Multisystemic Therapy

An Evidence-Based Program That Keeps At-Risk Youth Arrest Free and Prevents Out of Home Care

Overview

MST is a nationally-recognized, evidence-based program that helps fragile families cope with out-of-control teenagers with the goal of keeping youth arrest free and out of residential care. The program provides three to four months of almost daily support by trained therapists using a highly structured system. The program is based on a model developed and researched by the MST Institute.

Developed in the 1990′s, MST was designed to serve youth with serious anti-social behavior and often long arrest histories, blending cognitive behavioral therapy, behavior management training, family therapies and community psychology to get results. After 30 years of research and 18 studies, MST repeatedly has been shown to:

Keep youth in their homes, reducing out-of-home placements up to 50 percent
Keep youth in school
Keep youth out of trouble, reducing re-arrest rates up to 70 percent
Improve family relations and functioning
Decrease adolescent psychiatric symptoms, and
Decrease adolescent drug and alcohol use.

New York is one of several states to make a significant commitment towards utilizing and testing MST. In 2000, the Office of Children and Family Services (OCFS) began a small number of pilot projects utilizing MST for high-risk youth discharged from its facilities. The Children’s Village was one of the first local agencies to participate in the MST pilot, starting with a small project in the Bronx. CV has continued to work with MST and significantly expanded its service and expertise.

CV has been a Network Partner for MST since 2006, which enables us to provide training and supervision of replication projects. CV currently supports more than a dozen MST teams run by agencies in New York, New Jersey, Michigan and even in The Netherlands.

The Children’s Village is also a replication site for new adaptations of the MST model to address the specific needs of various types of youth and families. One model which CV is implementing is designed to address youth with substance abuse problems; another targets youth with problematic sexual behaviors. CV is also partnering with the University of Washington to be a replication site for MST Fit (Family Integrated Transitions), which is a residential aftercare model.

The Children’s Village’s History with MST

Children’s Village is the largest provider in New York State of MST, with a current slot capacity to serve 800 cases annually. CV has MST teams operating in New York City, Westchester County, and Long Island. These teams are reintegrating youthful offenders into their communities and preventing troubled kids from needing to be removed from their families. Both of these strategies are saving hundreds of thousands of dollars each year in reduced incarceration and residential placement costs.

Chronology:

2000: CV chosen by OCFS to pioneer the use of MST to treat youth released from OCFS facilities with the goal of reducing recidivism.
2002: MST program for Westchester County’s Probation Department that serves a PINS diversion youth.
2006: Intensive Preventive Program that serves high risk youth in the Bronx and Manhattan.
2006: MST Network Partner qualified to train and license teams in MST.
2010: Partnered with OCFS to provide Alternative to Detention services to youth in Brooklyn, known as the OCFS Brooklyn to Brooklyn initiative. This project involves intensive family based intervention to youth in the care and custody of OCFS who remain in the community.

CV’s Work with MST Adaptations:

MST-CM (Contingency Management) for Substance Abusing Youth

CV was one of the first agencies to pilot MST-CM and assisted the developers of MST-CM in defining clinical protocols, training curriculum and development, and testing of incentive protocols as a substance abuse intervention for Adolescents. CV is the only MST Network Partner agency approved to do training and consultation in MST-CM.

MST-PSB (Problematic Sexual Behavior)

CV initiated a program to treat youth with problematic sexual behavior, including youth adjudicated for sexual offenses, at our residential treatment center. CV received two Federal grants to support this work.

MST-FIT (Family Integrated Transitions) for Youth Leaving Residential Care

CV is currently partnering with the University of Washington to be a replication site for MST Fit, is a residential aftercare model .

Numbers served

CV is the largest MST provider in New York State with a current capacity to serve 800 cases annually, and has discharged over 2,100 cases since 2004.

Cost/Benefit

MST has been demonstrated as a cost effective juvenile justice model in numerous studies, including the July 2011 Washington State Institute for Public Policy (WSIPP) Return on Investment: Evidence-Based Options to Improve Statewide Outcomes report which indicated a monetary benefit of $29,302 ($6,521 taxpayer and $22,782 non-taxpayer in 2010 dollars) minus the average cost of treatment of $7,206, for a total cost savings of $22,096.

In their risk analysis of the estimated bottom line, WSIPP found that the MST treatment model has a 91% chance of producing benefits that exceed costs, thus indicating that it is an attractive evidence-based program that reduces crime and achieves a favorable return on investment, with a small chance of an undesirable outcome. Refer to the WSIPP website for further information: http://www.wsipp.wa.gov/pub.asp?docid=11-07-1201.

The annual cost for one of CV’s MST teams is approximately $400,000, which includes four therapists, a supervisor, licensing, training, travel, and supplies.

