Effective-RCT

Multisystemic Therapy® (MST®)

Topic: Antisocial Behavior, Behavioral Problems

Target Population: Adolescents, Families

Sector: Community-Based

Target Audience

This program is for adolescents who are 12 to 17 years old and who are juvenile offenders or are engaging in antisocial or delinquent behaviors and their families.

Summary

Multisystemic Therapy® (MST®), a short-term, community-based program, is designed to help reduce adolescent problematic, antisocial, and offending behaviors by focusing on multiple risk and protective factors that exist within the youth's everyday environment.

Evidence

Multiple internal and external randomized controlled trials (RCT) evaluating the effectiveness of MST have been conducted. Collectively, these studies have documented that, compared to control group youth, MST youth were less likely to be re-arrested, incarcerated, or placed on probation, and they experienced fewer out-of-home placements or placement in a juvenile training school. In addition, improvements have been noted in other targeted outcomes such as adolescent externalizing behaviors, family functioning and relations, caregiver felonies, and parenting behaviors. In general, these findings, especially those related to criminal activity, persist long term, and one study indicates program effects on arrests and incarceration lasted as long as 21 years post recruitment. Results of one RCT conducted in the United Kingdom found no differences between MST and treatment as usual in out-of-home placements; however, treatment as usual in this study was multicomponent, rigorous, as resource intensive as MST, and provided more flexibility than MST in meeting participants’ individual needs.

Components

Therapists administer comprehensive, personalized, and evidence-informed or evidence-based interventions, such as behavioral, cognitive behavioral, and family therapies, to adolescents and their families in their home, school, or community settings. The family is involved in the development of the intervention they receive. Though MST interventions are individualized, they are based on the following nine principles:

Find the fit - Determine how an adolescent's problem behaviors are aligned with his or her environment;
Focus on strengths - Promote behavior change in the youth by focusing on the youth's and family's positive characteristics;
Increase responsibility - Encourage the family to engage in mature behaviors and decrease immature conduct;
Remain present-focused and action-oriented - Examine current, specific issues facing the adolescent and his or her family so that clear goals and action steps can be identified and measured;
Target sequences of behavior - Focus on behavioral patterns, exhibited across multiple domains of the adolescent's environment, that contribute to and reinforce problem behaviors;
Developmentally appropriate - Ensure interventions are suitable for the youth's age, capabilities, and needs especially with respect to peer relations, academics, and career competencies;
Continuous effort - Confirm that the adolescent and his or her family are consistently practicing newly learned behaviors;
Evaluation and accountability - Monitor participant progress and place the responsibility of positive behavior change on the MST team not the family; and
Generalization - Empower the adolescent's caregivers to address the needs of family members in a variety of contexts in order to maintain positive changes.

Previous Use

MST was developed in the 1970s and has been implemented in 34 states and 15 countries and has reached more than 200,000 youth.

Training

MST involves a treatment team that consists of master's degree-level, trained therapists and a supervisor. An initial 5-day, on- or off-site orientation training is required. The cost for this training is $850 per participant plus travel expenses. After program start-up, training continues via weekly phone consultation and quarterly booster trainings. For more information, please visit https://www.mstservices.com/resources-training or use details in the Contact section below.

Considerations

Considerations for implementing this program include obtaining funding for program costs, developing and maintaining a qualified treatment team and making arrangements for them to complete training, understanding this comprehensive treatment requires small caseloads and frequent interaction with youth and their families, gaining participant buy-in and commitment, and ensuring the program is delivered with fidelity.

The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Implementation

If you are interested in implementing MST, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Time

Intervention length varies depending on need, but, usually, treatment is provided for 3 to 5 months. At the start of treatment, therapists meet with families multiple times a week; the frequency of visits is reduced over time as improvements are made. During treatment, therapists are available for continuous support.

Cost

The start-up cost for one MST team is approximately $22,500. Technical assistance to support initial program set-up is $4,000. In addition, annual license fees of $4,000 per organization (i.e., agency license) and an additional $2,500 per team (i.e., team license) are required.

