Evidence Rating: Effective | More than one study
Date:
This is a family and community-based treatment program for adolescents with serious antisocial, delinquent, and other problem behaviors. The program is rated Effective. The treatment group had a statistically significant reduction in rearrests and number of days incarcerated, compared with a control group that received usual services. However, there were no statistically significant differences between groups in substance use outcomes.
An Effective rating implies that implementing the program is likely to result in the intended outcome(s).
This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.
This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.
Program Goals/Target Population
The overriding goal of Multisystemic Therapy (MST) is to keep adolescents who have exhibited serious clinical problems (e.g., drug use, violence, severe criminal behavior) at home, in school, and out of trouble. Through intense involvement and contact with the family, MST aims to uncover and assess the functional origins of adolescent behavioral problems. It works to alter the youth’s ecology in a manner that promotes prosocial conduct while decreasing problem and delinquent behavior.
MST targets youths between the ages of 12 and 17 who present with serious antisocial and problem behavior and with serious criminal offenses. The MST intervention is used on these adolescents in the beginning of their criminal career by treating them within the environment that forms the basis of their problem behavior instead of in custody, removed from their natural ecology.
Program Components
MST typically uses a home-based model of service delivery to reduce barriers that keep families from accessing services. Therapists have small caseloads of four to six families; work as a team; are available 24 hours a day, 7 days a week; and provide services at times convenient to the family. The average treatment occurs over approximately 4 months, although there is no definite length of service, with multiple therapist–family contacts occurring each week. MST therapists concentrate on empowering parents and improving their effectiveness by identifying strengths and developing natural support systems (e.g., extended family, neighbors, friends, church members) and removing barriers (e.g., parental substance abuse, high stress, poor relationships between partners). In the family–therapist collaboration, the family takes the lead in setting treatment goals and the therapist helps them to accomplish their goals.
Key Personnel
Therapists with special MST training deal with a relatively small number of cases, due to the intensive nature of the intervention. Sessions at the home of the adolescent may occur every day or once a week, depending on the needs of the family and the stage in the program.
Program Theory
Systems and social ecological theories form the theoretical foundation of MST. As a family-based home intervention, MST identifies the practical issues that impact the youth’s serious antisocial behavior within his or her social environment. Various therapies inform the specific treatment techniques used, including behavioral, cognitive–behavioral, and the pragmatic family therapies (Henggeler and colleagues et al. 1992).
Study 1
Peer Aggression
Youth in the MST group reported lower peer aggression, compared with youth in the control group, at the immediate posttest. This difference was statistically significant.
Social Skills
There were no statistically significant differences between youth in the MST group and youth in the control group on any measures of social skills at the immediate posttest.
Family Cohesion
Youth in the MST group reported improved family cohesion, compared with youth in the control group, at the immediate posttest. This difference was statistically significant.
Rearrest
Youth in the MST group had fewer rearrests, compared with youth in the control group, 60-weeks after referral. This difference was statistically significant.
Recidivism
Henggeler and colleagues (1992) found that youth who participated in Multisystemic Therapy (MST) had lower recidivism rates (42 percent), compared with control group youth who received usual services (63 percent), 60-weeks after referral. This difference was statistically significant.
Incarceration
Youth in the MST group spent an average of 73 fewer days incarcerated, compared with youth in the control group, 60-weeks after referral. This difference was statistically significant.
Delinquency
Youth in the MST group had lower self-reported delinquency scores, compared with youth in the control group (whose scores were nearly 3 times greater), at the immediate posttest. This difference was statistically significant.
Study 2
Peer Relations
There were no statistically significant differences between youth in the MST group and youth in the control group in peer relations at the immediate posttest.
Family Cohesion
Families in the MST group reported improved family cohesion and adaptability, compared with families in the control group, at the immediate posttest. This difference was statistically significant.
Arrests
Borduin and colleagues (1995) found that 26.1 percent of youth in the MST group were arrested at least once, compared with 71.4 percent of youth in the control group, at the 4-year follow up. This difference was statistically significant.
Study 3
Recidivism
Timmons–Mitchell and colleagues (2006) found that youth in the MST group had lower recidivism rates (66.7 percent), compared with youth in the treatment-as-usual control group (86.7 percent), at the 18-month follow up. This difference was statistically significant.
Arrests for New Charges
Youth in the MST group were arrested and arraigned on new charges fewer times (an average of 1.44 times), compared with youth in the control group (an average of 2.29 times), at the 18-month follow up. This difference was statistically significant.
Substance Use
There were no statistically significant differences between youth in the MST group and youth in the control group in substance use at the 6-month follow up.
Moods and Emotions
Youth in the MST group showed greater improvements in moods and emotions, compared with youth in the control group, at the 6-month follow up. This difference was statistically significant.
