Multisystemic Therapy (MST) aims to enhance a families’ capacity to keep track of adolescent behavior and instill clear rewards and punishments for positive and negative or irresponsible behavior. When dealing with adolescents, MST frequently concentrates on reducing youths’ involvement in delinquent and substance-using behavior and replacing negative peers with prosocial peers who do not engage in problem behavior. Therapists concentrate on developing family structure and natural rewards or incentives to encourage desired healthy behaviors and attachment to prosocial peers.
This variant of MST targets adolescents who have been diagnosed as substance abusing or substance dependent according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DSM–IV. This program can be used with youths who have other mental or physical conditions or deficiencies as well. Although the emphasis is on juveniles, MST operates by incorporating the patients’ family and friends and addressing all potential spheres of behavioral influence.
Program Activities and Theory
MST interventions concentrate on the individual, family, peer, school, and social network variables that are linked with behavioral problems. These interventions draw heavily from strategic family therapy, structural family therapy, behavioral parent training, and cognitive behavioral therapies to address behavioral issues in a holistic and comprehensive manner.
MST is generally delivered at home. This type of service delivery reduces barriers that prevent families from accessing services. Therapists have small caseloads of four to six families. They are available 24 hours a day, 7 days a week, and provide services when it is convenient for the patient and the family. Treatment typically lasts 4 months, with multiple therapist–family contacts occurring each week. MST therapists concentrate on parental skills and building natural support systems of families, friends, and community members. While working on strengths, therapists also address roadblocks to therapy and healing such as parental substance use and strife.
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Henggeler and colleagues (2002) found significant differences for the measures of aggressive crimes, the Self-Report Delinquency Aggression scale, and the annualized conviction rates for aggressive crimes. Compared with the control participants, those receiving Multisystemic Therapy (MST) treatment had a 75 percent reduction in convictions for aggressive crimes since the age of 17. MST participants also reported committing fewer aggressive crimes in the past 12 months than the control group receiving usual services. There was no significant effect found in regard to property crimes.
Illicit Drug Use
The self-report measures of marijuana and cocaine use were not significant. However, juveniles in the MST group had significantly higher rates of marijuana abstinence than the control group based on biological tests (urine and hair analysis)—55 percent versus 28 percent, respectively. Rates of cocaine abstinence as determined by biological tests did not differ significantly.
Measured by the Young Adult Self-Report (YAS) Externalizing and Internalizing scale, there were no significant differences found between the treatment and control groups.
Additional analyses were conducted to determine whether demographic, clinical, and baseline substance use variables moderated the effect of MST on the primary outcomes. There were no significant moderator effects evidenced. This means that these variables did not affect the impact of the treatment.
Henggeler and colleagues (2006) found significant differences between the treatment groups (those receiving MST tailored to substance abuse) and the comparison group. Adolescents in the drug court (DC) and the drug court MST contingency management (DC/MST/CM) groups reported a significant decrease in alcohol use at the 4-month follow-up, compared with those in the family court (FC) comparison condition. Controlling for the baseline assessment, the treatment group continued to report significantly less alcohol use at the 12-month follow-up than those in the comparison condition. This shows a strong short-term effect in the first 4 months that persists up to 12 months later. For heavy alcohol use the short-term effect was not evident. However, at the 12-month follow-up, those in the treatment group reported significantly less heavy alcohol use than those in the comparison condition.
For marijuana use there was a significant reduction in self-reported use for all conditions—both treatment and comparison. There was a sharp decrease between baseline and the 4-month follow-up for all groups. However, by the 12-month follow-up, only the treatment groups still reported significantly lower levels of marijuana use. This suggests that, despite the initial reduction in marijuana use for all groups, only the treatment conditions were able to produce sustained long-term results.
A similar effect was evidenced for multiple drug use. At the 4-month follow-up, there were no significant differences between the treatment conditions and the comparison condition. However, at the 12-month follow-up youths receiving the treatment intervention reported significantly less use of multiple drugs than those receiving usual community services.
The effect sizes for all substance use measures (alcohol, heavy alcohol, marijuana, and multiple drug use) were all positive and fairly large. Between the intervention groups, those with an MST component demonstrated even stronger effects than those participating in drug court by itself. As measured by drug urine screens, participants in drug courts with MST components had significantly lower percentages of positive drug screens than participants who had only received the drug court intervention—7 percent, 17 percent, and 45 percent respectively. These effects were evident and had large effect size at the 4-month follow-up and remained large and significant at the 12-month follow-up.
There was a significant but small reduction in mental health symptoms for youths in the DC/MST/CM condition, compared with the other intervention groups and comparison group, at the 4-month follow-up. However, this effect was not evidenced at the 12-month follow-up. Overall, there were no significant long-term differences between the different treatment groups and the comparison group.
All three treatment conditions reported significantly fewer status offenses than those in the comparison condition. Between the different drug court interventions, the DC/MST condition demonstrated a significant decrease at the 4-month follow-up, compared with the other interventions. At the 12-month follow-up, all three drug court interventions displayed a significant decrease in status offenses compared with youths in FC. These changes in behavior correspond to a large effect size.
For crimes against persons, there was a significant effect found for youths in the DC and DC/MST/CM conditions. From baseline to 12-month follow-up, there was a significant decrease in self-reported crimes against persons for the DC and DC/MST/CM conditions. For youths in the comparison condition, there was an immediate decrease in crimes against persons evident from baseline to 4-month follow-up. However, by the 12-month follow-up there was a substantial increase in self-reported personal crimes for the comparison condition. Youths in the comparison condition reported an average of 50 crimes in the past 90 days, compared with the effective intervention conditions who reported an average of 20 crimes in the same time period. These changes in behavior correspond with a medium effect size. In terms of official arrests, there were no significant differences between the intervention groups and the comparison group.
Service System Outcomes
Participants in the DC/MST and DC/MST/CM conditions were more likely to graduate from drug court than those youths merely receiving drug court—45 percent versus 28 percent, respectively. In terms of out-of-home placements—time spent in correctional settings—control participants had the lowest rates of placement, compared with youths receiving the drug court and MST conditions. This is attributed to the increased number of appearances and involvement with drug courts, compared with family court. The increase in surveillance and knowledge of behavior by drug courts leads to the use of more out-of-home placements.
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