Program Goals

The goals of Multisystemic Therapy (MST) are:

For youth/adolescents:

• Eliminate or significantly reduce the frequency and severity of problem behavior(s).
• Learn skills on how to better cope with family, peer, school, and neighborhood problems.

For parents/caregivers:

• Learn skills to independently address the inevitable difficulties that arise in raising children and adolescents.
• Learn skills to help youth to cope with family, peer, school, and neighborhood problems.

Logic Model

View the Logic Model for Multisystemic Therapy (MST).

Essential Components

The essential components of Multisystemic Therapy (MST) include:

• Target Population:
• Delinquent or antisocial youth who are 12 to 17 years old and may also meet the following criteria:
• Youth at Imminent risk of out-of-home placement due to criminal offenses
• Physical aggression at home, at school, or in the community
• Verbal aggression, verbal threats of harm to others
• Substance abuse in the context of 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 who are actively suicidal, homicidal, or psychotic
• Youths whose psychiatric problems are the primary reason leading to referral, or who have severe and serious psychiatric problems.
• Juvenile sex offenders (sex offending in the absence of other delinquent or antisocial behavior). MST–Problem Sexual Behavior (MST-PSB), however, is an adaptation of MST that is available for youth with externalizing, delinquent behaviors, including aggressive (e.g., sexual assault, rape) and non-aggressive (e.g., molestation of younger children) sexual offenses
• Youth with moderate to severe difficulties with social communication, social interaction, and repetitive behaviors, which may be captured by a diagnosis of autism
• Intervention Context:
• Services are provided in the family's home or other places convenient to them and at times convenient to the family.
• Services are intensive, with intervention sessions being conducted from once per week to daily.
• A 24 hour/7 day/week on-call schedule is utilized to provide round-the-clock availability of clinical services for families.
• Therapists and Supervisors:
• MST staff members work on a clinical team of 2-4 therapists and a supervisor.
• MST therapists are Masters-prepared (clinical-degreed) professionals.
• MST clinical supervisors must be at least 50% part-time and may supervise 1-2 teams only.
• MST clinical supervisors are, at minimum, highly skilled Master's-prepared clinicians with training in behavioral and cognitive behavioral therapies and pragmatic family therapies (e.g., 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."
• All intervention techniques are evidence-based or evidence-informed.
• Each therapist carries a maximum caseload of 6 families and case length ranges from 3 to 5 months.
• Clinical Supervision:
• The MST clinical supervisor conducts on-site weekly team clinical supervision, facilitates the weekly MST 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, and all data are sent to the MST Institute (MSTI) which is charged with keeping the national and international 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 model.
• Agency:
• The agency must have community support for sustainability.
• With the buy-in of other organizations and agencies, MST is able to "take the lead" for clinical decision-making on each case.
• Stakeholders in the overall MST program have responsibility for initiating these collaborative relationships with other organizations and agencies while MST staff sustain them through ongoing, case-specific collaboration.

Program Delivery

Child/Adolescent Services

Multisystemic Therapy (MST) directly provides services to children/adolescents and addresses the following:

• Involvement in the Juvenile Justice system; youth at imminent risk of out-of-home placement due to criminal offenses; physical aggression at home, at school, or in the community; verbal aggression, verbal threats of harm to others; and substance abuse

Parent/Caregiver Services

Multisystemic Therapy (MST) directly provides services to parents/caregivers and addresses the following:

• Difficulty managing anger, substance abuse, and barriers to effective parenting (e.g., untreated mental illness, excessive stress)

Recommended Intensity:

Service intensity varies with the needs of the youth and family. Early in treatment, the therapist may meet with the family several times a week, but as treatment progresses, the intensity tapers. Close to treatment termination, the therapist may only contact the family as needed to assure that treatment gains have been maintained by the family. Throughout treatment, contacts may range from brief check-ins either by telephone or face-to-face, up to two-hour sessions addressing specific treatment issues such as substance misuse, family communication and problem solving.

Recommended Duration:

3-5 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 (MST) includes a homework component:

Homework may be assigned in relation to any of the following interventions:

• Parent Management Training
• Treatment for anger management
• Treatment for caregiver or youth substance abuse
• Family communication training

Languages

Multisystemic Therapy (MST) has materials available in languages other than English:

Norwegian, several other European languages, 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 as well as laptops and cell phones for all staff.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

• The supervisor will benefit from an understanding of the Juvenile Justice and Child Welfare systems and needs experience with family therapy and cognitive-behavioral therapy. The supervisor must have experience in managing severe family crises that involve safety risk to the family.
• 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).
• At least 66% of the therapists must have a Master's degree in counseling or social work.

