Multisystemic Therapy

What is Multisystemic Therapy (MST) for Youth Alcohol Recovery?

Multisystemic therapy (MST) aims to keep adolescents who have shown severe clinical issues at home, school, and away from trouble. These problems may involve alcohol and drug use, violence, and extreme criminal activity and behavior.

Multisystemic therapy

MST uses intense involvement and contact with the adolescent’s family. This practice helps to uncover and analyze the functional roots of the adolescent’s behavioral problems.

Multisystemic therapy consists of a short-term intervention of three to five months. However, there is no definite length of service. 

The program delivers around 60 hours of personalized treatment for each participating adolescent. Sessions usually occur at least twice a week and happen in a natural environment the participant feels comfortable in, which is usually their home.

Intensive family MST often focuses on young people's social ecology who are susceptible to severe clinical issues. Both the youth and their families engage to help decrease risk factors and improve adolescents' relationships with their family members, peers, school, and community.

Team members involved in the management and delivery of an MST program usually consist of one supervisor, four MST therapists, one data clerk, and one intake clinician or research assistant.

MST teams work closely with the adolescent’s parents to plan strategies to encourage and monitor their success at home, school, and the community.

How Does an MST Program Work? 

A multisystemic therapy treatment model works to change the youth’s ecology to encourage prosocial conduct while decreasing delinquent behavior problems. MST treatment programs’ target population are youths between the ages of 12 and 17 who show severe problems and serious antisocial behavior. These youths may also be juvenile offenders.

MST intervention is used on youths at the start of their criminal career. In some cases, juvenile offenders are treated within the same environment that forms the basis of their issues, as opposed to custody, where they may feel uncomfortable.

The program often uses a home-based service delivery model to reduce any barriers that prevent families from accessing services. MST therapists often work with four to six families at a time, working as a team. Due to MST services' intense nature, therapists mustn’t work with too many groups.

The MST team is available to families 24 hours a day, 7 days a week via an on-call rotation.

MST teams typically provide services at times that are convenient to the family. Home placement sessions may occur daily or once a week, depending on the family's requirements and the stage in the program.

Therapists focus on empowering parents of youth and helping them improve their effectiveness by identifying strengths. They also help to grow an adolescent’s natural support systems. 

These support systems may include: 

  • Extended family members
  • Friends
  • Neighbors
  • Church members

Likewise, therapists will try to remove familial barriers to progress. 

These barriers may include: 

  • Parental substance abuse
  • Stress
  • Poor relationships between partners

During MST intervention, family members take the lead in setting treatment goals for their loved ones. The therapist will help the family reach these goals for positive change.

The goals for each adolescent case measure success. Generally, MST services’ primary outcomes are to keep the adolescent:

  • Safely at home
  • In education or working
  • Avoiding serious criminal behavior
  • Out of trouble with the law

Therapists do not measure treatment success and positive changes by the length of time a family has spent in MST.

Benefits of Multisystemic Therapy 

There are many benefits of multisystemic therapy. These benefits include:

  • Reduced recidivism 
  • Reduced incarceration and criminal activity
  • Decreasing rates of out-of-home placements
  • Reduced delinquent behavior problems
  • Reduced substance use
  • Improved family functioning 
  • Improved mental health 
  • Reduced suicide 
  • Reduced foster care use 
  • Improved health outcomes
  • Cost savings in comparison with typical mental health services and juvenile offenders justice services

Is Multisystemic Therapy Evidence-Based?

Various studies show that multisystemic therapy reduces the chances of recidivism and incarceration for serious juvenile offenders. Structural family therapy is also proven to lessen delinquent and antisocial behavior and alcohol and drug use among young people.

Likewise, studies show that MST can improve participating members functioning at school, work, and home. MST services can also improve family functioning and reduce out of home placement. 

MST treatment programs may also reduce the likelihood of arrest and incarceration, especially for gang-related youths. 

A 21-year follow-up analysis of MST shows low recidivism and less common offenses among MST youth members than individual therapy participants. Arrest rates and incarceration days are also less for siblings and caregivers of MST adolescents 20 years after treatment.

Research also shows that MST of abused and neglected children improves the children’s and the parents and caregivers’ mental health. It also reduces the chances that the caregivers and parents will neglect or hurt their children.

Finally, MST family therapy for youths with mental health issues, or disturbed children, may reduce antisocial behavior and suicide attempts while improving family functioning.

How Much Does MST Cost?

The cost of intensive family MST varies from regions, treatment time, and provider. This is because most of the price reflects the salaries of dedicated MST staff members.

Generally, the cost of structural family therapy ranges from around $10,000 to $20,000 per youth. While this may sound expensive, compare this to the cost of an out of home placement for a young person of between $25,000 per year for a foster placement and up to $258,000 to secure a children’s home bed.

Resources

Multisystemic Therapy (MST), Youth, https://youth.gov/content/multisystemic-therapy-mst 

Tan, Jia Xuan, and Maria Lourdes Restrepo Fajardo., Efficacy of multisystemic therapy in youths aged 10-17 with severe antisocial behaviour and emotional disorders: systematic review., London journal of primary care vol. 9,6 95-103. 9 Aug. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694795/ 

Antisocial Behavior in Adolescents Aged 10–17 Years. Adolescent Res Rev 3, 67–93, 2018, https://link.springer.com/article/10.1007/s40894-017-0072-1 

Fain, Terry, Sarah Michal Greathouse, Susan Turner, and H. Dawn Weinberg, Is Multisystemic Therapy (MST) Effective for Hispanic Youth? An Evaluation of Outcomes for Juvenile Offenders in Los Angeles County. Santa Monica, CA: RAND Corporation, 2014, https://www.rand.org/pubs/research_briefs/RB9791.html 

Multisystemic Therapy Frequently Asked Questions, MST Services, https://www.mstservices.com/faq-mst 

Zajac, Kristyn et al. ‘Multisystemic Therapy for Externalizing Youth.’ Child and adolescent psychiatric clinics of North America vol. 24,3 (2015): 601-16, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4475575/ 

Wagner, David V et al. “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 vol. 82,3 (2014): 492-9, https://pubmed.ncbi.nlm.nih.gov/24417600/ 

Vidal, Sarah et al. ‘Placement and Delinquency Outcomes Among System-Involved Youth Referred to Multisystemic Therapy: A Propensity Score Matching Analysis.’ Administration and policy in mental health vol. 44,6 (2017): 853-866, https://pubmed.ncbi.nlm.nih.gov/28315074/ 

Letourneau, Elizabeth J et al. ‘Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial.’ Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43) vol. 23,1 2009, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2710607/ 

Letourneau, Elizabeth J et al. ‘Two-year follow-up of a randomized effectiveness trial evaluating MST for juveniles who sexually offend.’ Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43) vol. 27,6 (2013): 978-85, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490861/

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Updated on: October 21, 2020
Author
Ellie Swain
About
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Medically Reviewed
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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