MST Results

CV has a long history of experience working with the MST model and has consistently met or exceeded the national and international averages in all our programs. Outcomes for all our MST programs over the past year are shown below:

The results of rigorous scientific studies funded by the National Institutes of Mental Health and National Institute on Drug Abuse show that MST is a clinically effective and cost-effective approach to the treatment of youth with complex clinical problems and their multi-need families. In two randomized clinical trials involving chronic, violent juvenile offenders, MST significantly decreased problem behaviors in youth and psychiatric symptoms in parents, improved family functioning, significantly deceased incarceration and psychiatric hospitalization by 50-80%, and decreased criminal activity and re-arrest by 26-70%. Importantly, treatment gains were maintained over time (2.4 – 4 years following treatment), and continued reductions in criminal activity were associated with significant cost savings relative to youth who received usual services or individual treatment.

Because of these proven outcomes, MST has been selected as an effective program by SAMSHA, the Office of Juvenile Justice and Delinquency Prevention, U.S. Surgeon General, the Annie E. Casey Foundation, the Promising Practices Network at the Rand Corporation, and others. The National Institutes of Health State-of-the-Science Conference named MST one of only two programs to reduce youth violence and arrests. There are no other models available with this kind of evidence of ability to effect positive outcomes.

For more MST outcomes click here to go to the Achievements and Outcomes page.

How MST Works

MST interventions typically aim to:

improve caregiver discipline practices,
enhance family affective relations,
decrease youth association with deviant peers,
increase youth association with pro-social peers,
improve youth school or vocational performance,
engage youth in pro-social recreational outlets, and
develop an support network of extended family, neighbors, and friends to help caregivers achieve and maintain positive changes.

The program uses a strength-based model that recognizes the positive existing elements of a family’s life, and combines these strengths with the areas for change. MST services are delivered in the natural environment (e.g., home, school, community). The treatment plan is designed in collaboration with youth and family members and is, therefore, family driven rather than therapist driven. The ultimate goal of MST is to build on youth and family strengths and empower families to build an environment, through the mobilization of child, family, and community resources that promotes health.

Youth and families participate in setting specific goals and in evaluating the attainment of those goals and, thus, the success of the program. At the outset, we will meet with each family unit and work with them to prepare a statement of expectation of services and an outline of specific desirable goals using family strengths as levers to make therapeutic changes. The family signs this statement and we use this document throughout the service period as a check on progress.

Although MST is a family-based treatment model that has similarities with other family therapy approaches, there are several substantive differences:

MST places considerable attention on factors in the adolescent and family’s social networks that are linked with antisocial behavior. For example, MST priorities include removing offenders from negative peer groups, enhancing school or vocational performance, and developing a support network for the family to maintain therapeutic gains.
MST programs have an extremely strong commitment to helping families access services and removing barriers that may exist.
MST services are more intensive than traditional family therapies (e.g., several hours of treatment per week vs. 50 minutes).
Most importantly, MST has well-documented long-term outcomes with adolescents presenting serious antisocial behavior and their families.
MST-trained clinical therapists will visit families in their homes two to three times each week for a service period of three to five months. Contact will average approximately 60 hours over a period of three to four months with the last 3 to 4 weeks showing a decreased rate of contact as therapeutic change and growing independence is monitored. A bio-psycho-social assessment of the strengths and weaknesses of the individual, family, neighborhood/community, school and peers will be performed at the outset, with interventions being scientifically based, goal oriented and problem focused. Overarching goals are carried throughout the life of the case, with weekly goal setting, modifications and treatment planning to be carried out in collaboration with the families.
The MST model specifies low caseloads of four to six families per clinical therapist, each of whom works together with the families to develop an enduring social support network in their own neighborhood. Services are tailored to take into account the context of the individual family’s value system, their beliefs and their cultures.
Flexible schedules are set to accommodate family needs. In addition to regular MST clinical therapist visits, on-call services are available 24/7, addressing crisis needs as well as monitoring daily progress.

A unique feature of MST is its emphasis on constructing present-oriented systems of therapy and building responsible behavior rather than treating pathologies. Specific goals of the program include:

the improvement of parenting practices with training provided on such issues as alternatives to corporal punishment,
appropriate supervision of children,
age-appropriate expectations, choices and consequences, and
the importance of displaying affection and trust.

In addition to improved parenting skills, building an enduring social support network within the family, neighborhood and community is essential. This includes moving children from association with negative to pro-social peers, creating opportunities for positive recreational activities, teaching youth how to find positive recreational activities and, as appropriate, helping them find after-school work.

The clinical team is responsible for teaching the family organizational skills and removing barriers to service accessibility, educational, medical, neighborhood and community services building hope and positive expectations while helping families develop networks that will remain in place and promote long-term maintenance of favorable changes.

Contact Us

For more information on MST visit http://mstservices.com/ or contact Paul Schiller at pschiller@childrensvillage.org.

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