Evaluation Plan

The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Contact

Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu

You may also contact MST Services by phone 1-843-856-8226, email info@mstservices.com, or visit https://www.mstservices.com/contact-us

Source

https://www.mstservices.com/, https://www.blueprintsprograms.org/programs/32999999/multisystemic-therapy-mst/ and https://www.cebc4cw.org/program/multisystemic-therapy/detailed

References

Used in Placement

Asscher, J. J., Deković, M., Manders, W. A., van der Laan, P., & Prins, P. J. M. (2013). A randomized controlled trial of the effectiveness of multisystemic therapy in the Netherlands: Post-treatment changes and moderator effects. Journal of Experimental Criminology, 9(2), 169-187. https://doi.org/10.1007/s11292-012-9165-9

Asscher, J. J., Deković, M., Manders, W., van der Laan, P., Prins, P. J. M., & van Arum, S. (2014). Sustainability of the effects of multisystemic therapy for juvenile delinquents in the Netherlands: Effects on delinquency and recidivism. Journal of Experimental Criminology, 10(2), 227-243. https://doi.org/10.1007/s11292-013-9198-8

Borduin, C. M., Mann, B. J., Cone, L. T., Henggeler, S. W., Fucci, B. R., Blaske, D. M., & Williams, R. A. (1995). Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence. Journal of Consulting and Clinical Psychology, 63(4), 569-578. https://doi.org/10.1037/0022-006X.63.4.569

Boxer, P., Docherty, M., Ostermann, M., Kubik, J., & Veysey, B. (2017). Effectiveness of multisystemic therapy for gang-involved youth offenders: One year follow-up analysis of recidivism outcomes. Children and Youth Services Review, 73, 107-112. https://doi.org/10.1016/j.childyouth.2016.12.008

Butler, S., Baruch, G., Hickley, N., & Fonagy, P. (2011). A randomized controlled trial of multisystemic therapy and a statutory therapeutic intervention for young offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 50(12), 1220-1235.e2. https://doi.org/10.1016/j.jaac.2011.09.017

Fain, T., Greathouse, S. M., Turner, S. F., & Weinberg, H. D. (2014). Effectiveness of multisystemic therapy for minority youth: Outcomes over 8 years in Los Angeles county. The Journal for Juvenile Justice, 3(2), 24.

Fonagy, P., Butler, S., Cottrell, D., Scott, S., Pilling, S., Eisler, I., ... Goodyer, I. M. (2018). Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): A pragmatic, randomised controlled, superiority trial. The Lancet. Psychiatry, 5(2), 119-133. https://doi.org/10.1016/S2215-0366(18)30001-4

Fonagy, P., Butler, S., Cottrell, D., Scott, S., Pilling, S., Eisler, I., ... Goodyer, I. M. (2020). Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): 5-year follow-up of a pragmatic, randomised, controlled, superiority trial. The Lancet. Psychiatry, 7(5), 420-430. https://doi.org/10.1016/S2215-0366(20)30131-0

Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology, 60(6), 953-961. https://doi.org/10.1037/0022-006X.60.6.953

Henggeler, S. W., Melton, G. B., Smith, L. A., Schoenwald, S. K., & Hanley, J. H. (1993). Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders. Journal of Child and Family Studies, 2(4), 283-293. https://doi.org/10.1007/BF01321226

Johnides, B. D., Borduin, C. M., Wagner, D. V., & Dopp, A. R. (2017). Effects of multisystemic therapy on caregivers of serious juvenile offenders: A 20-year follow-up to a randomized clinical trial. Journal of Consulting and Clinical Psychology, 85(4), 323-334. https://doi.org/10.1037/ccp0000199

Löfholm, 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 and Adolescent Psychology, 43(4), 643-655. https://doi.org/10.1080/15374416.2014.883926

Ogden, T., & Hagen, K. A. (2006). Multisystemic treatment of serious behaviour problems in youth: Sustainability of effectiveness two years after intake. Child and Adolescent Mental Health, 11(3), 142-149. https://doi.org/10.1111/j.1475-3588.2006.00396.x

