucial aspect of MST is that it promotes behavior change within the youth’s natural environment. Specific strengths and weaknesses vary widely for delinquent and substance-abusing youths and their families. Each typically demonstrates several problem areas. MST also takes into consideration the individual’s childhood development background.
1. Parent and caregiver participation is critical to obtain favorable long-term outcomes. MST spends a lot of time and effort to help parents increase their ability to monitor and discipline their children effectively while providing a supportive emotional context. As such, parents must overcome any personal barriers they might have, such as their own drug abuse or psychiatric problems, that could hinder the child’s recovery. Parents need to develop their skills and their social resources, like the support of extended family, neighbors, friends and church members, to become effective parents.
2. As parents become more effective, MST therapists help them design interventions to decrease their youth’s involvement with delinquents and drugs. At times, they may decrease involvement with less desirable peers by establishing sanctions. They may increase involvement with prosocial peers by building youth skills and providing opportunities for them to participate in activities like sports, clubs, church youth groups or community service organizations.
3. Similarly, with the aid of the therapist, parents learn to establish more cooperative relationships between themselves, teachers and other school personnel. Thus, parents learn to collaborate with school personnel and to restructure the home environment in ways that support educational attainments.
4. To maintain treatment gains, MST devotes considerable energy to helping parents identify and build indigenous support systems. Emphasis is placed on developing informal networks comprised of friends, family, neighbors, church and so forth, rather than on formal support systems like those provided by state agencies. Formal supports should become a consideration only after all other indigenous supports have failed.
In all published studies to date, the Family Preservation Model of Service Delivery has provided multisystemic therapy. Family preservation is a model of service delivery based on the philosophy that the most effective and ethical route to helping children and youths is through helping their families. Findings indicate that employing family preservation methods is more effective than usual services at reducing long-term rates of criminal behavior, and costs less.
While particular treatment modalities used in family preservation programs vary, they all share critical service delivery characteristics. Characteristics of this model include:
Sessions rarely last more than 90 minutes and may last as few as 15 minutes. Depending upon the stage of treatment and extant crises, sessions may occur every day or as infrequently as once a week. These sessions usually take place in the family’s home at a convenient time, although meetings in a community location (e.g., school, recreation centers, project office) are often needed. This method along with the program philosophy of MST provides several significant advantages over traditional mental health practices.
MST has achieved favorable long-term outcomes and cost savings in several recent studies with violent and chronic juvenile offenders and with substance abusing and dependent juvenile offenders. A four-year follow-up by C. M. Borduin demonstrated that MST, in comparison with individual therapy, significantly reduced violent, drug-related and other criminal incidents among chronic juvenile offenders. In another study, funded by the National Institute of Mental Health (NIMH), MST essentially doubled the percentage of youths who remained arrest-free at the time of their long-term follow-up. Similarly, Henggeler showed that MST, in comparison with usual juvenile justice services, significantly reduced rates of incarceration and rearrest among violent and chronic juvenile offenders.
MST programs assume accountability for drawing families into the treatment process and for the outcome. This accountability plays a critical role in the high treatment-completion rates obtained in MST programs and in favorable outcomes. Moreover, as much as possible, incentives are provided to program staff who meet performance criteria.
In order to hold providers accountable for outcomes, they need clinical and supervisory resources necessary to accomplish treatment objectives. Hence, training, supervision and ongoing consultation are essential aspects of quality control in MST programs.
Scott W. Henggeler is the director of the Family Services Research Center and a professor at the Medical University of South Carolina. MST treatment programs, currently in 12 states and Canada, are developed in collaboration with MST Services Inc. of Charleston, S.C. For more information, contact Keller Strother by e-mail: mst@sprintmail.com or by phone: 803/853-8300.