Community Functioning
Youth in the MST group showed greater improvements in community functioning, compared with youth in the control group, at the 6-month follow up. This difference was statistically significant.
Behavior Toward Others
Youth in the MST group showed greater improvements in behavior toward others, compared with youth in the control group, at the 6-month follow up. This difference was statistically significant.
Home Functioning
Youth in the MST group showed greater improvements in home functioning, compared with youth in the control group, at the 6-month follow up. This difference was statistically significant.
School/Work Functioning
Youth in the MST group showed greater improvements in school and work functioning, compared with youth in the control group, at the 6-month follow up. This difference was statistically significant.
Study 1
The Henggeler and colleagues (1992) study reported the results of a randomized control trial of Multisystemic Therapy (MST) in South Carolina. The Family and Neighborhood Services project randomized juveniles to a treatment-as-usual (n = 41) or the MST intervention (n = 43). They were referred primarily on the basis of a determination by the Department of Youth Services (DYS) of their imminent risk of out-of-home placement due to their involvement in serious criminal activity. The young persons in the sample had on average 3.5 previous offenses and 9.5 weeks of previous incarceration. Fifty-four percent of the sample had at least one arrest for violent crime, with 71 percent having been previously incarcerated for at least 3 weeks. The mean age of the sample was 15.2 years, and 77 percent were male. Of the sample, 56 percent were African American, 42 percent were white, and 2 percent were Hispanic. Twenty-six percent lived with neither biological parent, and families had on average 2.7 children. There were no significant differences between groups.
The MST treatment for the 43 families lasted an average of 13.4 weeks, with 33 hours of direct contact and therapists providing 24-hour case coverage. Sessions typically lasted between 15 and 90 minutes and were held weekly or as frequently as daily, depending on the treatment stage and the severity of the crises experienced. The service-as-usual group received court orders (including curfews, school attendance, and program participation), which were monitored by probation officers who met with the youths at least once a month. Failure to comply with court orders was met with a court review, and possible referral to a DYS institution, with some receiving substantive services due to a combination of family difficulties and resistance associated with mental health issues.
The study measured participants’ criminal behavior, incarceration, self-reported delinquency, family and peer relations, social skills, and problem behaviors. Pretest and posttest surveys were administered, and archival records for arrests and incarceration were collected on average at 59.6 weeks post referral. One-way analyses of variance (or ANOVA) were used to test differences between groups in arrest and incarceration data, and one-way analyses of covariance (or ANCOVA) were used to test for differences between groups on self-reported delinquency and psychosocial measures at posttest, with pretest scores as covariates. The study authors did not conduct subgroup analyses.
Study 2
Borduin and colleagues (1995) examined the long-term effects of a randomized control trial of MST and an individual therapy in Missouri. Youths in the sample were eligible if they had at least two prior arrests, were living with at least one parent figure, and had no evidence of psychosis or dementia. Ninety-two juveniles were randomized to the MST condition, and 84 were randomized to a comparison individual therapy condition. The average age was 14.8 years and 67.5 percent were male. The majority (70 percent) were white; 30 percent were African American. The youths had on average 4.2 previous arrests, and all had been previously detained for at least 4 weeks. There were no significant demographic or criminal history differences between groups.
There were, however, significant differences in the duration of treatment for program completers, with MST participants averaging 23.9 hours, compared to 28.6 hours for the comparison treatment group. The study measured participant and family member psychiatric symptomatology, adolescent behavior problems (as reported by the mother), family functioning and interactions, peer relations, and criminal activity collected from State records at 3.95 years following release from probation.
Data was analyzed using multivariate analyses of variance (or MANOVA); survival analysis was used to assess the impact of the treatment conditions on criminal activity. The study authors conducted subgroup analyses on age, race, socioeconomic status, gender, pretreatment arrests for a violent crime, and number of pretreatment arrests.
Study 3
An independent randomized clinical trial of the effects of MST was conducted by Timmons–Mitchell and colleagues (2006). The study examined recidivism at 18 months and youth functioning at 6 months posttreatment. The study consisted of 93 youths who came before a family court in a Midwestern State between October 1998 and April 2001. To be included in the study, juveniles had to have a felony conviction, a suspended committal to the DYS facility, and parental consent to participate. Participants were then randomized into a treatment MST group (n = 48) and a treatment-as-usual (TAU) group (n = 45). The youths were all on probation or had previously been on probation at the time of the study.
The average age of the sample was 15.1 years at the time of enrollment; 22 percent of the sample was female. The participants were 77.5 percent white, 15.5 percent African American, 4.2 percent Hispanic, and 2.8 percent biracial. There were no significant differences between groups in age, racial or gender make up, or in previous criminal history (age of first offense and number of previous offenses, misdemeanors, and felonies).
