Multisystemic Therapy (MST) Overview - PowerPoint Presentation

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Multisystemic Therapy (MST) Overview

Presented byMST ServicesRevised – February 2016

Multisystemic Therapy (MST) Overview

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What is “MST”?

Community-based, family-driven treatment for antisocial/delinquent behavior in youthFocus is on “Empowering” caregivers (parents) to solve current and future problems

The MST “client” is the entire

ecology of the youth -

family, peers, school, and neighborhood

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MST Research and Dissemination

Family Services Research Center (FSRC) at the Medical University of South Carolina

MST Services MST Institute

Licensed and affiliated organizations:

MST Network Partner Organizations

Local MST Provider Organizations

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MST Presence Around the World

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Standard MST Teams in

Ohio-2019

Provider Agency

Counties Served

# of Teams

Applewood Center

Cuyahoga and Lorain

2

Buckeye Ranch

Franklin

2

Child

and Adolescent Behavioral Health

Stark, Medina, Wayne, and Holmes

2

Cuyahoga County Juvenile

Court

Cuyahoga

2

Cuyahoga County Dept. Child and Family Services-DCFSCuyahoga2Homes for KidsGeauga, Ashtabula, Trumbull and Mahoning2Family and Community ServicesPortage1Zepf CenterLucas1Total13 Counties14 Teams

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MST “Champions” & Advocates

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Therapy (MST) Overview

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How Does MST Work?

Key Points:

Theoretical a

nd

Research Underpinnings

Assumptions and MST

Theory of Change

How is MST Implemented?

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Therapy (MST) Overview

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Theoretical Underpinnings

Children and adolescents live in a social ecology of interconnected systems that impact their behaviors in direct and indirect ways

These influences act in both directions (they are reciprocal and bi-directional)

Based on social ecological theory of

Uri Bronfenbrenner

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Social Ecological Model

Community

Provider Agency

School

Neighborhood

Peers

Extended Family

Siblings

CHILD

Family Members

Caregiver

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Causal Models of Delinquency and Drug Use:

Common Findings of 50+ Years of Research

Family

School

Delinquent

Peers

Delinquent

Behavior

Prior Delinquent

Behavior

Neighborhood/Community

Context

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Common findings of 50+ years of research: delinquency and drug use are determined by multiple risk factors:

Family (low monitoring, high conflict, etc.)

Peer group (law-breaking peers, etc.)

School (dropout, low achievement, etc.)

Community (

 supports, 

transiency, etc.)

Individual (low verbal and social skills, etc.)

Delinquency is a Complex Behavior

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MST Assumptions

Children’s behavior is strongly influenced by their families, friends, and communities (and vice versa)

Families and communities are central and essential partners and collaborators in MST treatment

Caregivers/parents want the best for their children and want them to grow to become productive adults

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MST Assumptions (Cont.)

Families can live successfully without formal, mandated servicesProfessional treatment providers should be accountable for achieving outcomes

Science/research provides valuable guidance

And…

** Change can

occur quickly

**

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MST Theory of Change

MST

Improved Family Functioning

Peers

School

Reduced Antisocial Behavior and Improved Functioning

Community

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How is MST Implemented?

Intervention strategies: MST draws from research-based treatment techniquesBehavior therapy

Parent management training

Cognitive behavior therapy

Pragmatic family therapies

Structural Family TherapyStrategic Family Therapy

Pharmacological interventions (e.g., for ADHD)

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How is MST Implemented? (Cont.)

Single therapist working intensively with 4 to 6 families at a time3 to 5 months is the typical treatment time (4 months on average across cases)

Work is done in the community, home, school, and neighborhood: removes barriers to service access

Team

of 2 to 4 therapists plus a supervisor

24 hr./ 7 day week team availability: on-call system

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How is MST Implemented? (Cont.)

MST staff deliver all treatment – typically no or few services are brokered/referred outside the MST team

MST

staff must be able to have a “lead” clinical

role, ensuring services are individualized to

strengths and needs of each youth/family

Never-ending focus on engagement and alignment

with primary caregiver and other key stakeholders

(e.g. probation, courts, children and family services, etc.)

MST has strong track record of client retention

and satisfaction

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MST’s Research Heritage

Key Points:35+ years of Science

Consistent OutcomesRole of Model Adherence

Implementation Research Findings

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35+ Years of Science

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Published Outcome

,

Benchmarking

,

and Implementation Studies

Including

25 randomized trials and 28 independent evaluations (yielding >100

peer-reviewed journal articles)

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with serious juvenile offenders

7

independent

studies

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with adolescents with serious conduct problems -10 independent studies

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35+ Years of Science

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Therapy (MST) Overview

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55

Published Outcome

, B

enchmarking

, and I

mplementation Studies (cont’d)

2 with substance abusing or dependent juvenile offenders (MST-Substance Abuse)3 with juvenile sexual offenders (MST-Problem Sexual Behavior)3 with youths presenting serious emotional disturbance (MST-Psychiatric)3 with maltreating families (MST-Child Abuse and Neglect)6 with adolescents with chronic health care conditions (MST-Health Care)Diabetes, obesity, HIV, asthma

13 implementation studies

Complete

list of MST outcome studies:

www.mstservices.com/files/outcomestudies.pdf

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Long-term OutcomesMultisystemic Therapy (MST) Overview

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Very Long-Term OutcomesMultisystemic Therapy (MST) Overview