Ogden, T., Hagen, K., & Andersen, O. (2007). Sustainability of the effectiveness of a programme of multisystemic treatment (MST) across participant groups in the second year of operation. Journal of Children's Services, 2(3), 4-14. https://doi.org/10.1108/17466660200700022

Ogden, T., & Halliday-Boykins, C. A. (2004). Multisystemic treatment of antisocial adolescents in Norway: Replication of clinical outcomes outside of the US. Child and Adolescent Mental Health, 9(2), 77-83. https://doi.org/10.1111/j.1475-3588.2004.00085.x

Sawyer, A. M., & Borduin, C. M. (2011). Effects of multisystemic therapy through midlife: A 21.9-year follow-up to a randomized clinical trial with serious and violent juvenile offenders. Journal of Consulting and Clinical Psychology, 79(5), 643-652. https://doi.org/10.1037/a0024862

Schaeffer, C. M., & Borduin, C. M. (2005). Long-term follow-up to a randomized clinical trial of multisystemic therapy with serious and violent juvenile offenders. Journal of Consulting and Clinical Psychology, 73(3), 445-453. https://doi.org/10.1037/0022-006X.73.3.445

Sundell, K., Hansson, K., Löfholm, C. A., Olsson, T., Gustle, L., & Kadesjö, C. (2008). The transportability of multisystemic therapy to Sweden: Short-term results from a randomized trial of conduct-disordered youths. Journal of Family Psychology, 22(4), 550-560. https://doi.org/10.1037/a0012790

Timmons-Mitchell, J., Bender, M. B., Kishna, M. A., & Mitchell, C. C. (2006). An independent effectiveness trial of multisystemic therapy with juvenile justice youth. Journal of Clinical Child and Adolescent Psychology, 35(2), 227-236. https://doi.org/10.1207/s15374424jccp3502_6

Vidal, S., Steeger, C. M., Caron, C., Lasher, L., & Connell, C. M. (2017). Placement and delinquency outcomes among system-involved youth referred to multisystemic therapy: A propensity score matching analysis. Administration and Policy in Mental Health and Mental Health Services Research, 44(6), 853-866. https://doi.org/10.1007/s10488-017-0797-y

Weiss, B., Han, S., Harris, V., Catron, T., Ngo, V. K., Caron, A., ... Guth, C. (2013). An independent randomized clinical trial of multisystemic therapy with non-court-referred adolescents with serious conduct problems. Journal of Consulting and Clinical Psychology, 81(6), 1027-1039. https://doi.org/10.1037/a0033928

Not Used in Placement

Other

Baglivio, M. T., Jackowski, K., Greenwald, M. A., & Wolff, K. T. (2014). Comparison of multisystemic therapy and functional family therapy effectiveness: A multiyear statewide propensity score matching analysis of juvenile offenders. Criminal Justice and Behavior, 41(9), 1033-1056. https://doi.org/10.1177/0093854814543272

Blankestein, A., Lange, A., Rijken, R., Scholte, R., Moonen, X., & Didden, R. (2020). Brief report: Follow‐up outcomes of multisystemic therapy for adolescents with an intellectual disability and the relation with parental intellectual disability. Journal of Applied Research in Intellectual Disabilities, 33(3), 618-624. https://doi.org/10.1111/jar.12691

Blankestein, A., Rijken, R., Eeren, H. V., Lange, A., Scholte, R., Moonen, X., ... Didden, R. (2019). Evaluating the effects of multisystemic therapy for adolescents with intellectual disabilities and antisocial or delinquent behaviour and their parents. Journal of Applied Research in Intellectual Disabilities, 32(3), 575-590. https://doi.org/10.1111/jar.12551

Boonstra, C., Jonkman, C., Soeteman, D., & van Busschbach, J. (2009). Multisystemic therapy for seriously antisocial and delinquent juveniles: Two-year follow-up study. Systemic Therapy, 21, 94-104.

