Multisystemic Therapy (MST) For Youth Recovery

Multisystemic therapy (MST) is an intensive, manualized, licensed program for serious juvenile offenders or youth with severe conduct problems, including teenagers who abuse drugs or alcohol. This therapy provides comprehensive family and community-focused treatment to address a youth’s behavioral issues.

This blog covers how MST impacts serious juvenile offenders, how it works, and how its results can lead to successful rehabilitation.

What Is the Goal of Multisystemic Therapy?

MST strives to reveal, evaluate, and restructure the root causes behind adolescent behavioral issues. It achieves this by modifying the person’s behavior to foster positive conduct while reducing tendencies toward aggression, violence, antisocial behavior, substance abuse, or delinquency.

This transformation aims to ensure the person’s safety and well-being while keeping them engaged at home and school, preventing involvement in troublesome behavior.¹

Who Is Multisystemic Therapy For?

The target population for MST is youth, ages 12 to 17, who present with aggressive, antisocial, substance abuse, or criminal behaviors. It can also be for their families or caregivers. 

MST focuses primarily on at-risk or out-of-home populations, including:

• Juveniles with substance abuse disorders
• Violent juvenile offenders
• Chronic juvenile offenders
• Juvenile sexual offenders
• Juveniles displaying serious antisocial behavior

While MST typically targets underage individuals, it also involves the parents or guardians in the family unit. MST helps families address mood and anger management difficulties, substance abuse issues, and other risk factors to encourage healthy parenting.

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What Is Multisystemic Therapy – Substance Abuse (MST-SA)?

Multisystemic Therapy – Substance Abuse (MST-SA) is for youth ages 12 to 17 diagnosed as substance abusing or substance dependent.  MST concentrates on helping youth develop skills to better their quality of life.²

These skills include: 

• Assess and manage situations that lead to substance abuse
• Build protective factors such as social skills and family involvement
• Increase contact with peers who display positive behaviors

MST-SA integrates contingency management, behavior change models that reward positive behavior, and substance use treatment to help youth develop cognitive behavioral strategies and avoid high-risk situations.

How Does Multisystemic Therapy Prevent Alcohol Abuse Among Youth?

MST uses the following strategies to reduce alcohol abuse among youth:

• ABC assessments: The antecedents (prior causes), behaviors, and consequences of an instance of alcohol abuse are analyzed.
• Family and drug management plans: Therapists and family members develop a plan to help the youth avoid drinking.
• Drug refusal skills: The youth and family practice how to avoid using alcohol through extensive role-playing.
• Random urine tests: The MST team checks for alcohol consumption in the urine.
• Vouchers and prizes: A reward system that incentivizes meeting treatment metrics (e.g., clean urine tests, participation in sessions, etc.)

How Does Multisystemic Therapy Work?

MST applies treatment in several areas of the youth’s life, focusing on their supportive environment. MST therapists often work as a team with four to six families.

Team members may include:

• One supervisor
• Four MST therapists
• One data clerk
• One intake clinician or research assistant

The program delivers 60 hours of personalized alcohol addiction treatment for each participating youth and their family. Sessions usually occur at least twice a week in an environment where the child feels comfortable, such as at home.

MST staff deliver all treatment throughout recovery, focusing on engagement and alignment with the youth’s primary caregiver and other key stakeholders. 

An MST program usually lasts between 3 to 5 months. However, there is no definite length of service. During this period, the MST team is available to families 24 hours a day, seven days a week, via an on-call rotation.

What Is the Multisystemic Approach?

The multisystemic approach views individuals as part of a network of interconnected systems encompassing individual, familial, and extra-familial factors, such as peer networks, schooling, and neighborhood influence. MST sees the person as a web of interconnected systems rather than individuals.

The multisystemic intervention strategies within MST include:

• Behavior therapy
• Parent management training
• Cognitive behavior therapy
• Pragmatic family therapies 
• Pharmacological Interventions

By tackling substance abuse or delinquency at the systems level, MST can effectively facilitate comprehensive behavioral change within the youth’s natural environment.³

What Are the Core Principles of Multisystemic Therapy?

To be successful, MST centers on several primary principles to ground the therapeutic practice.

The core principles of MST include the following⁴:

1. Find the fit: The team assesses the “fit” between the identified problems and their broader systemic context.
2. Focus on strengths: The team develops interventions to emphasize the positive and utilize systemic strengths as levers for change.
3. Increase responsibility: The team designs interventions to promote responsible behavior and decrease irresponsible behavior among family members.
4. Present-focused, action-oriented, and well-defined: Interventions should tackle what’s happening in a young person’s life, enable participants to track progress, and outline concrete, achievable goals throughout recovery.
5. Targeting sequences: Interventions should target sequences of behavior within and between the interacting elements of the youth’s life—family, teaching, peers, home, school, and community—that sustain identified problems.
6. Developmentally appropriate: Interventions should fit the youth’s age and developmental needs.
7. Continuous effort: Interventions require daily or weekly effort by family members, ongoing evaluation of outcomes, frequent corrective interventions, and more opportunities for family members to experience success.
8. Evaluation and accountability: Intervention efficacy is evaluated continuously from multiple perspectives. Providers assume responsibility for overcoming barriers to successful outcomes.
9. Generalization: Interventions should meet the family’s needs long after treatment ends. Caregivers are empowered to address family members’ needs across multiple systemic contexts.

