Multisystemic Therapy Research Articles

Testing Whether Multisystemic Therapy for Emerging Adults Can Reduce Their Justice System Involvement

Testing Whether Multisystemic Therapy for Emerging Adults Can Reduce Their Justice System Involvement

Multisystemic Therapy for Children with Conduct Disorder

In the U.S., multisystemic therapy (MST) has been found effective for childhood conduct disorders, but the studies were conducted by the therapy's

Multisystemic Therapy and Functional Family Therapy Compared on their Effectiveness Using the Propensity Score Method

Multisystemic Therapy (MST) and Functional Family Therapy (FFT) have overlapping target populations and treatment goals. In this study, these interventions were compared on their effectiveness using a quasi-experimental design. Between October, 2009 and June, 2014, outcome data were collected from 697 adolescents (mean age 15.3 (SD 1.48), 61.9% male) assigned to either MST or FFT (422 MST; 275 FFT). Data were gathered during Routine Outcome Monitoring. The primary outcome was externalizing problem behavior (Child Behavior Checklist and Youth Self Report). Secondary outcomes were the proportion of adolescents living at home, engaged in school or work, and who lacked police contact during treatment. Because of the non-random assignment, a propensity score method was used to control for observed pre-treatment differences. Because the risk-need-responsivity (RNR) model guided treatment assignment, effectiveness was also estimated in youth with and without a court order as an indicator of their risk level. Looking at the whole sample, no difference in effect was found with regard to externalizing problems. For adolescents without a court order, effects on externalizing problems were larger after MST. Because many more adolescents with a court order were assigned to MST compared to FFT, the propensity score method could not balance the treatment groups in this subsample. In conclusion, few differences between MST and FFT were found. In line with the RNR model, higher risk adolescents were assigned to the more intensive treatment, namely MST. In the group with lower risk adolescents, this more intensive treatment was more effective in reducing externalizing problems.

Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): a pragmatic, randomised controlled, superiority trial

Adolescent antisocial behaviour is a major health and social problem. Studies in the USA have shown that multisystemic therapy reduces such behaviour and the number of criminal offences committed by this group. However, findings outside the USA are equivocal. We aimed to assess the effectiveness and cost-effectiveness of multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour. We did an 18 month, multisite, pragmatic, randomised controlled, superiority trial in England. Eligible participants aged 11-17 years with moderate-to-severe antisocial behaviour had at least three severity criteria indicating past difficulties across several settings and one of five general inclusion criteria for antisocial behaviour. We randomly assigned families (1:1) using stochastic minimisation, stratifying for treatment centre, sex, age at enrolment to study, and age at onset of antisocial behaviour, to receive either management as usual or 3-5 months of multisystemic therapy followed by management as usual. Research assistants and investigators were masked to treatment allocation; the participants could not be masked. The primary outcome was out-of-home placement at 18 months. The primary analysis included all randomised participants for whom data were available. This trial is registered, number ISRCTN77132214. Follow-up of the trial is still ongoing. Between Feb 4, 2010, and Sept 1, 2012, 1076 families were referred to nine multi-agency panels, 684 of whom were assigned to management as usual (n=342) or multisystemic therapy followed by management as usual (n=342). At 18 months, the proportion of participants in out-of-home placement was not significantly different between the groups (13% [43/340] in the multisystemic therapy group vs 11% [36/335] in the management-as-usual group; odds ratio 1·25, 95% CI 0·77-2·05; p=0·37). The findings do not support that multisystemic therapy should be used over management as usual as the intervention of choice for adolescents with moderate-to-severe antisocial behaviour. Department for Children, Schools and Families, Department of Health.

Multisystemic therapy not superior to management as usual for adolescent antisocial behaviour in an English trial

Child and adolescent conduct problems are common, persistent, and impairing; young people are disadvantaged by them, families suffer, and society is affected in the long term through waste of talent and accumulation of economic costs.1,2 Therefore, promising treatment options should be carefully evaluated.