Borduin, C. M., & Dopp, A. R. (2015). Economic impact of multisystemic therapy with juvenile sexual offenders. Journal of Family Psychology, 29(5), 687-696. https://doi.org/10.1037/fam0000113

Boxer, P. (2011). Negative peer involvement in multisystemic therapy for the treatment of youth problem behavior: Exploring outcome and process variables in "real-world" practice. Journal of Clinical Child and Adolescent Psychology, 40(6), 848-854. https://doi.org/10.1080/15374416.2011.614583

Boxer, P., Kubik, J., Ostermann, M., & Veysey, B. (2015). Gang involvement moderates the effectiveness of evidence-based intervention for justice-involved youth. Children and Youth Services Review, 52, 26-33. https://doi.org/10.1016/j.childyouth.2015.02.012

Curtis, N. M., Ronan, K. R., Heiblum, N., & Crellin, K. (2009). Dissemination and effectiveness of multisystemic treatment in New Zealand: A benchmarking study. Journal of Family Psychology, 23(2), 119-129. https://doi.org/10.1037/a0014974

Dæhlen, M., & Madsen, C. (2016). School enrolment following multisystemic treatment: A register-based examination among youth with severe behavioural problems. Children and Youth Services Review, 67, 76-83. https://doi.org/10.1016/j.childyouth.2016.05.016

Dopp, A. R., Coen, A. S., Smith, A. B., Reno, J., Bernstein, D. H., Kerns, S. E. U., & Altschul, D. (2018). Economic impact of the statewide implementation of an evidence-based treatment: Multisystemic therapy in New Mexico. Behavior Therapy, 49(4), 551-566. https://doi.org/10.1016/j.beth.2017.12.003

Eeren, H. V., Goossens, L. M. A., Scholte, R. H. J., Busschbach, J. J. V., & van der Rijken, Rachel E. A. (2018). Multisystemic therapy and functional family therapy compared on their effectiveness using the propensity score method. Journal of Abnormal Child Psychology, 46(5), 1037-1050. https://doi.org/10.1007/s10802-017-0392-4

Glisson, C., Schoenwald, S. K., Hemmelgarn, A., Green, P., Dukes, D., Armstrong, K. S., & Chapman, J. E. (2010). Randomized trial of MST and ARC in a two-level EBT implementation strategy. Journal of Consulting and Clinical Psychology, 78(4), 537-550. https://doi.org/10.1037/a0019160

Henggeler, S. W., Melton, G. B., Brondino, M. J., Scherer, D. G., & Hanley, J. H. (1997). Multisystemic therapy with violent and chronic juvenile offenders and their families: The role of treatment fidelity in successful dissemination. Journal of Consulting and Clinical Psychology, 65(5), 821-833. https://doi.org/10.1037/0022-006X.65.5.821

Henggeler, S. W., Rodick, J. D., Borduin, C. M., Hanson, C. L., Watson, S. M., & Urey, J. R. (1986). Multisystemic treatment of juvenile offenders: Effects on adolescent behavior and family interaction. Developmental Psychology, 22(1), 132-141. https://doi.org/10.1037/0012-1649.22.1.132

Henggeler, S. W., & Schaeffer, C. M. (2016). Multisystemic therapy®: Clinical overview, outcomes, and implementation research. Family Process, 55(3), 514-528. https://doi.org/10.1111/famp.12232

Hunkin, H., Malvaso, C. G., Chittleborough, C. R., Gialamas, A., Montgomerie, A., Falster, K., … Pilkington, R. M. (2024). Systematic review and meta-analysis: Multisystemic therapy and functional family therapy targeting antisocial behavior in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, https://doi.org/10.1016/j.jaac.2024.10.008

Lee, V., Watson, S., Shlonsky, A., & Tarren-Sweeney, M. (2024). A scoping review of randomized controlled trials of parenting and family-based interventions for 10 – 17 year-olds with severe and persistent conduct problems. Journal of Evidence-Based Social Work, 21(6), 720-748. https://doi.org/10.1080/26408066.2024.2409094

Littell, J. H., Pigott, T. D., Nilsen, K. H., Green, S. J., & Montgomery, O. L. K. (2021). Multisystemic therapy® for social, emotional, and behavioural problems in youth age 10 to 17: An updated systematic review and meta‐analysis. Campbell Systematic Review, 17(4), n/a. https://doi.org/10.1002/cl2.1158

