Program Profile: Multisystemic Therapy for Youth With Problem Sexual Behaviors (MST-PSB)

This program is an adaptation of Multisystemic Therapy, specifically designed for adolescents who have committed sexual offenses and demonstrated other problem behaviors. The program is rated Promising. Program participants had lower rates of self-reported person and property offenses as well as lower rates of arrests for sexual crimes and other crimes, compared with control group participants. These findings were statistically significant.

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

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.

Study 1

Borduin, Schaeffer, and Heiblum (2009) used a randomized control design for 48 juveniles convicted of sex offenses to assess the effectiveness of Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST–PSB) versus usual community services (UCS) to reduce sexual recidivism. The study took place in Missouri. To be included in the study, youth had to meet the following criteria:

• The youth had been arrested for a serious sexual offense (rape/sexual assault, molestation of younger children) with an order for outpatient counseling of those convicted of a sexual offense.
• The youth was currently living with at least one parent figure.
• The youth showed no evidence of psychosis or serious mental retardation.

Recruitment ran from July 1990 through November 1993; follow-up continued through October 2001. The average length of follow up was 8.9 years.

Twenty-four youths were assigned to each condition. The youths included in the study were overwhelmingly (96.5 percent) boys, had a mean age of 14.0 years, and averaged 4.33 previous arrests for sexual and nonsexual felonies. Of the youths, 72.5 percent were white, 27.1 percent were African American, and 2.1 percent indicated Hispanic ethnicity; 31.3 percent lived with only one parental figure. The mean length of treatment/services was 30.8 weeks for MST youth and 30.1 weeks for UCS participants. MST youth had a greater number of behavior problems than did UCS youth; this difference was statistically significant. There were no other statistically significant differences between the groups at baseline. The researchers used an intent-to-treat approach for analysis (two boys in the UCS group were placed in out-of-home placements during the research period).

The MST–PSB participants received individualized interventions in a home-based setting. Youth and their families received multiple contacts each week, averaging 3 hours each week across family, school, peer, and individual systems. The UCS participants received their treatment through the services of the juvenile court. They received 90-minute group therapy sessions twice a week, in groups of four to six, and weekly individual treatment lasting 60 to 90 minutes. The emphases of UCS treatment included the acceptance of personal responsibility for the offense, the elimination of deviant cognitions, the development of new social skills, the development of victim awareness and empathy, and engagement in behaviors/thoughts that prevent relapse.

Outcomes included self-reported person and property offenses, and official records of arrests for sexual crimes and other crimes. Participants completed the Self-Report Delinquency Scale (Elliott et al.1983). Data about arrests came from juvenile and adult criminal records obtained within the state of Missouri. The researchers used ANOVAs to determine whether significant differences existed for the pre- and posttest assessments between the intervention and control groups. The average follow-up time for both groups was 8.9 years. The researchers did not conduct subgroup analyses.

Both a clinical volume (Henggeler and Borduin 1990) and a treatment manual (Henggeler et al. 1998) are available for Multisystemic Therapy (MST). Treatment and training manuals (Borduin et al., 2005) are available for Multisystemic Therapy for Youth With Problem Sexual Behaviors (MST–PSB). More information can be found on the program website: https://www.mstpsb.com/

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:

Therapeutic Treatment for Juveniles Having Committed Sex Offenses

This practice includes a variety of treatment modalities (including cognitive-behavioral therapy, relapse prevention, and multisystemic therapy), which are designed to reduce the risks and harms associated with juveniles at risk of committing sexual offenses. The practice is rated Promising for reducing juveniles’ rates of general recidivism but rated No Effects for reducing sexual recidivism and violent recidivism.

Evidence Ratings for Outcomes

	Crime & Delinquency - Multiple crime/offense types
	Crime & Delinquency - Sex-related offenses
	Crime & Delinquency - Violent offenses

Family-based Treatment for Adolescent Delinquency and Problem Behaviors

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

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