Factorial Structure of the Therapist Adherence Measure-Revised (TAM-R) Within Multisystemic Therapy

Abstract. The Therapist Adherence Measure (TAM-R) is a central assessment within the quality-assurance system of Multisystemic Therapy (MST). Studies into the validity and reliability of the TAM in the US have found varying numbers of latent factors. The current study aimed to reexamine its factor structure using two independent samples of families participating in MST in the Netherlands. The factor structure was explored using an Exploratory Factor Analysis (EFA) in Sample 1 ( N = 580). This resulted in a two-factor solution. The factors were labeled “therapist adherence” and “client–therapist alliance.” Four cross-loading items were dropped. Reliability of the resulting factors was good. This two-factor model showed good model fit in a subsequent Confirmatory Factor Analysis (CFA) in Sample 2 ( N = 723). The current finding of an alliance component corroborates previous studies and fits with the focus of the MST treatment model on creating engagement.

Economic Impact of the Statewide Implementation of an Evidence-Based Treatment: Multisystemic Therapy in New Mexico

Several states have made considerable investments into large-scale implementation of evidence-based treatments (EBTs), yet little is known about key success indicators for these implementation efforts such as cost and sustainability. To that end, the present study examined the economic impact of statewide implementation of multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cuningham, 2009), a family- and community-based behavioral EBT for serious juvenile offenders in New Mexico. Participants were 1,869 youth who received MST across 23 teams during the study period. We conducted a cost-benefit analysis using metrics from state data sources that compared the cost of MST to its benefits (i.e., avoided expenses from pre- to posttreatment) in two domains: (a) behavioral health services (i.e., Medicaid claims) and (b) juvenile crime (i.e., taxpayer expenses, tangible and intangible expenses to crime victims). MST costs were based on Medicaid claims, which were reimbursed at an enhanced billing rate that was intended to cover expenses for both clinical and implementation (e.g., training, quality assurance) activities. Results suggest that implementation of MST in New Mexico over the 7-year study period may have produced net benefits, through 2 years posttreatment, of more than $4,643 per youth in avoided behavioral health claims and $15,019 per youth through reductions in juvenile crime. Stated differently, every dollar that New Mexico spent on MST appeared to have returned $3.34 for a total benefit of $64.2 million over the course of the study. We discuss implications of these findings for policymakers, administrators, and researchers who are interested in increasing the sustainability of complex EBTs in community settings.

Therapists' and Clients' Perceptions of Bonding as Predictors of Outcome in Multisystemic Therapy®.

This longitudinal study examined whether strength of and balance in self-reported caregiver, youth, and therapist emotional bonds in mid- and late treatment predicted outcomes in Multisystemic Therapy of adolescent behavior problems in a sample of 164 caregiver-youth dyads. Strength of and balance in bonds related to outcome in different ways, depending on the source of the report and time. Results showed a limited association between family members' emotional connection with the therapist and treatment outcome, whereas therapists' perceptions of bond with the caregiver showed highly significant associations across time. Caregiver-therapist agreement on emotional connection at both time points predicted therapist evaluation of treatment success and successful termination, but this was largely explained by therapists' level of alliance. Balance in bonds with the therapist between caregiver and youth had no significant associations with any outcome. The study major limitations such as examining only one component of alliance and possible implications are discussed.

Efficacy of multisystemic therapy in youths aged 10-17 with severe antisocial behaviour and emotional disorders: systematic review.

BackgroundAntisocial behaviour and conduct disorders are the most common behavioural and mental health problems in children and young people globally. An efficacious intervention is needed to manage these antisocial behaviours that have costly consequences. Multisystemic Therapy (MST), an intensive home-based intervention for youths with psychosocial and behavioural problems, is recommended under National Institute for Health and Clinical Excellence guidelines for conduct disorder. However, reviews on the efficacy of MST are mixed.AimTo review randomised controlled trials (RCTs) reporting efficacy of MST among youths presenting with antisocial behaviour and emotional disorder respectively.MethodA systematic map term to subject heading search was conducted in PsycINFO, Embase, and Ovid Medline databases for articles up to November 2015. RCTs comparing MST vs.treatment as usual (TAU) in youths presenting with antisocial behaviour and emotional disorder were included.Results12 RCTs (n = 1425) reported efficacy of MST vs. TAU in youths presenting with antisocial behaviour and emotional disorder. Clinically significant treatment effects of MST showed a reduction of antisocial behaviour which includes delinquency. MST, vs. psychiatric hospitalisation, was associated with a reduction of suicidal attempts in youths presenting with psychiatric emergencies. 4 studies showed that MST was less costly than TAU in the short term, with further analysis required for long-term cost-effectiveness.ConclusionMST is an efficacious intervention for severe antisocial behaviours in reduction of delinquency and should be included in clinical practices. MST was shown to have a positive effect on emotional disorder but further research is needed to evaluate the efficacy of MST with emotional disorder. Further analysis is required to assess the services utilized for long-term cost effectiveness.