The treatment group was enrolled in the MST program for an average of 144.84 days. Service delivery was provided to the 48 families with a high level of fidelity to the MST program. TAU participants’ access to services was monitored by probation officers and court services. While the TAU group did have referrals to anger management, drug and alcohol, and individual and family therapy services, records indicated that attendance was sporadic and that the group had an overall low level of service use.
Arrest data was collected for the MST group for the 19 months posttreatment. For the TAU group, who do not have a clear treatment end point, arrest data was counted if the arrest occurred between 6 and 24 months postrecruitment. For the same reason, adolescent functioning data was collected at baseline, immediately after treatment, and at a 6-month follow- up for the MST group, and at baseline, and 6 months and 12 months postrecruitment for the TAU group. The arrest data was collected from family court records. Child functioning was measured using six areas of the Child and Adolescent Functional Assessment Scale: school and work, home, community, behavior toward others, moods/emotions, and substance use. Offense data was analyzed with likelihoods and relative odd ratios using logistic regression and survival analysis. Adolescent functioning data was analyzed using general linear modeling. The study authors did not conduct subgroup analyses.
All Multisystemic Therapy (MST) programs must be licensed by MST Services. MST Services created the MST Program Development Method™ (PDM) from the successes and challenges of organizations implementing MST over more than a decade of MST dissemination. Because each organization brings a variety of strengths into this process, the PDM is rarely applied exactly the same way each time. Rather, it is an assembled set of tools that will allow the local program developer to assess the strengths, identify the weaknesses, locate the opportunities and plan for the threats unique to each organization within its own community context.
Prior to MST training, an Expert MST Program Developer provides on-site and/or telephone consultation regarding the development and implementation of a successful MST program. The program start-up services include technical assistance and materials designed to produce a program description, projected budget, and implementation timeline. Key critical elements include review of funding proposal documents and/or responses, clear articulation of the target population definition and prioritization process, referral and discharge criteria and processes, development of program-specific policies and procedures, recommendations regarding clinical record keeping practices and initial program evaluation planning.
More information can be found on the website for MST: https://www.mstservices.com/.
Subgroup Analysis
Borduin and colleagues (1995) conducted subgroup analyses on age, race, socioeconomic status, gender, pretreatment arrests for a violent crime, and number of pretreatment arrests. They found that Multisystemic Therapy (MST) had no statistically significant impacts on any of the moderator variables.
These sources were used in the development of the program profile:
Study 1
Henggeler, Scott W., Gary B. Melton, and Linda A. Smith. 1992. “Family Preservation Using Multisystemic Therapy: An Effective Alternative to Incarcerating Serious Juvenile Offenders.” Journal of Consulting and Clinical Psychology 60(6):953–61.
Study 2
Borduin, Charles M., Barton J. Mann, Lynn T. Cone, Scott W. Henggeler, Bethany R. Fucci, David M. Blaske, and Robert A. Williams. 1995. “Multisystemic Treatment of Serious Juvenile Offenders: Long-Term Prevention of Criminality and Violence.” Journal of Consulting and Clinical Psychology 63(4):569–78.
Study 3
Timmons–Mitchell, Jane, Monica B. Bender, Maureen A. Kishna, and Clare C. Mitchell. 2006. “An Independent Effectiveness Trial of Multisystemic Therapy With Juvenile Justice Youth.” Journal of Clinical Child and Adolescent Psychology 35:227–36.
These sources were used in the development of the program profile:
Barnoski, Robert. 2009. Providing Evidence-Based Programs With Fidelity in Washington State Juvenile Courts: Cost Analysis (Document No. 09–12–1201). Olympia, Wash.: Washington State Institute for Public Policy.
http://www.wsipp.wa.gov/rptfiles/09-12-1201.pdfCurtis, Nicola M., and Kevin R. Ronan. 2004. “Multisystemic Treatment: A Meta-Analysis of Outcome Studies.” Journal of Family Psychology 18(3):411–19.
Henggeler, Scott W. 1997. “Treating Serious Antisocial Behavior in Youth: The MST Approach.” Juvenile Justice Bulletin. Washington, D.C.: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention.
http://www.ncjrs.gov/pdffiles/165151.pdfHenggeler, Scott W., Gary B. Melton, Linda A. Smith, Sonja K. Schoenwald, and Jerome H. Hanley. 1993. “Family Preservation Using Multisystemic Treatment: Long-Term Follow-Up to a Clinical Trial With Serious Juvenile Offenders.” Journal of Child and Family Studies 2:283–93.
Henggeler, Scott W., Gary B. Melton, Michael J. Brondino, David G. Scherer, and Jerome H. Hanley. 1997. “Multisystemic Therapy With Violent and Chronic Juvenile Offenders and Their Families: The Role of Treatment Fidelity in Successful Dissemination.” Journal of Consulting and Clinical Psychology 65(5):821–33.
