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Multisystemic Therapy for Disruptive Behavior Problems & Substance Abuse

What is Multisystemic Therapy?

Multisystemic Therapy (MST) was developed in the late 1970s to address several limitations of existing mental health services for serious child and adolescent disruptive behavior problems, delinquency, and substance abuse. These limitations include minimal effectiveness, low accountability of service providers for outcomes, and high cost. Given substantial empirical evidence suggesting that serious antisocial behavior and substance abuse is determined by the interplay of individual, family, peer, school, and neighborhood factors, traditional treatment efforts-which are often individually-oriented and narrowly focused-generally fail to address the complexity of youth needs. In addition, traditional treatments are often delivered in restrictive out-of-home placements (e.g., residential treatment centers, outpatient clinics, juvenile detention facilities) and are limited in their ability to alter the natural ecology to which the youth will eventually return.

Basic Principles

Consistent with social-ecological models of behavior and findings from causal modeling studies of delinquency and drug use, MST posits that youth antisocial behavior is multidetermined and linked with characteristics of the individual youth and his or her family, peer group, school, and community contexts. As such, MST interventions aim to attenuate risk factors by building youth and family strengths (protective factors) on a highly individualized and comprehensive basis. The provision of home-based interventions circumvents barriers to service access that often characterize families of serious juvenile offenders. An emphasis on parental empowerment to modify the natural social network of their children facilitates the maintenance and generalization of treatment gains.

Course of Treatment

MST is a pragmatic and goal-oriented treatment that specifically targets those factors in each youth's social network that are contributing to his or her antisocial behavior and/or substance abuse. Thus, MST interventions typically aim to achieve the following: 1) improve caregiver discipline practices; 2) enhance family affective relations; 3) decrease youth association with deviant peers and increase youth association with prosocial peers; 4) improve youth school or vocational performance; 5) engage youth in prosocial recreational outlets; and 6) develop an indigenous support network of extended family, neighbors, and friends to help caregivers achieve and maintain such changes. Specific treatment techniques used to facilitate these gains are integrated from those therapies that have the most empirical support, including cognitive behavioral, behavioral, and the pragmatic family therapies.

MST services are delivered in the natural environment (e.g., home, school, community). The treatment plan is designed in collaboration with family members and is, therefore, family-driven rather than therapist-driven. The ultimate goal of MST is to empower families to build an environment-through the mobilization of indigenous child, family, and community resources-that promotes health. The typical duration of home-based MST services is approximately 4 months, with multiple therapist-family contacts occurring each week.

Although MST is a family-based treatment model that has similarities with other family therapy approaches, several substantive differences are evident. First, MST places considerable attention on factors in the adolescent and family's social networks that are linked with antisocial and/or substance abusing behavior. Hence, for example, MST priorities include removing offenders from deviant peer groups, enhancing school or vocational performance, and developing an indigenous support network for the family to maintain therapeutic gains. Second, MST programs have an extremely strong commitment to removing barriers to service access. Third, MST services are more intensive than traditional family therapies (e.g., several hours of treatment per week vs. 50 minutes). Fourth, and most important, MST has well-documented long-term outcomes with adolescents presenting serious antisocial and/or substance abusing behavior and their families. The strongest and most consistent support for the effectiveness of MST comes from controlled studies that focused on violent and chronic juvenile offenders.
 

Resources & Recommended Readings

MST Services website

Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic therapy for antisocial behavior in children and adolescents (2nd ed.). New York: Guilford Press.

Sheidow, A. J., & Henggeler, S. W. (2008). Multisystemic therapy with substance using adolescents: A synthesis of research. In A. Stevens (Ed.), Crossing frontiers: International developments in the treatment of drug dependence (pp. 11-33). Brighton, England: Pavilion Publishing.

Henggeler, S. W., Sheidow, A. J., & Lee, T. (2007). Multisystemic treatment (MST) of serious clinical problems in youths and their families. In D. W. Springer & A. R. Roberts (Eds.), Handbook of forensic mental health with victims and offenders: Assessment, treatment, and research (pp. 315-345). New York: Springer Publishing.

Rowland, M. D., Henggeler, S. W., Gordon, A. M., Pickrel, S. G., Cunningham, P. B. & Edwards, J. E. (2000). Adapting Multisystemic therapy to serve youth presenting psychiatric emergencies: Two case studies. Child Psychology & Psychiatry Review, 5, 30-43.

Henggeler, S. W., Letourneau, E. J., Chapman, J. E., Borduin, C. M., Schewe, P. A., & McCart, M. R. (2009). Mediators of change for Multisystemic therapy with juvenile sexual offenders. Journal of Consulting and Clinical Psychology, 77, 451-462.

Schoenwald, S. K., Heiblum, N., Saldana, L., & Henggeler, S. W. (2008). The international implementation of Multisystemic Therapy. Evaluation & the Health Professions, 31, 211-225.

 
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