Manual Information

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

Program Manual(s)

All components of the quality assurance system are manualized. The treatment manual for antisocial behavior is available for purchase from Guilford Press. The other manuals are provided to MST sites. Sites are licensed through MST Services, Inc. (www.mstservices.com), which has the exclusive license for the transport of MST technology and intellectual property developed at the Medical University of South Carolina.

• Henggeler, S. W., & Schoenwald, S. K. (1998). Multisystemic Therapy supervisory manual. The MST Institute.
• Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic Therapy for antisocial behavior in children and adolescents (2nd ed.). Guilford Press.
• MST Services. (2018). Multisystemic Therapy organizational manual. Author.
• Schoenwald, S. K. (1998). Multisystemic Therapy consultation manual. The MST Institute.

Training Information

There is training available for this program.

Training Contact:

• Tom Pietkiewicz, Director of Business Development
  MST Services
  www.mstservices.com/resources-training
  tom.pietkiewicz@mstservices.com
  phone: (843) 352-4306

Training Type/Location:

With regard to the initial 5-day training, organizations can access the training in one of two ways. New staff can come to Charleston, SC, and participate in one of the monthly open-enrollment trainings provided by the company. Alternatively, providers can elect to have the company conduct the 5-day initial training at their site when starting multiple teams at the same time. After start-up, training continues through weekly telephone consultation and on-site quarterly booster trainings for each team of clinicians.

Number of days/hours:

All trainees complete the Standard 5-day orientation. The team participates in weekly consultation with an expert on the intervention, quarterly booster training, ongoing organizational assistance, and quality assurance support through the monitoring of treatment fidelity/adherence.

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. The intervention expert also assists at the organizational level as needed.

Additional Resources:

There currently are additional qualified resources for training:

Agencies that are licensed the parent company as Network Partner Organizations can provide the intervention's 5-day orientation training. See the list at www.mstservices.com.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Multisystemic Therapy (MST) as listed below:

The objectives of the pre-implementation assessment process are to:

• Identify the mission, policies, and practices of the customer organization and of the community context in which it operates.
• Specify the clinical, organizational, fiscal, and community resources needed to successfully implement MST.

Using the MST Feasibility Questionnaire, an MST Program Developer will attempt to assess the needs of the future MST program site by reviewing the resources needed to operate a successful MST program.

An MST Program Developer will also provide on-site and/or telephone consultation that will include activities such as the following:

• Meetings with the organization's leadership and clinical staff
• Meetings with staff from agencies that influence patterns of referral, reimbursement, and/or policy affecting the customer organization's capacity to implement MST
• Presentation of MST to the community stakeholders to assure the buy-in needed for program success after start-up
• Assistance in designing clinical record-keeping to document treatment goals and progress
• Assistance in developing systems to measure outcomes
• Review of evaluation proposals
• Consultation regarding Requests for Proposals (RFPs) relevant to the development and funding of the MST program
• Assistance with recruiting additional staff including sample job descriptions, review of hiring advertisements, interviewing and selecting the most qualified staff

For further information about this process, please contact either: Tom Pietkiewicz, Director of Business Development, email: tom.pietkiewicz@mstservices.com, phone: 843-352-4306 or Melanie Duncan, PhD, Program Development Coordinator, email: melanie.duncan@mstservices.com, phone: 843-284-2221.

Formal Support for Implementation

There is formal support available for implementation of Multisystemic Therapy (MST) as listed below:

Implementation support is available from either MST Services or from any of the more than 20 MST training organizations, called Network Partner organizations. Contact information for MST Network Partner organizations can be found at http://www.mstservices.com/teams/network-partners.

Fidelity Measures

There are fidelity measures for Multisystemic Therapy (MST) as listed below:

Quality assurance support activities focus on monitoring and enhancing program outcomes through increasing therapist adherence to the MST treatment model. The MST Therapist Adherence Measure (TAM) and the MST Supervisor Adherence Measure (SAM) have been validated in the research on MST with antisocial and delinquent youth and are now being implemented by all licensed MST programs. Both measures are available through the MST Institute at www.mtsi.org. An overview of the Multisystemic Therapy (MST) Quality Assurance Program can be found at https://www.msti.org/mstinstitute/qa_program/. A brief review of the two MST fidelity measures is below:

• The Therapist Adherence Measure Revised (TAM-R) is a 28-item measure that evaluates a therapist's adherence to the MST model as reported by the primary caregiver of the family. The adherence scale was originally developed as part of a clinical trial on the effectiveness of MST. The measure proved to have significant value in measuring an MST therapist's adherence to MST and in predicting outcomes for families who received treatment. More information is available at: https://www.msti.org/mstinstitute/qa_program/tam.html.
• The Supervisor Adherence Measure (SAM) is a 43-item measure that evaluates the MST Supervisor's adherence to the MST model of supervision as reported by MST therapists. The measure is based on the principles of MST and the model of supervision presented in the MST Supervisory Manual. More information is available at: https://www.msti.org/mstinstitute/qa_program/sam.html.

