Program Profile: Multisystemic Therapy–Family Integrated Transitions (MST-FIT)

This intervention provides integrated individual and family services to juveniles who have co-occurring mental health and chemical dependency disorders during their transition from incarceration back into the community. The program is rated Promising. Treatment group youth were at statistically significantly lower risk for felony recidivism, compared with control group youth. However, there was no impact on overall recidivism, violent felony recidivism, or misdemeanor recidivism.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals

The Multisystemic Therapy–Family Integrated Transitions (MST–FIT) program provides integrated individual and family services to juveniles who have co-occurring mental health and chemical dependency disorders. Services are provided during a juvenile’s transition from incarceration back into the community. The overall goal of MST–FIT is to provide necessary treatment to youth, thereby reducing recidivism. The program also seeks to connect youth and their families to appropriate community supports, achieve youth abstinence from alcohol and other drugs, improve youth mental health, and increase youth prosocial behavior.

The program was developed after the Washington State Legislature initiated a pilot rehabilitation program for juveniles with co-occurring substance abuse and mental health disorders who had received sentences to enter a state Juvenile Rehabilitation Administration (JRA) institution.

Target Population

To be eligible to participate in MST–FIT, a youth must meet the following criteria:

• The youth must be younger than 17 ½ years old.
• The youth must be in a JRA institution and scheduled to be released to 4 or more months of parole/supervision.
• The youth must have a substance abuse or dependence disorder and any of the following: any Axis 1 disorder, currently prescribed psychotropic medication, or demonstrated suicidal behavior within the past 3 months.

Youth must also reside in King, Pierce, Snohomish, Kitsap, Thurston, Mason, Yakima, Benton, or Kittitas counties, where the MST–FIT program is currently available.

Program Components

The MST–FIT program begins in a youth’s final 2 months in a residential facility and continues for 4 to 6 months during parole supervision. MST–FIT is based on components of three programs: Multisystemic Therapy (MST), Dialectical Behavior Therapy (DBT), and Motivational Enhancement Therapy (MET). The overarching framework of the program is derived from MST, a family-based preservation model for community-based treatment. MST provides the foundation of the intervention, while the other intervention strategies are delivered within the MST framework. MST tailors treatment goals to a youth’s individual risk and protective factors within his or her natural environment (i.e., family, school, and community). This treatment component uses therapists to coach caregivers in establishing productive partnerships with schools, community supports, parole, and other systems, and to help caregivers develop skills to be effective advocates for those in their care.

Although the MST component concentrates on the extent to which the youth’s surrounding environments support prosocial behavior, MST–FIT incorporates elements of DBT to address individual-level characteristics in both youth and caregivers by replacing maladaptive emotional and behavioral responses with more effective and skillful responses. The skills training component of DBT targets emotional dysregulation that underlies problems youth with co-occurring disorders have, such as anger, impulse control, and moodiness. Throughout the intervention, coaches look for opportunities to encourage youth to apply the skills they learn in real-world settings.

Finally, MST–FIT uses aspects of MET to engage youths and their families in treatment, with the objective of increasing their commitment to change. MST–FIT therapists use MET techniques to develop the initial engagement of all parties and to maintain their commitment throughout treatment.

Relapse prevention/community reinforcement is also used to increase the youth's and family’s awareness of issues such as substance use and high-risk situations. A range of effective coping strategies are provided, and a plan is established for youth to resume treatment, should they relapse.

Key Personnel

The MST–FIT team consists of contracted therapists with backgrounds in children’s mental health, family therapy, and chemical dependency. The team serves four to six families at any given time. Service delivery occurs in the families’ homes and communities, and services are available 24 hours a day, 7 days a week.

Study

This study by Trupin and colleagues (2011) evaluated the ability of the Multisystemic Therapy?Family Integrated Transitions (MST?FIT) program to affect recidivism rates. The total sample size was 274 youths who were transitioning back to the community from one of five Washington State Juvenile Rehabilitation Administration (JRA) facilities between 2001 and 2005. The sample included 105 youths who participated in MST?FIT and served as the treatment group. The control group consisted of 169 eligible youths who did not participate in MST?FIT because they returned to counties where the program was unavailable; this group received treatment-as-usual JRA parole services. The average age of youth in the total sample was 16.35 years. Eighty-three percent of the sample were male; 70 percent were white, 15 percent were African American, 12 percent were Hispanic, and 4 percent were American Indian/Alaska Native.

Since the study did not use random assignment, logistic regression was used to determine significant differences between groups. There were no significant differences for gender, age at release, Native American ethnicity, age at first prior conviction, prior drug convictions, criminal history, or prior person (violent) convictions. However, there were significant differences on four variables: African American ethnicity, Hispanic ethnicity, the degree to which a county was either urban or rural, and Initial Security Classification Assessment (ISCA) risk assessment scores. (ISCA is a JRA tool that measures an individual?s overall risk for re-offense.) Treatment group participants were more likely to be African American and less likely to be Hispanic. This was expected because counties that were eligible for the MST?FIT program were more urban, more ethnically Black, and less Hispanic than counties without MST?FIT.

The evaluation period was 36 months postrelease from the JRA facility. For youths in both the treatment and control groups, the evaluation period began on the first day the youth was released. The primary outcome of interest was recidivism. Recidivism was measured as convictions, to align with the Washington State Legislature?s official definition. Three types of reconvictions were examined: total misdemeanor and felony convictions, felony convictions, and violent felony convictions. Felony and violent felony categories were not mutually exclusive, with felony convictions incorporating all types of felonies. Recidivism data was collected from administrative databases available through Washington State?s Administrative Office of the Courts and Department of Corrections.

The study used an intent-to-treat model, meaning all youths were included in program effects analyses, regardless of the extent of their participation in the MST?FIT program. A nonproportional hazards model using Cox regression was used to evaluate the difference in survival rate between the MST?FIT treatment group and control group for overall and felony recidivism. Binary logistic regression was used to evaluate differences between the groups for violent felony and misdemeanor recidivism due to lower incidences of these convictions. Chi-square and t-tests were used to examine group differences in regard to demographics and propensity for recidivism.

No subgroup analyses were conducted. 

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Following are CrimeSolutions-rated programs that are related to this practice:

Treatment in Secure Corrections for Serious Juveniles Who Have Committed Serious or Multiple Offenses

This practice includes interventions targeting serious (violent and chronic) juveniles sentenced to serve time in secure corrections. The overall goal is to decrease recidivism rates when juveniles are released and return to the community. The practice is rated Effective for reducing general recidivism and serious recidivism of violent and chronically offending juveniles.

Evidence Ratings for Outcomes

	Crime & Delinquency - Serious recidivism
	Crime & Delinquency - Multiple crime/offense types

Juvenile Reentry Programs

This practice consists of reintegrative programs and services designed to prepare juveniles, who were placed out of their homes, for reentry into the community. The overall goal is to reduce the recidivism rate of juveniles released from out-of-home placements. The practice is rated Promising. There was a statistically significant decrease in the recidivism rates of juveniles who participated in the reentry programs, compared with juveniles in the comparison groups.

Evidence Ratings for Outcomes

Crime & Delinquency - Multiple crime/offense types

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?