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Consistent Outcomes

In Comparison with Control Groups, MST:Led to higher consumer satisfactionDecreased long-term rates of re-arrest 25% to 70%

47% to 64% decreases in long-term rates of days in out-of-home placements

Improved family relations and functioning

Increased mainstream school attendance and performance

Decreased adolescent psychiatric symptomsDecreased adolescent substance use

But, none of this happens without adherence to MST

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Quality Assurance and Continuous Quality Improvement in MST

Goal of MST Implementation: Obtain positive outcomes for MST youth and their families

QA/QI Process:

Training and ongoing support (orientation training, boosters, weekly expert consultation, and weekly supervision)

Organizational support for MST programs

Implementation monitoring (measure adherence and outcomes, and work sample reviews)Improve MST implementation as needed, using feedback from training, ongoing support, and measurement

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MST Expert/

Consultant

TAM

Therapist

Adherence

Measure

CAM

Consultant

Adherence

Measure

PIR

Program Implementation Review and other reports

SAM

Supervisor

Adherence

Measure

MST

Coach

Input/feedback via internet-based data collection

Training/support, including MST manuals/materials

MST QA/QI Overview

Output to –

MST Coach

Output to –

MST Expert

Output to –

MST

Supervisor and MST Expert

Output to

–

Organization, Program Stakeholders and MST Coach

MST

Supervisor

MST

Therapist

Youth/

Family

Organizational Context

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MST Quality Assurance System

Research-based adherence measures:TAM – youth criminal charges 36% lower for families with maximum adherence score (1) than for families with minimum adherence score (0)

SAM – youth criminal charges 53% lower for families with maximum SAMSP score (1) than for families with minimum SAMSP score (0)

CAM – consultant/MST expert adherence predicts improved therapist adherence and improved youth outcomes

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MST Transportability Study:

Relationship between TAM-R and Youth Criminal Outcomes (2.3 year follow-up)

TAM-R Predicting Post-Treatment Criminal Charges

0 (Min.)

1 (Max.)

0.64 (Mean)

0.38 (-1 SD)

0.92 (+1 SD)

1.3

1.5

1.7

1.9

2.1

2.3

2.5

0 (Min.)

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1 (Max.)

TAM-R Score

Number of Post-Treatment Charges

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MST Transportability Study:

Relationship between SAM and Youth Criminal Outcomes (2.3 year follow-up)

SAM Structure & Process Predicting Post-Treatment Criminal Charges

0.86 (+1 SD)

1 (Max.)

0 (Min.)

0.76 (Mean)

0.66 (-1 SD)

1

1.5

2

2.5

3

3.5

4

0 (Min.)

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1 (Max.)

Supervisor SAMSP

Number of Post-Treatment Charges

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Questions?

Thank you for your time and attentionmag19@case.eduwww.mstservices.com

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Cost Effectiveness of MST

Washington State Institute for Public Policy (2011)Evaluating “evidence-based” options to reduce the future need for prison beds, save money, and lower crime rates.

Estimated net taxpayers benefits for using MST in lieu of placement: $29,302/youth

Benefits of $4.07 for every $1.00 invested in MST implementation

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Standard MST Referral Criteria (ages 12-17)

Inclusionary CriteriaYouth at risk for placement due to anti-social or delinquent behaviors, including substance abuse

Youth involved with the juvenile justice systemYouth who have committed sexual offenses in conjunction with other anti- social behavior

Exclusionary Criteria

Youth living independently

Sex offending in the absence of other anti social behavior

Youth with moderate to

severe autism

(difficulties

with social communication, social interaction, and repetitive

behaviors)

Actively homicidal, suicidal or psychoticYouth whose psychiatric problems are primary reason leading to referral, or have severe and serious psychiatric problems      31Multisystemic Therapy (MST) Overview

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Missouri Delinquency Project

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Simpsonville Study:

2.4 Year Follow-up

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MST Ultimate Outcomes2015 MSTI Data Report

AT HOME

90%

These results are based on a comprehensive review of the 11,958 cases* (85.4% of 13,995 cases referred for treatment) that were closed for clinical reasons (i.e., completed treatment, low engagement, or placed).

IN SCHOOL/ WORKING

85.6%

NO ARRESTS

86.2%

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Environment of Alignment and Engagement

of Family and Key Participants

Measure

Re-evaluate

Prioritize

Do

Intermediary

Goals

Intervention

Development

MST Conceptualization

of “Fit”

Assessment of

Advances & Barriers to

Intervention Effectiveness

Intervention

Implementation

MST

Analytical

Process

Referral

Behavior

Overarching

Goals

Desired Outcomes

of Family and Other

Key Participants

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How is MST Similar to Other Treatments?

Common Characteristics of Family Preservation Services: Services are provided to the family and individuals

Target children at risk of out-of-home placement

Time-limited, flexibly- scheduled

Tailored to the needs of family members

Services are provided in the context of the family’s values, beliefs, and culture.Low caseloads (2-6), 24hr/7day availability Fraser. 1998

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How is MST Different?

In general, MST differs from other treatments for antisocial behavior in these areas:Research: Proven long-term effectiveness through rigorous scientific evaluations

Treatment theory: A clearly defined and empirically grounded treatment theoryImplementation: A focus on provider accountability and adherence to the model

Focus on long-term outcomes: Empowerment of caregivers to manage future difficulties

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