Fidelity Measure Requirements:

Therapist adherence is assessed monthly during treatment using caregiver reports on the TAM-R.

Established Psychometrics:

• Henggeler, S. W., Borduin, C. M., Schoenwald, S. K., Huey, S. J., & Chapman, J. E. (2006). Multisystemic Therapy Adherence Scale - Revised (TAM-R). Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina.
• Schoenwald, S. K., Sheidow, A. J., Letourneau, E. J., & Liao, J. G. (2003). Transportability of Multisystemic Therapy: Evidence for multi-level influences. Mental Health Services Research, 5, 223–239. https://doi.org/10.1023/A:1026229102151
• Schoenwald, S. K., Letourneau, E. J., & Halliday-Boykins, C. A. (2005). Predicting therapist adherence to a transported family-based treatment for youth. Journal of Clinical Child and Adolescent Psychology. 34(4), 658–670. https://doi.org/10.1207/s15374424jccp3404_8

Implementation Guides or Manuals

There are implementation guides or manuals for Multisystemic Therapy (MST) as listed below:

All components of the MST program are manualized. The treatment manuals for antisocial behavior (Multisystemic Therapy for Antisocial Behavior in Children and Adolescents) and serious emotional disturbance (Serious Emotional Disturbance in Children and Adolescents: Multisystemic Therapy) are available from Guilford Press. Additional MST-related manuals are provided to sites when they implement MST. These sites are licensed through MST Services, Inc., which has the exclusive license for the transport of MST technology and intellectual property developed at the Family Services Research Center of the Medical University of South Carolina. The following are included separately:

• Multisystemic Therapy for Antisocial Behavior in Children and Adolescents - Second Edition - specifying MST clinical protocols based on the nine core treatment principles (available through the MST Stores)
• MST Supervisory Manual - specifying the structure and processes of the weekly onsite supervisory sessions and ongoing development of therapist competences
• MST Consultation Manual - specifying the role of the MST consultant in helping teams achieve youth outcomes and in building the competencies of team therapists and supervisors
• MST Organizational Manual - addressing administrative issues in developing and sustaining a MST program

Implementation Cost

There have been studies of the costs of implementing Multisystemic Therapy (MST) which are listed below:

• Dopp, A. R., Borduin, C. M., Wagner, D. V., & Sawyer, A. M. (2014). The economic impact of Mmultisystemic Therapy through midlife: A cost-benefit analysis with serious juvenile offenders and their siblings. Journal of Consulting and Clinical Psychology, 82(4), 694-705. https://doi.org/10.1037/a0036415
• Klietz, S. J., Borduin, C. M., & Schaeffer, C. M. (2010). Cost–benefit analysis of Multisystemic Therapy with serious and violent juvenile offenders. Journal of Family Psychology, 24(5), 657–666. https://doi.org/10.1037/a0020838
• Sheidow, A. J., Bradford, W. D., Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C., Schoenwald, S. K., & Ward, D. M. (2004). Treatment costs for youths receiving Multisystemic Therapy or hospitalization after a psychiatric crisis. Psychiatric Services, 55(5), 548–554. https://doi.org/10.1176/appi.ps.55.5.548
• Vermeulen, K. M., Jansen, D. E. M. C., Knorth, E. J., Buskens, E., & Reijneveld, S. A. (2017). Cost-effectiveness of Multisystemic Therapy versus usual treatment for young people with antisocial problems. Criminal Behaviour and Mental Health, 27(1), 89–102. https://doi.org/10.1002/cbm.1988

Research on How to Implement the Program

Research has been conducted on how to implement Multisystemic Therapy (MST) as listed below:

