Multisystemic Therapy for Youth With Problem Sexual Behaviors (MST–PSB)

Program Goals

Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST–PSB) is an adaptation of MST aimed at adolescents who have committed sexual offenses and demonstrated other problem behaviors. MST–PSB is designed to reduce problem sexual behaviors, antisocial behaviors, and out-of-home placements. The program targets factors underlying problematic juvenile sexual behavior, primarily by addressing a youth’s socialization processes and interpersonal transactions. Program staff provide treatment within the adolescent’s natural environment—that is, where the youth lives. As a result, program staff members also work directly with the youth’s family and directly or indirectly with others in the youth’s community, such as peers, teachers, or probation officers. One goal of this work with the youth’s family is to empower the parents by providing them the skills and resources needed to raise their adolescent.


Program Activities/Program Theory

Most program activities and services are delivered either at home or in a community-based setting (such as school or recreation center), at times that are convenient for the family. The precise program components are selected based on the needs of the individual and family being treated. This plan is developed from a functional assessment of the youth, the family, and their social network, and is guided by nine treatment principles.


The individualized treatment components address identified risk factors. However, in general, many of the MST–PSB activities focus on working with the family to:


  • Reduce denial by both parents and child about the sexual offense and its consequences
  • Enhance parenting knowledge
  • Remove barriers to effective parenting
  • Promote affection and communication among family members

Parents are trained to play an active role, such as monitoring school performance and working with their child to encourage age-appropriate, healthy peer associations. Staff work with the family and other persons in the youth’s ecology (e.g., teachers, extended family) to help develop risk-reduction plans, strengthen relapse prevention, and promote victim safety. The youth is given the opportunity to develop social and problem-solving skills, and may receive program components that modify belief systems or attitudes that contribute to sexual offending.


The youth and family have multiple contacts each week, totaling approximately 3 hours. Therapists are available around the clock to deal with clinical issues.


Program components draw on strategies from pragmatic family therapies, behavioral parent training, and cognitive–behavioral therapy.


Key Personnel

The program is delivered by master’s-level trained therapists. Therapists generally work with between four and six families.

Intervention ID

13 to 17


Study 1

Individual Adjustment

Borduin, Schaeffer, and Heiblum (2009) found that MST participants showed decreases in symptoms over time and parents reported decreases in behavior problems. In comparison, usual community services (UCS) participants showed increases in symptoms, and parents reported increases in problem behaviors.


Family Relations

MST participants showed increases in cohesion and adaptability at posttreatment, whereas UCS participants showed decreased cohesion and adaptability.


Peer Relations

Teachers, parents and youths reported increases in emotional bonding and social maturity from pre- to posttreatment for MST youth, whereas decreases were reported for UCS youths. MST youth also showed decreases in youth aggression toward peers, while UCS youths showed increased aggression toward peers posttreatment.


Self-Report Delinquent Behavior

MST youths reported decreases in person and property crime from pre- to posttreatment, while UCS youths reported increases.



MST participants had 83 percent fewer arrests for sexual crimes and 70 percent fewer arrests for other crimes compared to UCS youths. At the end of the follow-up period, 45.8 percent of UCS participants had been arrested at least once for a sexual crime and 58.3 percent for a nonsexual crime, compared to 8.3 percent and 29.2 percent, respectively, for MST participants. MST participants spent 80 percent fewer days in secure facilities than did UCS youths.


Time from treatment release to arrest also differed significantly for the two groups. MST participants showed a lower risk of rearrest during follow-up than UCS youths. By the end of the follow-up period, 29.2 percent of MST participants had been arrested at least once, compared to 75.0 percent of UCS participants.

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