The Multisystemic Therapy–Family Integrated Transitions (MST–FIT) program provides integrated individual and family services to juvenile offenders who have co-occurring mental health and chemical dependency disorders. Services are provided during a juvenile’s transition from incarceration back into the community. The overall goal of MST–FIT is to provide necessary treatment to youth, thereby reducing recidivism. The program also seeks to connect youth and their families to appropriate community supports, achieve youth abstinence from alcohol and other drugs, improve youth mental health, and increase youth prosocial behavior.
The program was developed after the Washington State Legislature initiated a pilot rehabilitation program for juvenile offenders with co-occurring substance abuse and mental health disorders who had received sentences to enter a state Juvenile Rehabilitation Administration (JRA) institution.
To be eligible to participate in MST–FIT, a youth must meet the following criteria:
- The youth must be younger than 17 ½ years old.
- The youth must be in a JRA institution and scheduled to be released to 4 or more months of parole/supervision.
- The youth must have a substance abuse or dependence disorder and any of the following: any Axis 1 disorder, currently prescribed psychotropic medication, or demonstrated suicidal behavior within the past 3 months.
Youth must also reside in King, Pierce, Snohomish, Kitsap, Thurston, Mason, Yakima, Benton, or Kittitas counties, where the MST–FIT program is currently available.
The MST–FIT program begins in a youth’s final 2 months in a residential facility and continues for 4 to 6 months during parole supervision. MST–FIT is based on components of three programs: Multisystemic Therapy (MST), Dialectical Behavior Therapy (DBT), and Motivational Enhancement Therapy (MET). The overarching framework of the program is derived from MST, a family-based preservation model for community-based treatment. MST provides the foundation of the intervention, while the other intervention strategies are delivered within the MST framework. MST tailors treatment goals to a youth’s individual risk and protective factors within his or her natural environment (i.e., family, school, and community). This treatment component uses therapists to coach caregivers in establishing productive partnerships with schools, community supports, parole, and other systems, and to help caregivers develop skills to be effective advocates for those in their care.
Although the MST component concentrates on the extent to which the youth’s surrounding environments support prosocial behavior, MST–FIT incorporates elements of DBT to address individual-level characteristics in both youth and caregivers by replacing maladaptive emotional and behavioral responses with more effective and skillful responses. The skills training component of DBT targets emotional dysregulation that underlies problems youth with co-occurring disorders have, such as anger, impulse control, and moodiness. Throughout the intervention, coaches look for opportunities to encourage youth to apply the skills they learn in real-world settings.
Finally, MST–FIT uses aspects of MET to engage youths and their families in treatment, with the objective of increasing their commitment to change. MST–FIT therapists use MET techniques to develop the initial engagement of all parties and to maintain their commitment throughout treatment.
Relapse prevention/community reinforcement is also used to increase the youth's and family’s awareness of issues such as substance use and high-risk situations. A range of effective coping strategies are provided, and a plan is established for youth to resume treatment, should they relapse.
The MST–FIT team consists of contracted therapists with backgrounds in children’s mental health, family therapy, and chemical dependency. The team serves four to six families at any given time. Service delivery occurs in the families’ homes and communities, and services are available 24 hours a day, 7 days a week.
12 to 19
Overall, Trupin and colleagues (2011) found mixed results. Results showed that Multisystemic Therapy–Family Integrated Transitions (MST–FIT) had a significant effect on felony recidivism at 36 months postrelease. However, the MST–FIT intervention did not appear to have a significant effect on overall recidivism (misdemeanor and felony), misdemeanor recidivism, and violent felony recidivism.
Of the entire sample of study participants, 78 percent had some type of recidivism. However, the MST–FIT intervention did not have a significant impact on overall recidivism (misdemeanor or felony).
Fifty-eight percent of the entire sample had a felony by the time of the follow-up. At 36 months post-release, the MST–FIT intervention was significantly associated with a lower risk of felony recidivism. The hazard ratio (0.70) indicated the hazard of recidivism for youths in the MST–FIT treatment group was 30 percent lower than it was for youths in the control group.
Violent Felony Recidivism
Violent felony recidivism was less common. Only 28 percent of the entire sample had a violent felony at the time of follow-up. However, the MST–FIT intervention did not have an impact on violent felony recidivism.
Misdemeanor recidivism was also uncommon. Only 18 percent of the entire sample had a misdemeanor at the follow-up. However, the MST–FIT intervention did not have an impact on misdemeanor recidivism.