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What Are the Benefits of Multisystemic Therapy?

There are many benefits of MST for youth that last into adulthood. Some of these benefits include:

• Reduced criminal activity or chance of prison
• Decreasing rates of out-of-home placements
• Reduced delinquent behavior problems
• Reduced substance use
• Decreased antisocial behavior
• Improved family function
• Improved mental health
• Reduced suicide rates
• Reduced foster care use
• Improved mental health outcomes

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Is Multisystemic Therapy Evidence-Based?

MST is evidence-based. Many well-conducted randomized controlled trials find large, statistically significant reductions in youth criminal activity over follow-up periods ranging from 2 to 22 years.⁵

Here are several examples of MST’s effectiveness:

• A 2017 study found 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.⁶
• An MST family services research center found that MST programs for youth with serious offenses reduced long-term rearrest rates by 42% on average, compared with probation, residential confinement, and other alternatives.⁷
• A 25-year follow-up analysis of MST shows lower criminal activity among MST youth members than non-MST therapy participants. This randomized clinical trial proves that arrest and imprisonment rates are also lower for siblings and caregivers of MST adolescents after treatment.⁸
• A 2010 randomized effectiveness trial found that MST for abused and neglected children improves their and their parent's mental health. It also reduces the chances that the caregivers and parents will neglect or hurt their children.⁹
• MST family therapy for youths with mental health issues may reduce antisocial behavior and suicide attempts while improving family functioning.⁶

A Multisystemic Therapy Success Story

Multisystemic therapy can be applied in various situations and requires varying intensity levels, team involvement, behavior and safety planning, and outside support. How it’s applied will depend on the severity of a youth’s mental health difficulties and behavior. 

Here’s an example of MST for a youth with substance abuse and violent behavioral patterns:

Arthur, a 16-year-old, presents with common behaviors MST addresses. His parents want him to be monitored outside of the house before he hurts himself or someone else.

These behaviors include:

• Daily substance use
• Dealing drugs at school
• Stealing his parents' alcohol
• Running away frequently
• Engaging in behaviors of physical and verbal aggression at home and school

These are the steps the MST therapist and team take to address the situation:

1. The MST therapist and team address the parents' approaches to Arthur's behavior.
2. They identify that poor communication and physical discipline contribute to his risky behaviors.
3. The team identifies sequencing patterns to help parents understand how altercations become explosive.
4. The team sets a safety plan, requiring Arthur to pass daily dorm and item searches for substances.
5. A plan is placed with support from teachers and community members to increase his attendance and reduce his chance of buying drugs.
6. The MST team requires drug testing. If Arthur passes, he earns rewards.
7. The team applies sequences to help Arthur and his family understand what is influencing his substance abuse, grant him insight into his triggers, and reduce his triggers.

Over time and with the proper interventions, Arthur can significantly reduce his substance abuse and aggressive behaviors.

How Much Does MST Cost?

The cost of intensive family MST varies depending on a family’s insurance, the length of treatment, and the provider.

One study notes that costs for MST for a family insured by Medicaid were about $5,500 per family. For youths in crisis needing more intensive and considerable psychiatric support, MST can exceed $10,000 per family with Medicaid.¹⁰

Is MST Cost-Effective?

International research indicates that MST is a cost-effective intervention. It reduces the cost of placing children out of home and the costs associated with criminal or substance-abusing behavior.

Data indicates that the savings from implementing MST are between $12 and $28 for every $1 spent. Data also shows that MST is a more effective and sustainable treatment over time, reducing costs for families in the long run.¹¹

How Does MST Differ From Other Family Therapy Options?

While MST is a proven effective treatment option for families, it’s not the only option for families with a youth in crisis. An alternative treatment option is functional family therapy (FFT). 

The primary difference between MST and FFT lies in the population they treat. FFT focuses on high-risk underage individuals who haven’t committed serious crimes. MST treats underage individuals on track to end up incarcerated, such as repeat violent offenders. 

Throughout treatment, contact with an MST therapist averages 60 or more hours. In FFT, family-therapist contact ranges between 25 to 30 hours of treatment.¹²

Summary

Multisystemic therapy (MST) is an intense therapy for underage individuals with severe involvement in the justice system or substance abuse issues. MST involves a combination of individual, family, and community mental health services and interventions.

MST is provided over 4 to 5 months, multiple times a week, and a team is available 24/7 in case of crises. It’s an excellent option for comprehensively treating chronic juvenile offenders.