Mustafa, F. A. (2018). Randomised controlled trials for multisystemic therapy: When is enough, enough? The Lancet. Psychiatry, 5(5), 390-390. https://doi.org/10.1016/S2215-0366(18)30098-1

Painter, K. (2009). Multisystemic therapy as community-based treatment for youth with severe emotional disturbance. Research on Social Work Practice, 19(3), 314-324. https://doi.org/10.1177/1049731508318772

Porter, M., & Nuntavisit, L. (2016). An evaluation of multisystemic therapy with Australian families. Australian and New Zealand Journal of Family Therapy, 37(4), 443-462. https://doi.org/10.1002/anzf.1182

Robinson, B. A., Winiarski, D. A., Brennan, P. A., Foster, S. L., Cunningham, P. B., & Whitmore, E. A. (2015). Social context, parental monitoring, and multisystemic therapy outcomes. Psychotherapy, 52(1), 103-110. https://doi.org/10.1037/a0037948

Ryan, S. R., Brennan, P. A., Cunningham, P. B., Foster, S. L., Brock, R. L., & Whitmore, E. (2013). Biosocial processes predicting multisystemic therapy treatment response. Biological Psychology, 92(2), 373-379. https://doi.org/10.1016/j.biopsycho.2012.12.002

Satodiya, R., Bied, A., Shah, K., Parikh, T., & Ash, P. (2024). A systematic review of multisystemic therapy in adolescent sex offenders. Journal of the American Academy of Psychiatry and the Law, 52(1), 51.

Schechter, J. C., Brennan, P. A., Cunningham, P. B., Foster, S. L., & Whitmore, E. (2012). Stress, cortisol, and externalizing behavior in adolescent males: An examination in the context of multisystemic therapy. Journal of Abnormal Child Psychology, 40(6), 913-922. https://doi.org/10.1007/s10802-012-9612-0

Sheerin, K. M., Borduin, C. M., Brown, C. E., & Letourneau, E. J. (2021). An evaluation of mechanisms of change in multisystemic therapy for juvenile Justice‐Involved youths A decade following treatment. Journal of Marital and Family Therapy, 47(1), 208-219. https://doi.org/10.1111/jmft.12446

Sheidow, A. J., McCart, M. R., & Davis, M. (2016). Multisystemic therapy for emerging adults with serious mental illness and justice involvement. Cognitive and Behavioral Practice, 23(3), 356-367. https://doi.org/10.1016/j.cbpra.2015.09.003

Smith-Boydston, J. M., Holtzman, R. J., & Roberts, M. C. (2014). Transportability of multisystemic therapy to community settings: Can a program sustain outcomes without MST services oversight? Child & Youth Care Forum, 43(5), 593-605. https://doi.org/10.1007/s10566-014-9255-0

Tiernan, K., Foster, S. L., Cunningham, P. B., Brennan, P., & Whitmore, E. (2015). Predicting early positive change in multisystemic therapy with youth exhibiting antisocial behaviors. Psychotherapy, 52(1), 93-102. https://doi.org/10.1037/a0035975

Vermeulen, K. M., Jansen, Daniëlle 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

Wagner, D. V., Borduin, C. M., Sawyer, A. M., & Dopp, A. R. (2014). Long-term prevention of criminality in siblings of serious and violent juvenile offenders: A 25-year follow-up to a randomized clinical trial of multisystemic therapy. Journal of Consulting and Clinical Psychology, 82(3), 492-499. https://doi.org/10.1037/a0035624

Weiss, B., Han, S. S., Tran, N. T., Gallop, R., & Ngo, V. K. (2015). Test of “Facilitation” vs. “Proximal process” moderator models for the effects of multisystemic therapy on adolescents with severe conduct problem. Journal of Abnormal Child Psychology, 43(5), 971-983. https://doi.org/10.1007/s10802-014-9952-z

Last Reviewed Date: 2/21/2025

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