The overriding goal of the Multisystemic Therapy (MST) model is to keep adolescents who have exhibited serious clinical problems (e.g., drug abuse, violence, severe emotional disturbance) at home, in school, and out of trouble. Multisystemic Therapy for Child Abuse and Neglect (MST–CAN) adopts the principles of MST by treating youth, parents, and families with child physical abuse and neglect reports within their home ecology and by intervening in the systems, family, and care-giving environment. Treatment aims to reduce the recurrence of abuse, prevent out-of-home placement, reduce parent-to-child aggression (psychological and physical), and improve parent mental health functioning and parenting skills and behaviors.
MST–CAN delivers services in the home to reduce barriers that typically keep families from accessing services. Therapists have small caseloads of four to six families; work as a team of at least three therapists to include a crisis caseworker, and a full-time supervisor with psychiatrist support; are available on call 24 hours a day, 7 days a week; and provide services at times convenient to the family. The average treatment occurs over roughly 7 months, with multiple therapist–family contacts occurring each week.
Treatment is provided to all family members, with therapists treating an average of five family members per case. MST–CAN therapists engage family members in treatment and work to foster a positive relationship between the family and their Child Protection caseworker. In a collaborative relationship with the therapist the family sets treatment goals, and ongoing assessment and safety planning is a significant component of the model. Specific treatment techniques include cognitive–behavioral therapy (CBT) for anger management, CBT treatments for the impact of trauma or posttraumatic stress disorder on adults and children, reinforcement-based therapy for adult substance abuse, behavioral family therapy for communication and problem-solving issues, functional analysis for family conflict and the use of force in parenting, and abuse clarification. Safety planning and abuse clarification are used in all cases. Other treatments are used as needed.
Duration and Key Personnel
MST–CAN is an intensive program with regular contact (from three times a week to daily) for a duration of 6 to 9 months, using therapists with relatively low caseloads (generally four to six families). MST–CAN requires a fulltime supervisor, a crisis case manager, at least 3 therapists, and a parttime psychiatrist. Special training and care are given for safety planning, dealing with problem-solving and communication difficulties, 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, it identifies the practical issues facing recovery within the family’s immediate environment.
The Swenson and colleagues (2010) study was a randomized trial of treatments for physically abused and neglected children and their families in
Participants were randomized to a Multisystemic Therapy for Child Abuse and Neglect (MST–CAN) condition (n= 44) and an Enhanced Outpatient Treatment (EOT) condition (n= 42). Both treatments were carried out by a local mental health center. The EOT participants were given the standard services for physically abused youths (substance use, parent training, individual therapy, family therapy, parent–child sessions), but also enhanced services encouraging family engagement, plus a parenting program called Systematic Training for Effective Parenting of Teens. MST–CAN participants received on average of 88 hours of treatment over 7.6 months, while EOT participants received 76 hours of treatment over 4.0 months.
The mean age of the youths in the sample was 13.88 years; 55.8 percent were female; 68.6 percent were African American, and 22.1 percent white. The mean age of parents (reported for abuse) was 41.79 years; 65.1 percent were female, and 58.1 percent were single parents. Measurements were taken at baseline and at 2, 4, 10, and 16 months past the baseline. Numerous methods and sources were used to measure family functioning, child and parent functioning, parenting behavior, social support, reabuse, and out-of-home placement. The instruments used were the Child Behavior Checklist, the Trauma Symptom Checklist for Children, the Global Severity Index and the Positive Symptom Total Scale of the Brief Symptom Inventory, the Conflict Tactics Scale, the Interpersonal Support Evaluation List, and data on reabuse and out-of-home placement from CPS.
Data in the study was analyzed using latent growth curve modeling and effect sizes (Cohen’s d) were calculated for the models in an intent-to-treat analysis.
Child and Parent Functioning
In the study by Swenson and colleagues (2010), the Multisystemic Therapy for Child Abuse and Neglect (MST–CAN) treatment group presented significantly greater improvement than the Enhanced Outpatient Treatment (EOT) in internalizing, posttraumatic stress disorder, child-reported dissociative symptoms, and total symptoms. Parents in MST–CAN reported significantly greater improvements in psychiatric distress, which decreased by 75 percent, compared with the EOT group, which saw no change.
MST–CAN was significantly more effective than EOT in reducing child- and parent-reported neglect, psychological aggression, and minor and severe assault. MST–CAN youth reported half as many severe assaults as the EOT group. However, while the MST–CAN group had fewer referred incidents of abuse, there were no significant differences between both treatment groups over the 16 months postbaseline.
MST–CAN youths were significantly less likely to have an out-of-home placement (or to change placement) than the EOT group over the 16-month period.
MST–CAN parents reported significant moderate increases in their development of external social support over the 16-month period postbaseline, while the EOT group showed no change.