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Multisystemic Therapy (MST) typically uses a home-based model of service delivery to reduce barriers that keep families from accessing services (Heneggeler, Schoenwald, Bordiun, Rowland, and Cunningham, 1998). Therapists have small caseloads of four to six families; work as a team; are available 24 hours a day, 7 days a week; and provide services at times convenient to the family. The average treatment involves about 60 hours of contact during a 4-month period. MST therapists concentrate on empowering parents and improving their effectiveness by identifying strengths and developing natural support systems (e.g., extended family, neighbors, friends, church members) and removing barriers (e.g., parental substance abuse, high stress, poor relationships between partners). Specific treatment techniques used to facilitate these gains are integrated from those therapies that have the most empirical support, including behavioral, cognitive-behavioral, and the pragmatic family therapies. This family–therapist collaboration allows the family to take the lead in setting treatment goals as the therapist helps them to accomplish their goals.
The first controlled study of Multisystemic Therapy with juvenile offenders (Henggeler et al., 1986) evaluated the effectiveness of MST compared with usual community treatment for innercity juvenile offenders and their families. The study’s success led to several randomized trials and quasi-experimental studies aimed at extending the effectiveness of MST to other populations of youths who presented serious clinical problems and their families.
The National Institute of Mental Health–funded Simpsonville, S.C., study (Henggeler et al., 1992; Henggeler et al., 1993) examined MST as an alternative to the incarceration of violent and chronic juvenile offenders. The primary goals of the project were to decrease criminal activity, out-of-home placements, and cost of services. The project included 84 violent and chronic juvenile offenders, of whom 54 percent had been arrested for violent crimes. Their mean number of arrests was 3.5, and they averaged 9½ weeks of prior placement in correctional facilities. The average age of the youths was 15.2 years, and 77 percent were male. The average Hollingshead social class score was 25. Twenty-six percent lived with neither biological parent. Fifty-six percent were African-American, with the remainder white. Youths were assigned randomly to receive MST, using the family preservation model of service delivery (MST; n=43) or usual services provided by the South Carolina Department of Juvenile Justice (n=41). The average duration of treatment was 13 weeks. Assessment batteries, consisting of standardized measurement instruments, were administered pretreatment and posttreatment.
In the most comprehensive and extensive completed evaluation of MST to date (Borduin et al., 1995), the effectiveness of MST was compared with individual therapy (IT). Participants (n=200) were 12- to 17-year-old juvenile offenders and their families, referred from the local Department of Juvenile Justice office and randomly assigned to receive either MST (n=92) or IT (n=84). Twenty-four families refused services. The juvenile offenders were involved in extensive criminal activity as evidenced by their average of 4.2 previous arrests and the fact that 63 percent had been incarcerated previously. The average age of the youths was 14.8 years, with 67 percent male. Seventy percent were white, 30 percent African-American. Sixty-five percent were from families characterized by low socioeconomic class, and 53 percent lived with two parental figures. Standardized assessment batteries were conducted at pretreatment and posttreatment.
The transport of MST programs to community settings began in the mid 1990s and provided an opportunity for independent evaluations of the effectiveness of MST in treating adolescent antisocial behavior, and two of these replications have been published. Ogden and his colleagues (2004) directed a 4-site randomized trial in which participants were 100 seriously antisocial adolescents in Norway (Norway does not have a juvenile justice system). The youths were randomized to MST versus usual Child Welfare Services conditions. In the Unites States, Timmons-Mitchell and her colleagues (2006) have also provided an independent replication of MST effectiveness with juvenile offenders in community settings. Ninety-three juvenile offenders were randomized to MST versus treatment as usual services.
The results of the Simpsonville study showed that MST was effective at reducing rates of criminal activity and institutionalization. At the 59-week postreferral follow-up, youths receiving MST had significantly fewer re-arrests and weeks incarcerated than did youths receiving usual services. At posttreatment, youths receiving MST reported a significantly greater reduction in criminal activity than did youths receiving usual services. Families receiving MST reported more cohesion, whereas reported family cohesion decreased in the usual services condition. Further, families receiving MST reported decreased adolescent aggression with peers, while such aggression remained the same for youths receiving usual services. Significantly, the relative effectiveness of MST was not moderated by demographic characteristics (e.g., race, age, social class, gender, and arrest and incarceration history). Similarly, preexisting problems in family relations, peer relations, social competence, behavior problems, and parental symptomatology were not differentially predictive of outcomes. Moreover, a 2.4-year follow-up (Henggeler et al., 1993) showed that MST doubled the percentage of youths who did not recidivate, in comparison with usual services.