• Brunk , M. A., Chapman, J. E., & Schoenwald, S. K. (2014). Defining and evaluating fidelity at the program level in psychosocial treatments. Zeitschrift fur Psychologie, 222(1), 22–29. https://doi.org/10.1027/2151-2604/a000162
• Halliday -Boykins, C. A., Schoenwald, S. K., & Letourneau, E. J. (2005). Caregiver-therapist ethnic similarity predicts youth outcomes from an empirically based treatment. Journal of Consulting and Clinical Psychology, 73(5), 808–818. https://doi.org/10.1037/0022-006X.73.5.808
• Henggeler, S. W., Schoenwald, S. K., Liao, J. G., Letourneau, E. J., & Edwards, D. L. (2002). Transporting efficacious treatments to field settings: The link between supervisory practices and therapist fidelity in MST programs. Journal of Child and Adolescent Psychology, 31(2), 155–167. https://doi.org/10.1207/S15374424JCCP3102_02
• Lange , A. M. C., van der Rijken, R. E. A., Busschbach, J. J. V., Delsing, M. J. M. H., & Scholte, R. H. J. (2017). It's not just the therapist: Therapist and country-wide experience predict therapist adherence and adolescent outcome. Child Youth Care Forum, 46, 455–471. https://doi.org/10.1007/s10566-016-9388-4
• Lofholm, C. A., Eichas, K., & Sundell, K. (2014). The Swedish implementation of Multisystemic Therapy for adolescents: Does treatment experience predict treatment adherence?. Journal of Clinical Child & Adolescent Psychology, 43(4), 643–655. https://doi.org/10.1080/15374416.2014.883926
• Ogden, T., Bjornebekk, G., Kjobli, J., Patras, J., Christiansen, T., Taraldsen, K., & Tollefsen, N. (2012). Measurement of implementation components ten years after a nationwide introduction of empirically supported programs – A pilot study. Implementation Science, 7, Article 49. https://doi.org/10.1186/1748-5908-7-49
• Pantoja, R. (2015). Multisystemic Therapy in Chile: A public sector innovation case study. Psychosocial Intervention, 24(2), 97–103. https://doi.org/10.1016/j.psi.2015.07.002
• Schoenwald, S. K., Carter, R. E., Chapman, J. E., & Sheidow, A. J. (2008). Therapist adherence and organizational effects on change in youth behavior problems one year after Multisystemic Therapy. Administration and Policy in Mental Health and Mental Health Services Research, 35, Article 379. https://doi.org/10.1007/s10488-008-0181-z
• Schoenwald, S. K., Chapman, J. E., Henry, D. B., & Sheidow, A. J. (2012). Taking effective treatments to scale: Organizational effects on outcomes of Multisystemic Therapy for youths with co-occurring substance use. Journal of Child & Adolescent Substance Abuse, 21(1), 1–31. https://doi.org/10.1080/1067828X.2012.636684
• Schoenwald, S. K., Chapman, J. E., Sheidow, A. J., & Carter, R. E. (2009). Long-term youth criminal outcomes in MST transport: The impact of therapist adherence and organizational climate and structure. Journal of Clinical Child and Adolescent Psychology, 38(1), 91–105. https://doi.org/10.1080/15374410802575388
• Schoenwald, S. K., Halliday-Boykins, C. A., & Henggeler, S. W. (2003). Client-level predictors of adherence to MST in community service settings. Family Process, 42(3), 345–359. https://doi.org/10.1111/j.1545-5300.2003.00345.x
• Schoenwald, S. K., Sheidow, A. J., & Chapman, J. E. (2009). Clinical supervision in treatment transport: Effects on adherence and outcomes. Journal of Consulting and Clinical Psychology, 77(3), 410–421. https://doi.org/10.1037/a0013788
• Schoenwald, S. K., Sheidow, A. J., & Letourneau, E. J. (2004). Toward effective quality assurance in evidence-based practice: Links between expert consultation, therapist fidelity, and child outcomes. Journal of Child and Adolescent Clinical Psychology, 33(1), 94–104. https://doi.org/10.1207/S15374424JCCP3301_10
• Schoenwald, S. K., Sheidow, A. J., Letourneau, E. J., & Liao, J. G. (2003). Transportability of Multisystemic Therapy: evidence for multi-level influences. Mental Health Service Research, 5(4), 22–239. https://doi.org/10.1023/A:1026229102151
• Walsh , C., & Best, P. (2019). Practitioners' experiences of using blended models within family support: A proof of concept study involving Cognitive-Behavioural Therapy (CBT), Multisystemic Therapy (MST) and Incredible Years (IY) interventions. Journal of Family Social Work, 22(4–5), 369–388. https://doi.org/10.1080/10522158.2019.1616240
• Welsh, B. C., & Greenwood, P. W. (2015). Making it happen: State progress in implementing evidence-based programs for delinquent youth. Youth Violence and Juvenile Justice, 13(3), 243–257. https://doi.org/10.1177/1541204014541708

Relevant Published, Peer-Reviewed Research

Child Welfare Outcomes: Permanency and Child/Family Well-Being

Additional References