Multi-Systemic Therapy

Question 1

Underlying Theory

Answer 1

• A combinations of factors linked with serious anti social behaviour
• individual
• family
• peer
• school
• neighbourhood
• The scope of MST interventions is not limited to the individual adolescent or family

Question 2

Practice context

Answer 2

• Intensive family and community based treatment program that focuses on addressing all the environmental systems that impact chronic and violent juvenile offenders

Question 3

Techniques and Strategies

Answer 3

• MST therapists aim to:
  • work intensively with parents or carers to empower them with the tools and resources to manage the young person’s behaviours;
  • increase young people’s engagement with and success in education and training;
  • promote positive activities for parent and young person• reduce young people’s offending and/or anti-social behaviour;
  • improve family relationships
  • tackle underlying problems in the young person or parent, including substance misuse.

Question 4

Applications

Answer 4

• Multisystemic Therapy (MST) is an intensive family and community-based treatment program that focuses on addressing all environmental systems that impact chronic and violent juvenile offenders – their homes and families, schools and teachers, neighborhoods and friends.
• MST recognizes that each system plays a critical role in a youth’s world and each system requires attention when effective change is needed to improve the quality of life for youth and their families. MST works with the toughest offenders ages 12 through 17 who have a very long history of arrests.
  • MST clinicians go to where the child is and are on call 24 hours a day, seven days a week
  • They work intensively with parents and caregivers to put them in control
  • The therapist works with the caregivers to keep the adolescent focused on school and gaining job skills
  • The therapist and caregivers introduce the youth to sports and recreational activities as an alternative to hanging out

Question 5

Evidence Base

Answer 5

• Proven long-term effectiveness through rigorous scientific evaluations MST is a well-validated treatment model (Kazdin & Weisz, 1998) with 16 published outcome studies (14 randomized, two quasi-experimental)
• Studies with violent and chronic juvenile offenders showed that MST reduced long-term rates of rearrest by 25 percent to 70 percent compared with control groups.

• Studies with long-term follow-ups showed that MST reduced days in out-of-home placements by 47 percent to 64 percent compared with control groups.

• Findings from across the UKResearch and audit data from the MST teams based across the UK shows that it is possible to replicate these positive results and that MST:
  • Keeps children in their homes – 90% of young people remain at home
  • Keep children in school - 75% are in school or working• Keep children out of trouble - 82% have no new criminal charges

Question 6

Effectiveness of MST for anti social youths

Answer 6

Curtis, Ronan and Borduin 2004

• Results indicated that across different presenting problems and samples, the average effect of MST was d = .55; following treatment, youths and their families treated with MST were functioning better than 70% of youths and families treated alternatively.
• Results also showed that the average effect of MST was larger in studies involving graduate student therapists (i.e., efficacy studies; d = .81) than in studies with therapists from the community (i.e., effectiveness studies; d = .26).
• In addition, MST demonstrated larger effects on measures of family relations than on measures of individual adjustment or peer relations.

Question 7

MST for Conduct Disorder

Answer 7

Eyberg et al (2008)

• No single intervention emerged as superior for disruptive behaviours. However, multi-systemic therapy (combination of CBT, family therapy and pharmacotherapy) has a significant evidence base.

                          Curtis et al (2004)

• Outcomes for multisystemic treatment were significantly better for 70% of adolescents and their families when compared to those receiving alternative treatment.
• Positive effects sustained for up to 4 years

Question 8

MST for substance abuse

Answer 8

Vaughn (2004)

• Multisystemic therapy combined of CBT and family therapy very effective for addictive substance abuse

                         Liddle (2004)

• Research suggest family based multisystemic therapy leads to most reductions in alcohol and drug use and related family problems