Programs that Work

Multisystemic Therapy (MST)

Program Info

Outcome Areas

Healthy and Safe Children
Strong Families

Indicators

Children living in a permanent home
Children and youth not engaging in violent behavior or displaying serious conduct problems

Topic Areas

     Age of Child
       Adolescence
     Type of Service
       Family Support
       Parent Education
       Youth Development
     Type of Outcome Improved
       Juvenile Justice
       Physical Health
       Substance Abuse
       Violent Behavior

Evidence Level (What does this mean?)

Proven

Program Overview

Multisystemic Therapy (MST) is an intensive, family-based treatment approach for improving the antisocial behavior of serious juvenile offenders. MST seeks to reduce youth criminal activity and other kinds of negative behavior (for example, drug abuse) in a cost-effective manner by limiting the need for incarceration or other types of out-of-home placement.

Developed in the 1970s, the MST model is based on the belief that youth behavior is determined by multiple factors (such as characteristics of the youth, family relations, peer interactions, or community influences), and each of these factors can be targeted to promote positive behavioral change. Thus, depending on the youth’s individual circumstances, MST treatment may aim to improve a caregiver’s discipline practices, decrease the youth’s interaction with deviant peers, improve the youth’s school performance, or aim to produce other positive results.

MST treatment is conducted in natural settings (for example, in the youth’s home, school, or community) under the premise that youths and their families must learn how to function more effectively within their natural environment if they are to sustain improvements after treatment concludes. MST treatment typically lasts about four months, and involves several hours of contact per week.

Program Participants

MST targets juvenile offenders and their families. The targeted youth are chronic, violent, or substance abusing juvenile offenders at high risk of out-of-home placement.

Evaluation Methods

In one study (Henggeler, Melton, and Smith, 1992), 84 serious juveniles offenders and their families were randomly assigned to two groups: One group received MST and the other received the usual services provided by the local Department of Youth Services. Going into the study, the youths averaged 3.5 previous arrests and 9.5 prior weeks of incarceration. The youths lived in South Carolina; they had an average age of 15.2 years; 77 percent were male; and 56 percent were African-American, 42 percent were Caucasian, and 2 percent were Hispanic-American.

Before the treatment began, both groups completed a battery of tests evaluating family relations, self-reported delinquency, and other items. The same tests were given after treatment, approximately 13 weeks later. Fifty-six participants completed both tests and were included in the analysis of test results. (A separate analysis determined that attrition from the study did not affect the comparability of the two groups.) Fifty-nine weeks after the start of treatment, researchers examined arrest and incarceration records for all 84 youth to determine if there were differences between the two groups. Still later, in a follow-up study (Henggeler et al., 1993), researchers analyzed arrest data for the two groups, 2.4 years after initial treatment began.

In another study (Borduin et al., 1995), 176 serious juvenile offenders and their families were randomly assigned to two groups: One group received MST and the other received individual therapy. Going into the study, the youths averaged 4.2 previous arrests. The youths lived in Missouri; they had an average age of 14.8 years; 68 percent were male; and 70 percent were Caucasian and 30 percent were African-American.

Each group completed a battery of tests prior to and after treatment, approximately four months later. Of the original 176 participants, 126 completed the two sets of tests and were included in the analysis of test results. (A separate analysis determined that attrition from the study did not affect the comparability of the two groups.) Researchers also analyzed arrest data for all youths in the two groups, comparing differences four years after the study began. In a related analysis, the two groups were compared to see if there were differences in the number of substance-related arrests (Henggeler et al., 1991).

Key Evaluation Findings

Three related studies of serious juvenile offenders and their families (Henggeler et al., 1991, 1992 and 1993) found the following:

After 13 weeks of treatment
- MST youth reported significantly less peer aggression than did non-MST youth.
- MST youth reported significantly lower use of alcohol and marijuana than did non-MST youth.
- MST families showed significantly more family cohesion than did non-MST families.
Fifty-nine weeks after treatment began
- Significantly fewer MST participants had been arrested than had non-MST participants (42 percent versus 62 percent).
- MST participants had spent significantly fewer days in incarceration than had non-MST participants. Twenty percent of MST participants had been incarcerated, compared with 68 percent of non-MST participants.
Almost two-and-one-half years after treatment began, significantly fewer MST participants had been arrested than had non-MST participants (61 percent versus 80 percent).
MST proved just as effective with youths of different races, ages, genders, and levels of prior arrests or incarceration. It also was just as effective for youths with differing types of family relations, peer relations, or behavior problems.

Another set of studies of serious juvenile offenders and their families (Borduin et al., 1995; Henggeler et al., 1991) found the following:

After about four months of treatment, MST families reported significantly greater family cohesion and fewer youth behavior problems than did non-MST families.
Four years after treatment began
- Significantly fewer MST youths had been arrested compared with non-MST youths (26 percent versus 71 percent).
- Significantly fewer MST youths had been arrested for substance-related offenses compared with non-MST youths (4 percent versus 16 percent).
Among the youths that were arrested following treatment, those in the MST group were arrested for significantly fewer serious and violent crimes than were those in the non-MST group.
MST was equally effective with youths of different genders and ethnic backgrounds.

Probable Implementers

MST programs are typically housed within public mental health organizations, or in private provider organizations that offer mental health services. MST programs typically interact with multiple local agencies (for example, juvenile justice, mental health, and social welfare agencies), as well as with schools and family courts.

