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Multisystemic Therapy

Description of the Strategy

Multisystemic therapy (MST) is a familyand community-based treatment of serious emotional and behavioral problems presented by adolescents. The development of this model began in the late 1970s, and today MST is a leading evidence-based treatment of serious antisocial behavior in youths, with programs transported to more than 30 states and 8 nations. This entry presents the keys to the effective outcomes achieved in randomized trials of MST, a summary of those outcomes, and the current thrust of MST-related research and dissemination efforts.

Several processes are critical to the success of MST.

Addresses Known Determinants of Problems

A wealth of longitudinal and correlational research has shown that serious antisocial behavior in adolescents (e.g., violence, substance abuse, criminal activity) is multidetermined. These influences can be conceptualized within a social-ecological conceptual framework. That is, antisocial behavior is influenced by the interplay of youth characteristics (e.g., cognitive skills, attitudes toward antisocial behavior) and aspects of the multiple systems in which the youth is embedded. The main systems and their influences include the family (e.g., discipline strategies, affective relations, parental psychopathology), peers (e.g., support of antisocial behavior), school (e.g., academic and social climates), family social network (e.g., social support, isolation), and neighborhood (e.g., criminal subculture).

A central clinical task of the MST therapist is to conduct a broad-based functional analysis to determine the most proximal predictors of the presenting problems identified by the family and other stakeholders (e.g., juvenile justice authorities, school officials). This analysis serves as the basis for initial clinical decision making. Thus, for example, if the main reason that a youth is able to steal cars at 2:00 A.M. with his friends is that his single-parent mother works a night shift or has a drug problem that compromises her ability to provide effective monitoring, the therapist might focus his or her attention on bringing additional monitoring resources (e.g., extended family) into the family and providing evidence-based substance abuse treatment for the parent. Subsequently, it would also be necessary to develop family-based strategies that disengage youths from deviant peers while supporting involvement with prosocial peer activities. Extensive descriptions of these and other MST-related intervention strategies are provided in published treatment manuals.

Provides Treatment Where the Problems Occur

MST programs use a home-based model of service delivery, and this model has several important features that contribute to favorable clinical outcomes and very high rates of treatment completion. First, therapists have caseloads of only four to six families per therapist, which allows the provision of intensive services needed to prevent expensive out-of-home placements. Second, to overcome barriers to service access (i.e., families of antisocial youths have high no-show rates for clinic-based services), therapists provide treatment in the home and other community locations (e.g., school). Third, conducting clinical assessments in the home provides more valid information for clinical decision making and for outcome measurement. Fourth, the provision of home-based services facilitates the treatment engagement process. And fifth, the thorny issue of treatment generalization is largely negated when changes are made where the actual problems have emerged.

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