Henggeler, Scott W., J. Douglas Rodick, Charles M. Borduin, Cindy L. Hanson, Sylvia M. Watson, and Jon R. Urey. 1986. “Multisystemic Treatment of Juvenile Offenders: Effects on Adolescent Behavior and Family Interactions.” Development Psychology 22(1):132–41.
Henggeler, Scott W., Phillippe B. Cunningham, Susan G. Pickrel, Sonja K. Schoenwald, and Michael J. Brondino. 1996. “Multisystemic Therapy: An Effective Violence Prevention Approach for Serious Juvenile Offenders.” Journal of Adolescence 19(1):47–61.
Henggeler, Scott W., Sharon F. Mihalic, Lee Rone, Christopher R. Thomas, and Jane Timmons–Mitchell. 1998. Blueprints For Violence Prevention, Book 6: Multisystemic Therapy. Boulder, Colo.: Center for the Study and Prevention of Violence.
Henggeler, Scott W., Sonja K. Schoenwald, Charles M. Borduin, Melisa D. Rowland, and Phillippe B. Cunningham. 2009. Multisystemic Therapy for Antisocial Behavior in Children and Adolescents (Second Edition). New York, N.Y.: Guilford Press.
Mitchell–Herzfeld, Susan, Therese A. Shady, Janet Mayo, Do Han Kim, Kelly Marsh, Vajeera Dorabawila, and Faye Rees. 2008. Effects of Multisystemic Therapy (MST) on Recidivism Among Juvenile Delinquents in New York State. New York, N.Y.: New York State Office of Children and Family Services.
https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=257230Ogden, Terje, and Kristine Amlund Hagen. 2006. “Multisystemic Therapy of Serious Behavior Problems in Youth: Sustainability of Therapy Effectiveness 2 Years After Intake.” Child and Adolescent Mental Health 11(3):142–49.
Ogden, Terje, and Colleen A. Halliday–Boykins. 2004. “Multisystemic Treatment of Antisocial Adolescents in Norway: Replication of Clinical Outcomes Outside of the United States.” Child and Adolescent Mental Health 9:76–82.
Schaeffer, Cindy M., and Charles M. Borduin. 2005. “Long-Term Follow-Up to a Randomized Clinical Trial of Multisystemic Therapy With Serious and Violent Juvenile Offenders.” Journal of Consulting and Clinical Psychology 73(3):445–53.
Following are CrimeSolutions-rated programs that are related to this practice:
The practice of using traditional juvenile justice system processing in lieu of alternative sanctions to deal with juvenile criminal cases. The practice is rated No Effects for reducing recidivism compared to the youth that were diverted from the system. Test
Evidence Ratings for Outcomes
Crime & Delinquency - Multiple crime/offense types |
In general family-based treatment practices consist of a wide range of interventions that are designed to change dysfunctional family patterns that contribute to the onset and maintenance of adolescent delinquency and other problem behaviors. This practice is rated Effective for reducing recidivism, and Promising for reducing antisocial behavior and substance use, and improving psychological functioning and school performance.
Evidence Ratings for Outcomes
Crime & Delinquency - Multiple crime/offense types | |
Mental Health & Behavioral Health - Externalizing behavior | |
Drugs & Substance Abuse - Multiple substances | |
Mental Health & Behavioral Health - Psychological functioning | |
Education - Academic achievement/school performance |
This practice involves the use of psychosocial interventions to reduce antisocial behavior in juveniles. Psychosocial interventions consist of both preventive and therapeutic interventions but share the common goal of improving psychosocial functioning. The practice is rated Effective for the reduction of antisocial behavior.
Evidence Ratings for Outcomes
Juvenile Problem & At-Risk Behaviors - Antisocial behaviors |
Age: 12 - 17
Gender: Male, Female
Race/Ethnicity: White, Black, Hispanic, Other
Geography: Suburban Urban Rural
Setting (Delivery): Other Community Setting, Home
Program Type: Alternatives to Detention, Cognitive Behavioral Treatment, Conflict Resolution/Interpersonal Skills, Family Therapy, Individual Therapy, Parent Training
Targeted Population: Serious/Violent Offender, Young Offenders
Current Program Status: Active
326 Calhoun Street, 4th Floor, McClennan Banks Building 326 Calhoun Street, 4th Floor, McClennan Banks Building 710 Johnnie Dodds Blvd., Suite 200
Professor
Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
SC 29425-9401
United States
Email
Scott W. Henggeler
Professor
Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
Charelston, SC 29425-9401
United States
Email
Marshall E. Swenson
Manager of New Program Development
MST Services
Mount Pleasant, SC 29464
United States
Website
Email