11 Forensic issues in adult attendees to a specialist tourette syndrome service

Objective To examine the frequency of forensic issues in patients attending a Tourette’s syndrome (TS) clinic in relation to comorbid conditions and other possible risk factors. Method Clinical notes of 223 attenders over the age of 17 to the Tourette syndrome clinic at St George’s Hospital were analysed. The information recorded for each patient included diagnoses (including co-morbidities), illicit drug usage, forensic history, family history of criminality. For the purposes of this study ‘forensic issues’ included any formal interactions with the police, including cautions. Results Of the 223 patients, 71% were male, 39 had forensic Issues (17.5%) of which 8 had received prison sentences, including 2 suspended sentences. Tic severity was not recorded in a uniform way for all patients, but 79% were rated on a clinicians’ global impression, as severe in 19% of forensic cases v 10% of controls (NS). Comorbid conditions were more prevalent in the presence of forensic issues: Oppositional Defiant Disorder (ODD) (31% v 13% *significant), Conduct Disorder diagnosed as a child (CD) (18% v 2% *), Attention Deficit Hyperactivity Disorder (ADHD) (67% v 41% *), Obsessive Compulsive Disorder (40% v 27% NS) and depression (26% v 22% NS). Personality disorder was recorded in only 5/223 (2.2%) patients as a whole and was almost certainly clinically under-ascertained. Substance misuse was seen in 59% of the forensic group v 22% of controls * including cannabis (n=54), MDMA (21), cocaine (18), amphetamine (10), prescription drugs (4), LSD (3), “acid” (3), ketamine (2), “mushrooms” (2), solvents (1). Those receiving prison sentences all had multiple co-morbidities. A family forensic history was seen in 21% v 11% of controls (NS). Conclusion These data showed that 17.5% of this predominantly male patient group had had forensic issues. It is difficult to assess the significance of this figure as there could be important psychosocial factors that have not been included in the analysis and in some cases police involvement was in a phase of life earlier than the clinical assessment. We included a wide range of seriousness of offences/alleged offences. We found significantly increased ODD and CD (childhood diagnoses), ADHD and substance misuse in the forensic group but not a significantly higher proportion of severe tic disorders. In common with the general forensic literature, these are risk factors that could be actively addressed in the younger age group eg parenting programmes, CBT for impulsivity and multisystemic therapy.

The Allocation of Sexually Transgressive Juveniles to Intensive Specialized Treatment: An Assessment of the Application of RNR Principles.

The aim of this study was to compare results of and develop guidelines for mandatory allocation of sexually transgressive juveniles to Multisystemic Therapy - Problem Sexual Behavior (MST-PSB), Secure Youth Care (SYC), or Forensic Youth Care (FYC), based on the risk-need-responsivity model. Results of current allocation showed a population with relatively less treatment needs to receive community-based MST-PSB, compared with populations receiving residential SYC and FYC. Furthermore, estimated recidivism risk levels did not always support the need for risk reduction by the imposition of limitation of freedom of movement and maximum supervision, provided by all three treatment modalities. Based on the assessed sexual recidivism risk, 38% of the juveniles in FYC, 7% in SYC, and 24% in MST-PSB received treatment that was too intensive, which is considered detrimental to motivation and development. Future allocation practices could benefit from assessing treatment needs and recidivism risk, by use of an actuarial tool.

What Works for Adolescent Black Males at Risk of Suicide: A Review.

We reviewed the controlled studies that report outcome findings for Black adolescent males 24 years of age and younger at risk of suicide. Our review identified 48 articles published from 2000 to 2015, 33 that met our initial criteria for full-text articles review, resulting in 6 that met all inclusion criteria. We sought to understand what works for Black males experiencing suicide ideation or engaging in suicidal behaviors (e.g., attempts). We identified crossover effects for multisystemic therapy for reducing the risk for suicide ideation and attempts. Attachment-based family therapy was salient for use as a component of clinical practice for Black males being treated for suicide ideation. While remaining randomized control trials did involve Black youth, dis-aggregated data based on ethnicity and gender were not reported. Overall, the located studies are too few to provide unequivocal guidance for practice.

Treating Mental Illness Among Diabetic Black Male Adolescents: A Review.

