The overriding goal of Multisystemic Therapy (MST) is to keep adolescents who have exhibited serious clinical problems (e.g., drug use, violence, severe criminal behavior) at home, in school, and out of trouble. Multisystemic Therapy–Psychiatric (MST–P) adapts the principles of MST by treating youths with psychiatric problems within their home environment and intervening in the systems, family, and care-giving environment. Treatment aims to reduce the risk of self-harm (including suicide), depression, and anxiety as well as externalizing symptoms such as drug use and criminal behavior among youths at risk of out-of-home placement due to serious behavioral problems with co-occurring mental health symptoms.
MST typically uses a home-based model of service delivery to reduce barriers preventing families from accessing services. Therapists have small caseloads (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 occurs over roughly 4 months, with multiple therapist–family contacts occurring each week. 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 use, high stress, poor relationships between partners). Specific treatment techniques used to facilitate these gains are integrated from a variety of therapies, including behavioral, cognitive–behavioral, and pragmatic family therapies. In the family–therapist collaboration, the family takes the lead in setting treatment goals and the therapist helps them to accomplish their goals.
MST principles are adopted for the treatment of youths suffering psychiatric crises by developing strategies to reduce the risk of self-harm to suicidal youth, including:
- Standardized safety assessment of the home with ecologically-based safety planning process
- Developing a safety plan with the family to eliminate potential self-harm risks
- Containing and observing youths
- Distancing the patient from deviant peers and other activities that trigger self-harm
- Empowering responsible adults in the immediate environment to enhance structure and surveillance in the environment
MST–P also uses various strategies to address serious psychiatric illnesses in the youth and/or caregiver:
- Psychiatrist(s) integrated into the clinical team
- Integration of evidence-based psychiatric interventions for youth and family members
- Therapists trained to assess youth and family members for psychiatric problems and coordinate care with team psychiatrist
Duration and Key Personnel
MST–P is an intensive program with daily contact for a 3- to 6-month duration with therapists who have relatively low caseloads (generally, four to six families). MST–P requires therapists with special MST training, as well as a fulltime crisis case worker and a parttime child psychiatrist. Special training is given: intensive safety training associated with suicidal, homicidal, or psychotic behaviors in youths; training to recognize and treat psychiatric problems in the child and caregivers; and substance use intervention where caregivers have alcohol and drug problems.
Systems and social ecological theories form the theoretical foundation of MST. As a family-based home intervention, MST identifies the practical issues which impact a patient’s recovery, within the patient’s immediate environment.
10 to 17
Suicide Attempts and Ideation
The 2004 Huey and colleagues study found significant differences between self-reported suicide attempts of the Multisystemic Therapy–Psychiatric (MST–P) group and the comparison group. Significant treatment effects were found for youth-rated attempted suicide indicating that MST–P was more effective than psychiatric hospitalization at reducing suicide. Significant time effects were also found for caregiver-rated suicide attempts, suggesting that both MST–P and the psychiatric hospitalization were associated with decreased symptomatology over time.
While suicide attempts decreased over time for both the MST–P and comparison groups, MST–P provided greater and more rapid reductions than hospitalization. No significant differences between MST–P and hospitalization were found for suicidal ideation, youth depressive affect, or youth-rated parental control. Significant time effects suggest that both treatment conditions were associated with reductions of youth-reported suicidal ideation over time.
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