Week 5: Treatment of DBD (MST)

Question 1

Multisystemic Therapy

Answer 1

 Serious clinical problems result from the interplay of multiple factors
-Children (could be genetically predisposed)
-Parent
-Neighborhood (gangs etc)
-School
-Probation
 Caregivers are key to positive long-term outcomes for youth
-Sustainability (they will be there after therapy is done)
 Integration of evidence-based practice
 Problem solving skills training
 Parent management training
 Change global reinforcement context
 Association with deviant peers
 Intensive services that overcome barriers to service access
 Therapist available 24/7
 Services in home and directly other settings
 Typically 4 months of treatment

Question 2

MST Evidence Ideas

Answer 2

 MST has been tested with youth presenting a wide range of problems
-Chronic and violent juvenile offenders
-Substance using juvenile offenders
-Youth in psychiatric crisis
 MST has been shown to improve important variables
-Statistical versus clinical significance - just saying two groups are different does not really explain if these differences are meaningful
-Functional outcomes - these show actual improvements

Question 3

MST Evidence study

Answer 3

 Participants
 176 youth enrolled
 Ages 12 to 17 years
 68% male
 Court-referred
 At least 2 prior arrests
 Mean of 4 prior arrests

 Design
 Random assignment
 Two groups
 MST
 Individual therapy
 Mean of 24 hours of treatment
 Assessed for 4 years

Question 4

MST Evidence results

Answer 4

 MST youth arrested for less serious crimes
 MST youth less likely to be arrested for violent crimes
 Statistically significant differences
 Clinically significant differences

Question 5

MST Costs

Answer 5

 Estimated cost for an average participant in MST is $4743
 $87, 961 for one year in a residential juvenile detention facility
 United States spends $15 million a day to keep juvenile offenders incarcerated

Question 6

MST: Mechanisms of Action

Answer 6

 How does MST work?
 Mediators of treatment
 Recall that a mediator is a variable that explains the association
between A and B

Question 7

MST: Mediators of Treatment

Answer 7

 Before treatment measured
-Family functioning
-Delinquent peer affiliation
-Delinquent behavior
 During treatment measured
-MST adherance
-Extent to which therapists were engaged in behaviors consistent with MST
-Higher adherence = higher “dose” of MST
 After treatment measured
-Family functioning
-Delinquent peer affiliation
-Delinquent behavior

Question 8

MST: Mediators of Treatment results

Answer 8

 Adherence to treatment is associated with changes in family functioning
 Changes in family functioning and delinquent peer affiliations are responsible for at least some of the change in delinquent behavior

Changes in family function mediate the relationship between MST adherence and the drop in delinquent behavior

Mostly works by improving family fx