To examine randomized controlled trials (RCTs) for treatment evidence for Black male adolescents suffering from comorbid mental illness and diabetes mellitus. A review of the studies published in English-language journals was conducted. We found no RCT focused on Black males with diabetes mellitus Type 2 (DMT2). However, we found RCT inclusive of Black male adolescents with diabetes mellitus Type 1 (DMT1). Multisystemic therapy appears to be the best supported overall treatment for DMT1 management and psychosocial functioning followed by an enhanced form of behavioral family systems therapy for diabetics. Metformin was the only treatment in this review noted for use within DMT2. Metformin and a nursing-based telephone case management intervention realized utility as secondary services. There are gaps present for what effectively treats comorbid mental illness and DMT2 in Black male adolescents. For comorbid mental illness and DMT1, there are gaps in additional efficacious treatments, effectiveness across conditions, and effect duration beyond 24 months.

The effectiveness of multi-systemic family therapy in bullying behavior of adolescents

IntroductionMulti-systemic family therapy is a type of psychotherapy that base on the assumption that all kinds of difficulties in individuals are at least partly explained by dysfunctions in the family system and other systems to which the individual belongs.ObjectivesThis study examined associations between bullying behavior and family ethos, and provides data for changes after treatment with Multi-systemic family therapy-Integrative model, as a culturally sensitive approach.MethodsThirty-six adolescents with bullying behavior and their families were evaluated. Participants were randomly assigned into two groups: Family therapy group (FT-G) and Control group (CG). The FT-G was treated with integrative model for 6 months; the focus of FT sessions was on proximity-control goals and plans, bugs in the plans, emotive, and types of relations between family members programs. The CG was treated with the same frequency as the FT-G, but with interventions consisting of a detailed survey of their mental health, adolescents’ feelings, daily routines and life events. Every month, data were collected through interviews, questionnaires, observation facilitating techniques and observations of a family play therapy.ResultsIn the study participated 36 outpatient adolescents ages 14–16. Seventeen adolescents were male and 19 female (Fig. 1).ConclusionsAt baseline, 70 percent of participants met criteria for more than one of the following disorders, by ICD-10: conduct disorder, substance use, bulimia, borderline personality disorder, and attention deficit/hyperactivity disorder. Six months after the baseline measurement, there was a significant decrease in bullying behavior, substance use, smoking, excessive social media use, and anger control for the FT-G compared with the CG.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Special issue: double joy ‐ Asian Chinese families and Multisystemic Therapy (MST)

Special issue: double joy ‐ Asian Chinese families and Multisystemic Therapy (MST)

Corrigendum

Journal of Family TherapyVolume 39, Issue 2 p. 284-284 CorrigendumFree Access Corrigendum This article corrects the following: Comment on Patricia Moran: ‘Selecting self-report outcome measures for use in family and systemic therapy’ Judith Lask, Volume 39Issue 1Journal of Family Therapy pages: 60-62 First Published online: December 12, 2016 First published: 22 March 2017 https://doi.org/10.1111/1467-6427.12160AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL In Lask (2017), the following error was published on page 62. The last reference: The, Y. Y., Lask, J. and Stratton, P. (2015) From family to Relational SCORE-15. An alternative adult version of a systemic self report measure for couples and LGBT people. Journal of Family Therapy, this volume. First author's surname was spelt incorrectly and should have read: Teh, Y. Y., Lask, J. and Stratton, P. (2015) From family to Relational SCORE-15. An alternative adult version of a systemic self report measure for couples and LGBT people. Journal of Family Therapy, this volume. We apologize for this error. Reference Lask, J. (2017) Comment on Patricia Moran: ‘Selecting self-report outcome measures for use in family and systemic therapy’. Journal of Family Therapy, 39: 60– 62. Volume39, Issue2Special Issue: double joy ‐ Asian Chinese families and Multisystemic Therapy (MST)April 2017Pages 284-284 ReferencesRelatedInformation

Placement and Delinquency Outcomes Among System-Involved Youth Referred to Multisystemic Therapy: A Propensity Score Matching Analysis.