Funding

Funding for MST may come from a variety of sources, including Medicaid reimbursement, state children’s services funding, and state reimbursements to managed care organizations that treat emotionally disturbed youth.

A review of national research on MST (Aos et al., 1999) found that the average program cost is about $4,500 per MST participant (in 1998 dollars). Current community-based MST programs operate at a cost of about $6,000 to $7,000 per episode of treatment with the greatest cost variable being staff salaries that vary with geographic location.

Implementation Detail

Program Design

MST uses techniques from cognitive, behavioral, and family therapies. Each MST treatment plan is designed in collaboration with the youth’s family members, and is family-driven rather than therapist-driven. The overall objectives of MST treatment are to empower caregivers with the skills and resources they will need to address the inevitable difficulties associated with raising teenagers, and to empower youths with skills and resources for coping with family, peer, school, and neighborhood problems. Over the course of treatment, MST therapists place developmentally appropriate demands on the youths and family members so that they behave in an increasingly responsible manner.

Curriculum

MST does not have a prescribed or set curriculum.

Staffing and Training

Masters-level therapists, who work as full-time employees for the MST program, provide treatment. Each therapist carries a caseload of four to six families. The therapists are organized into “teams” of two to four; each team of therapists receives on-site supervision, usually by a Ph.D.-level mental health professional. MST therapists are required to track weekly progress and outcomes on each case by completing case paperwork and participating in clinical supervision and MST consultation.

Staff training and program development assistance are provided by MST Services, through licensing agreements with the Medical University of South Carolina and the Family Services Research Center. The core services for program development and training include the following:

Organizational assessment and assistance;
an initial five-day training session;
weekly MST clinical consultations;
quarterly “booster” training sessions; and
ongoing monitoring for treatment fidelity and adherence.

Issues to Consider

This program received a "proven" rating. Two rigorous studies found that MST was effective in reducing arrests and incarceration among serious juvenile offenders. Furthermore, positive outcomes were shown to persist for two to four years after treatment began. While the program founder was involved in all the major studies of MST, the research was conducted and reported according to high scientific standards.

Additional research has examined how MST performs with other populations, such as substance-abusing juvenile offenders (Henggeler et al., 1999a) or youths in psychiatric crisis (Henggeler et al., 1999b). These studies showed mixed results, suggesting that MST may need to be adapted if it is to serve populations with specific needs beyond those of “typical” juvenile offenders.

Other research has investigated MST’s effectiveness when delivered under less closely supervised conditions (Henggeler et al., 1997). Again, the results were mixed, suggesting that adherence to strict MST protocols (including regular, expert supervision) may be key to program success. These less-favorable studies do not take away from the demonstrated success of MST when delivered under standard protocols and with serious juvenile offenders. Rather, these later studies indicate the difficulties programs may face as they attempt to extend their interventions to new populations or implement their interventions with less fidelity to initial program design.

Example Sites

MST programs operate in 30 states, and in 7 countries outside of the USA including Canada, Norway, New Zealand, England, Northern Ireland, Sweden, and Denmark. All licensed sites are listed on MST's website: www.mstservices.com.

Contact Information

For further information about program development, treatment model dissemination, and training, contact:

Marshall E. Swenson, MSW, MBA
Vice President, New Program Development
MST Services
710 Johnnie Dodds Blvd., Suite 200
Mt. Pleasant, SC 29464
Tel: 843-856-8226, ext. 215
Direct: 843-284-2215
Fax: 843-856-8227
Email: marshall.swenson@mstservices.com

For further information about research-related issues, contact:
Dr. Scott W. Henggeler
Family Services Research Center
Department of Psychiatry and Behavioral Sciences
Medical University of South Carolina
171 Ashley Avenue
Charleston, SC 29425-0742
phone: (843) 876-1800
Fax: (843) 876-1808

Available Resources

For general information on MST program design, training, research, and publications, see the MST Services website: www.mstservices.com.

Bibliography

Aos, S., P. Phipps, R. Barnoski, and R. Lieb   The Comparative Costs and Benefits of Programs to Reduce Crime   Olympia, WA: Washington State Institute for Public Policy, Version 3.0, May 1999. http://www.wa.gov/wsipp/crime/pdf/costbenefit.pdf

Borduin, C., B. Mann, L. Cone, S. Henggeler, B. Fucci, D. Blaske, and R. Williams   “Multisystemic Treatment of Serious Juvenile Offenders: Long-Term Prevention of Criminality and Violence,”   Journal of Consulting and Clinical Psychology, Vol. 63, No. 4, 1995, pp. 569-578.

Henggeler, S., C. Borduin, G. Melton, B. Mann, L. Smith, J. Hall, L. Cone, and B. Fucci,    “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, Vol. 1, No. 3, 1991, pp. 40-51.

Henggeler, S., G. Melton, M. Brondino, D. Scherer, and J. Hanley,   “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, Vol. 65, No. 5, 1997, pp. 821-833.

Henggeler, S., M. Rowland, J. Randall, D. Ward, S. Pickrel, P. Cunningham, J. Zealberg, L. Hand, A. Santos, S. Miller, and J. Edward,   “Home-Based Multisystemic Therapy as an Alternative to the Hospitalization of Youths in Psychiatric Crisis: Clinical Outcomes,”   Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 38, No. 11, 1999b, pp. 1331-1339.

Last Reviewed

April 2004

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