Program Goals

The overall goals of Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) are:

• Youth is currently living at home.
• Youth is attending school (is not truant) or vocational training; youth may have a job if of a legally appropriate age not to attend school.
• Youth has not been arrested for an offense since the beginning of MST-PSB treatment.
• Youth has demonstrated an absence of any problem sexual behavior and no sexually related arrests or substantiated child abuse investigations.

Logic Model

The program representative did not provide information about a Logic Model for Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB).

Essential Components

The essential components of Multisystemic Therapy for Problem Sexual Behavior (MST-PSB) include:

• MST-PSB is an adaptation of MST that was developed for 10- to 17.5-year-old youth with sexually related externalizing delinquent behaviors, including aggressive (e.g., sexual assault, rape) and non-aggressive (e.g., molestation of younger children) sexual offenses. Youth may also exhibit the following characteristics:
• At imminent risk of out-of-home placement due to criminal offenses
• Physical aggression at home or school or in the community
• Verbal aggression and threats of harm to others
• Substance abuse in the context of the problems listed above
• Programs will need to exclude:
• Youth living independently or youth for whom a primary caregiver cannot be identified despite extensive efforts to locate all extended family, adult friends, and other potential surrogate caregivers
• Youth referred primarily due to concerns related to suicidal, homicidal, or psychotic behaviors
• Youth with pervasive developmental delays
• Intervention Context:
• Services are provided in the family's home or other convenient places and at times convenient to the family.
• Services are intensive, with intervention sessions conducted from once a week to every day.
• A 24 hour/7 day per week on-call schedule is utilized to provide round-the-clock availability of clinical services for families.
• Therapists and Supervisors:
• MST-PSB staff members work on a clinical team of 2-4 therapists and a supervisor.
• MST-PSB therapists are Master's-prepared (clinical-degreed) professionals.
• MST-PSB clinical supervisors must be allocate at least 50% of their time to each MST-PSB team and may supervise 1-2 teams only.
• MST-PSB clinical supervisors are, at minimum, highly skilled Master's-prepared clinicians with training in behavioral and cognitive-behavioral therapies and pragmatic family therapies (i.e., Structural Family Therapy and Strategic Family Therapy).
• Application of the Intervention:
• Interventions are developed using an analytical model that guides the therapist to assess factors that are driving the key clinical problems, and then in designing interventions that are applied to these driving factors or "fit factors".
• Each therapist carries a maximum caseload of 4 families and case length ranges from 5 to 7 months.
• Clinical Supervision:
• The MST-PSB clinical supervisor conducts on-site weekly team clinical supervision, facilitates the weekly MST-PSB telephone consultation, and is available for individual clinical supervision for crises.
• Program Monitoring and Use of Data:
• Agencies collect data as specified by MST Services/MST Associates, and all data are sent to the MST Institute (MSTI), which is charged with keeping the national database system
• MSTI data reports are used to assess and guide program implementation.
• Agencies use these reports to monitor and assure fidelity to the MST-PSB model.
• Agency:
• The agency must have community support for sustainability.
• With the buy-in of other organizations and agencies, MST-PSB staff is able to "take the lead" for clinical decision-making on each case.
• Stakeholders in the overall MST-PSB program have responsibility for initiating these collaborative relationships with other organizations and agencies while MST-PSB staff sustains them through ongoing, case-specific collaboration.

Program Delivery

Child/Adolescent Services

Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) directly provides services to children/adolescents and addresses the following:

• Sexually related externalizing, delinquent behaviors, including aggressive (e.g., sexual assault, rape) and non-aggressive (e.g., molestation of younger children) sexual offenses; other externalizing behaviors such as verbal and physical nonsexual aggression, substance abuse, truancy, and criminal activity that interfere with youth/family functioning and/or may result in the youth being placed outside of the home are also addressed

Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Family therapy (using a Structural and/or Strategic Family Therapy approach) is a primary treatment modality within MST-PSB, and the vast majority of treatment sessions focus on the family system. As an in-home, community- based model that focuses on all elements of the youth's natural ecology, the family is engaged as a central change agent for the youth's behavior. Extended family members are often engaged in treatment interventions along with nuclear family members. Long-term outcomes and generalization of acquired skills are hoped to be enhanced by this strength-based, ecological approach in which caregivers are supported in managing youth behaviors across the systemic elements of their ecology (e.g., school, community, peer relationships).

Parent/Caregiver Services

Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) directly provides services to parents/caregivers and addresses the following:

• Denial, minimization, and or victim blaming; difficulty managing anger, substance abuse, and barriers to effective parenting (e.g., untreated mental illness, excessive stress)

Recommended Intensity:

Frequency and intensity of treatment are dependent on the unique needs of the youth and family. In general, families receive three or more contacts per week with the average contact lasting 1-2 hours. However, if the family is in crisis or urgent needs arise, the amount of contact will likely be even greater. During the latter stages of treatment, session frequency may lessen to promote more autonomy and generalization of treatment effects.

Recommended Duration:

5-7 months

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Foster / Kinship Care
• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) includes a homework component:

A number of the core treatment principles in MST support the concept of youth and family work between sessions. Youth and caregiver interventions are designed to require continuous effort, increase client responsibility, require action oriented behaviors, and promote generalization of skills through practice. Thus weekly goals are collaboratively developed with the family that, for example, support the acquisition of newly learned behaviors, the monitoring of interventions to gauge effectiveness, and tracking behavioral baselines.

Languages

Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) has materials available in languages other than English:

Danish, Dutch, Japanese, Norwegian, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Office space to house the team and conduct consultation and supervision is required. All team members must also have cell phones and access to computers. Each team must have at least one video camera (for training and quality assurance purposes).