Multisystemic therapy (MST) was developed to help youth with serious social, emotional, and behavioral problems. Research on the efficacy and effectiveness of MST has shown positive outcomes in different domains of development and functioning among various populations of youth. Nonetheless, even with a large body of literature investigating the treatment effects of MST, few studies have focused on the effectiveness of MST through large-scale dissemination efforts. Utilizing a large sample of youth involved in a statewide dissemination of MST (n = 740; 43% females; 14% Black; 29% Hispanic; 49% White; Mage = 14.9 years), propensity score matching was employed to account for baseline differences between the treatment (n = 577) and comparison (n = 163) groups. Treatment effects were examined based on three outcomes: out-of-home placement, adjudication, and placement in a juvenile training school over a 6-year period. Significant group differences remained after adjusting for baseline differences, with youth who received MST experiencing better outcomes in offending rates than youth who did not have an opportunity to complete MST due to non-clinical or administrative reasons. Survival analyses revealed rates of all three outcomes were approximately 40% lower among the treatment group. Overall, this study adds to the body of literature supporting the long-term effectiveness of MST in reducing offending among high-risk youth. The findings underscore the potential benefits of taking evidence-based programs such as MST to scale to improve the well-being and functioning of high-risk youth. However, strategies to effectively deliver the program in mental health service settings, and to address the specific needs of high-risk youth are necessary.

Action for Children – Multisystemic therapy, Manchester

Children and Young People NowVol. 2017, No. 2 Special Report Practice: Preventing Care ProceedingsAction for Children – Multisystemic therapy, ManchesterAdam OffordAdam OffordSearch for more papers by this authorAdam OffordPublished Online:4 Dec 2017https://doi.org/10.12968/cypn.2017.2.30AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 17 January 2017Volume 2017Issue 2ISSN (print): 1755-8093ISSN (online): 2515-7582 Metrics History Published online 4 December 2017 Published in print 17 January 2017 Information© MA Education LimitedPDF download

Predictive validity of an observer-rated adherence protocol for multisystemic therapy with juvenile drug offenders

ObjectiveMultisystemic therapy (MST) is perhaps the best validated treatment for youth who engage in serious and chronic antisocial behavior (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2009). Despite evidence suggesting that high treatment adherence is needed to achieve optimal MST outcomes, this research is limited because past studies have relied on adherence reports derived solely from treatment participants (i.e., caregivers, youth, and therapists). To address this gap in the literature, the present study assessed the reliability and predictive validity of an observational protocol for rating adherence to MST. MethodThe sample was drawn from a randomized clinical trial of juvenile drug offenders (77.5% male, 65% African American) referred to one of four treatment conditions (Henggeler et al., 2006). Audiotaped sessions of youth and their families were selected from the first month of MST and trained undergraduate students independently rated therapist adherence to the nine MST treatment principles. We assessed the validity of MST adherence in predicting outcomes at post-recruitment and 12-month follow-up. ResultsGood interrater reliability (ICC=0.642) was found across all raters for our composite index of adherence. High adherence to MST during the first month of therapy predicted decreases in externalizing behavior at post-recruitment and decreases in youth alcohol consumption at 12-month follow-up. ConclusionsThese results provide independent support for the link between treatment fidelity and behavioral outcomes in the context of MST. Further, this study demonstrates the feasibility of using novice, undergraduate judges to reliably code therapist adherence.

It\u2019s not just the Therapist: Therapist and Country-Wide Experience Predict Therapist Adherence and Adolescent Outcome

ObjectiveTherapist adherence is a quality indicator in routine clinical care when evaluating the success of the implementation of an intervention. The current study investigated whether therapist adherence mediates the association between therapist, team, and country-wide experience (i.e. number of years since implementation in the country) on the one hand, and treatment outcome on the other hand. We replicated and extended a study by Löfholm et al. (2014).MethodData over a 10-year period were obtained from 4290 adolescents (12–17 years) with antisocial or delinquent problem behavior, who were treated with Multisystemic Therapy (MST) by 222 therapists, working in 27 different teams in the Netherlands. Multilevel structural equation modeling was used to assess the associations between experience, therapist adherence, and post-treatment outcomes.ResultsTreatment outcomes were directly predicted by therapist experience, countrywide experience, and therapist adherence, but not by team experience. Moreover, therapist adherence mediated the association between therapist and country-wide experience, and treatment outcomes. The association between therapist experience and therapist adherence was not affected by the number of years of team experience or country-wide experience.ConclusionThe effect of country-wide experience on outcome may reflect increasing experience of training and supporting the therapists. It suggests that nation-wide quality control may relate to better therapist adherence and treatment outcome for adolescents treated with systemic therapy.