In the second study, families receiving MST reported and evidenced more positive changes in their dyadic family interactions than did IT families at posttreatment. For example, MST families reported increased cohesion and adaptability and showed increased supportiveness and decreased conflict–hostility during family discussions, in comparison with IT families. Most important, results from a 4-year follow-up of recidivism showed that youths who received MST were significantly less likely to be rearrested than youths who received individual therapy. MST completers (n=77) had lower recidivism rates (22.1 percent) than MST dropouts (46.6 percent; n=15), IT completers (71.4 percent; n=63), IT dropouts (71.4 percent; n=21), and treatment refusers (87.5 percent; n=24). Moreover, MST dropouts were at lower risk of rearrest than IT completers, IT dropouts, and refusers. In addition, MST youths were less likely to be arrested for violent crimes (e.g., rape, attempted rape, sexual assault, aggravated assault, assault/battery) following treatment than were IT youths. Neither adolescent age, race, social class, gender, nor pretreatment arrest history moderated the effectiveness of MST. Finally, an almost 14-year follow-up (Schaeffer and Borduin, 2005) showed that MST participants had 54 percent fewer arrests and spent 57 percent fewer days of confinement in adult detention facilities than did their IT counterparts. This differential in recidivism applied across violent, drug, and nonviolent offenses.
The Norway transportability study’s short-term outcomes at 6 months post recruitment showed that MST was significantly more effective at reducing youth internalizing and externalizing symptoms and out-of-home placement as well as increasing youth and social competence and family satisfaction with treatment (Ogden and Halliday–Boykins, 2004). Significantly, analyses demonstrated differential site effects—the onsite with problematic adherence to the MST intervention protocols had the worst outcomes. In addition, a 2-year follow-up has shown that MST effect on out-of-home placements and youth internalizing and externalizing problems were maintained (Ogden and Hagen, 2006). At 6 months post recruitment in the USA transportability study (Timmons–Mitchell, Bender, Kishna, and Mitchell, 2006), youths in the MST condition evidenced significantly improved functioning in several different areas, and had fewer arrests at 18-month follow-up than counterparts who received usual juvenile justice services. These results provide further support for the capacity of MST to achieve favorable outcomes when implemented with fidelity in community practice settings.
In summary, across several trials with violent and chronic juvenile offenders, MST produced 25 percent to 70 percent decreases in long-term rates of re-arrest, and 47 percent to 64 percent decreases in long-term rates of days in out-of-home placements. A recent meta-analysis that included most of these studies (Curtis, Ronan, and Borduin, 2004) indicated that the average MST effect size for both arrests and days incarcerated was .55, with efficacy studies having stronger effects than effectiveness studies.
Borduin, Charles M., Barton J. Mann, Lynn T. Cone, Scott W. Henggeler, Bethany R. Fucci, David M. Blaske, and Robert A. Williams. 1995. “Multisystemic Treatment of Serious Juvenile Offenders: Long-Term Prevention of Criminality and Violence.” Journal of Consulting and Clinical Psychology 63(4):569–78.
Curtis, Nicola M., and Kevin R. Ronan. 2004. “Multisystemic Treatment: A Meta-Analysis of Outcome Studies.” Journal of Family Psychology 18(3):411–19.
Henggeler, Scott W. 1997. “Treating Serious Antisocial Behavior in Youth: The MST approach.” Juvenile Justice Bulletin. Washington, DC: Office of Juvenile Justice and Delinquency Prevention.
Henggeler, Scott W., W. Glenn Clingempeel, Michael J. Brondino, and Susan G. Pickrel. 2002. “Four-Year Follow-Up of Multisystemic Therapy With Substance-Abusing and Substance-Dependent Juvenile Offenders. Journal of the American Academy of Child and Adolescent Psychiatry 41(7):868–74.
Henggeler, Scott W., Phillippe B. Cunningham, Susan G. Pickrel, Sonja K. Schoenwald, and Michael J. Brondino. 1996. “Multisystemic Therapy: An Effective Violence Prevention Approach for Serious Juvenile Offenders.” Journal of Adolescence 19(1):47–61.
Henggeler, Scott W., Gary B. Melton, Michael J. Brondino, David G. Scherer, and Jerome H. Hanley. 1997. “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 65(5):821–33.
Henggeler, Scott W., Gary B. Melton, and Linda A. Smith. 1992. “Family Preservation Using Multisystemic Therapy: An Effective Alternative to Incarcerating Serious Juvenile Offenders.” Journal of Consulting and Clinical Psychology 60(6):953–61.
Henggeler, Scott W., Gary B. Melton, Linda A. Smith, Sonja K. Schoenwald, and Jerome H. Hanley. 1993. “Family Preservation Using Multisystemic Treatment: Long-Term Follow-Up to a Clinical Trial With Serious Juvenile Offenders.” Journal of Child and Family Studies 2:283–93.
Henggeler, Scott W., Sharon F. Mihalic, Lee Rone, Christopher R. Thomas, and Jane Timmons–Mitchell. 1998. Blueprints For Violence Prevention, Book 6: Multisystemic Therapy. Boulder, Colo.: Center for the Study and Prevention of Violence.
Henggeler, Scott W., J. Douglas Rodick, Charles M. Borduin, Cindy L. Hanson, Sylvia M. Watson, and Jon R. Urey. 1986. “Multisystemic Treatment of Juvenile Offenders: Effects on Adolescent Behavior and Family Interactions.” Development Psychology 22(1):132–41.
Marshall E. Swenson
MST Services
710 J. Dodds Boulevard
Mount Pleasant, SC 29464
Phone: (843) 856-8226
Fax: (843) 856-8227
E-mail: marshall.swenson@mstservices.com
Web site: http://www.mstservices.com
