Multisystemic Therapy

Multisystemic Therapy (MST) is an intensive, family-centered, community-based practice model successfully applied and tested with diverse racial, ethnic, and socioeconomic groups. MST initially focused on eliminating the antisocial behaviors of juvenile offenders aged 12 to 17. After 30 years and over 18 experimental studies, MST demonstrated that it can reduce costly, less effective out-of-home placements by as much as 50 percent, and rearrest rates by as much as 70 percent. It improves school attendance and performance, as well as psychiatric symptoms, and diminishes or eliminates substance use. Because frequent family, school, and community contacts and activities are required, clinicians work with four to seven families at a time. Model-pertinent case-specific assessment and planning documents from these efforts are updated weekly and shared with the MST supervisor, who uses these data to plan weekly coaching of a team of clinicians. This structured quality assurance greatly contributes to MST's ability to achieve targeted outcomes, usually within four to six months.

MST assessment and interventions are specifically anchored in ecological systems theory. Interactions within and between the family, school, the youth's peers, and the community may support or constrain prosocial behavior, or may maintain antisocial behaviors. With the youth and family caregivers, MST clinicians identify proximal contributing factors in multiple systems that maintain behaviors of concern. Together, They draw fit circle assessments. At the center of the circle is a well-defined (including frequency, duration, and intensity) behavior of concern. Thorough consideration of interactions within and between the family, school, the youth's peers, and the community identifies contributing factors that may maintain that behavior. These factors are drawn outside the circle with directional arrows, indicating if They shape other contributing factors and the behavior of concern. Problem fit circles serve as a map for designing interventions to eliminate specific contributing factors. Assessment and interventions are carefully designed and closely monitored by MST supervisors and consultants for fidelity to theory-based principles.

An assessment is made to understand the “fit” between identified problems and key factors from other systems shaping youth behavior. A similar assessment of the fit of the youth's successes also helps guide the treatment process. MST therapists use strengths from the youth's environment as levers for positive change. Focusing on family strengths has numerous advantages such as building on strategies that the family already knows how to use, creating a sense of hope, identifying protective factors, decreasing frustration by emphasizing problem solving, and enhancing caregivers’ confidence. Interventions are designed to promote responsible behavior and decrease irresponsible actions by family members. Interventions address what's happening now in the delinquent's life. Therapists look for action that can be immediately taken, targeting specific, well-defined problems. Such interventions enable participants to track the progress of treatment and provide clear criteria to measure success. family members are expected to actively work toward goals by focusing on present-oriented solutions versus gaining insight or focusing on the past. When the goals are met, the treatment can end.

Interventions target sequences of behavior within and between the various interacting elements of the adolescent's life—family, teachers, friends, home, school and community—that sustain the identified problems. Interventions are designed to be appropriate to the youth's age and to fit their developmental needs. A developmental emphasis stresses building the adolescent's ability to get along well with peers and to acquire academic and vocational skills that will promote a successful transition to adulthood. Interventions require daily or weekly effort by family. Intensive, multifaceted change efforts support more rapid problem resolution, earlier [Page 902]identification of when interventions need fine-tuning, continuous evaluation of outcomes, more frequent corrective interventions, and more opportunities for family members to experience the success that They orchestrated. Intervention effectiveness is continuously evaluated from multiple perspectives with MST team members held accountable for overcoming barriers to successful outcomes. MST does not label families as “resistant, not ready for change or unmotivated.” This approach avoids blaming the family and places the responsibility for positive treatment outcomes on the MST team. Interventions are designed to invest the caregivers with the ability to address the family's needs after the intervention is over. The caregiver is viewed as the key to long-term success. family members drive the change process in collaboration with the MST therapist.

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