Manuals and Training

Prerequisite/Minimum Provider Qualifications

The supervisor must have an understanding of the juvenile justice system, experience with family therapy and cognitive-behavioral therapy, and experience in managing severe family crises that involve safety risk to the family.

Supervisors are, at a minimum, highly skilled Master's-prepared clinicians with training in behavioral and cognitive behavioral therapies and pragmatic family therapies (i.e., Structural Family Therapy and Strategic Family Therapy).

Therapists must have a Master's degree in a mental health-related field.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:

• Russell Borduin, PhD
  MST Associates
  www.mstpsb.com
  info@mstpsb.com

Training Type/Location:

With regard to the standard MST orientation 5-day training, organizations can obtain the training in one of three ways. New staff can come to Charleston, SC, and participate in one of the quarterly open-enrollment trainings provided by the Multisystemic Therapy Services (MSTS). Or, organizations can send staff to any 5-day trainings provided by Licensed MST Network Partners (see a list of licensed Network Partners at www.mstservices.com). Alternatively, providers can elect to have MSTS conduct the 5-day initial training at the provider site.

MST-PSB specific 2-day orientation training can only be obtained via MST Associates (the sole dissemination agent for MST-PSB). Initial training for new MST-PSB teams is delivered on site as an integrated component of program start up. Training for subsequent hires typically occurs off site. Contact the MST-PSB Director of Clinical Training for further information.

Number of days/hours:

All trainees must first complete the standard MST 5-day orientation. An additional 2 day orientation training covering the unique aspects and augmentations of the MST-PSB clinical model is then required.

After program start-up, training continues through weekly telephone consultation for each team of clinicians aimed at monitoring treatment fidelity and adherence to the treatment model, and through quarterly on-site booster trainings (1 1/2 days each). Trained experts teach the supervisor to implement a manualized supervisory protocol and collaborate with the supervisor to promote the ongoing clinical development of all team members. Experts also assist at the organizational level as needed.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) as listed below:

MST Associates completes a comprehensive site assessment when launching a new MST-PSB team. A number of specific assessment and planning forms/tools are utilized in the site assessment process. These include, but are not limited to, tools and forms that:

• Ensure agency readiness to embrace program fidelity
• Identify and assess community stakeholders and the level of needed support
• Assess economic sustainability
• Assess for stakeholder support and/or any barriers to success of program.

In addition, an MST-PSB consultant is available for telephonic stakeholder interviews to assess for support and/or to identify any barriers to success of program. Inquiries into delivering MST- PSB can be directed to Richard J. Munschy, PsyD, Clinical Training Director, MSTA (contact information in training section). Initial feasibility assessment, including needs assessment and organizational readiness among others, is conducted by phone and supported by specific assessment tools at that time.

Formal Support for Implementation

There is formal support available for implementation of Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) as listed below:

The comprehensive site assessment mentioned above includes, but is not limited to:

• Ensuring a clear and comprehensive understanding of the fidelity and organizational requirements of delivering the model
• Identifying key stakeholders who will be involved or impacted by the project
• Formulating specific treatment population parameters and referral processes
• Establishing benchmarked outcome measures
• Supporting fiscal projections and budgets
• Supporting effective staff selection and recruitment
• Providing a community presentation prior to team launch
• Facilitating stakeholder meetings to establish the goals and guidelines of the program

Once the team has been launched, MSTA provides ongoing weekly clinical consultation for the team (via phone) designed to provide ongoing support and training and to ensure model fidelity. In addition, separate support/training calls are delivered to the team supervisors to enhance supervisor skills, ensure fidelity at the therapy supervisory and organizational level, and to continue training within the model.

In addition to the initial orientation training provided to the team (seven full days: five days of standard MST Orientation and two days of MST-PSB Orientation Training), booster trainings are delivered onsite quarterly. Six-Month Program Implementation Reports are generated in collaboration with the team supervisor to report on fidelity measures, outcomes, and utilization. Careful analysis of these findings are coupled with specific recommendations designed to pursue high fidelity and superior outcomes.

Fidelity Measures

There are fidelity measures for Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) as listed below:

MST- PSB utilizes standard MST fidelity measures and protocols. These include the following instruments:

• The Therapist Adherence Measure-Revised (TAM- R) which is completed by the caregivers of the referred youth and is designed to assess the therapist's fidelity to the MST treatment principles
• The Supervisor Adherence Measure (SAM) a 36-item measure that evaluates the MST Supervisor's adherence to the MST model of supervision as reported by MST Therapists. This measure is based on the principles of MST and the model of supervision presented in the MST Supervisor's Manual
• The Consultant Adherence Measure (CAM), a 23-item measure that evaluates the MST Consultant's adherence to the MST model of consultation as reported by MST Therapists and Supervisors. This measure is based on the principles of MST and the model of consultation presented in the Multisystemic Therapy Consultation Manual.

In addition, fidelity to organizational practices is reviewed consistently and reported upon every six months via the required and recommended program practice section of the Program Implementation Review Report.

All MST- PSB teams' fidelity measure scores and treatment outcomes are stored in an international database maintained by the MST Institute. This allows for rapid comprehensive assessment of fidelity and outcome trends at any given time and real time quality assurance/intervention.

Implementation Guides or Manuals

There are implementation guides or manuals for Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) as listed below:

The site assessment and program launch process are clearly outlined in detail in an MST consultation manual. Each site receives step-by-step instruction and support for the complete assessment and implementation process from an MST-PSB consultant. Ongoing program implementation is guided by the MST Organizational Manual and informed by the Six-month Program Implementation Reports.

Research on How to Implement the Program

Research has not been conducted on how to implement Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Additional References