Multisystemic therapy

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Multisystemic therapy (MST) is an intense, family-focused and community-based treatment program for juveniles with serious criminal offenses who are possibly abusing substances. It is also a therapy strategy to teach their families how to foster their success in recovery. [1]

Contents

The goals of MST are to lower rates of criminal behavior in juvenile offenders. There are several things MST therapy must include: integration of empirically based treatment to acknowledge a large variety of risk factors that may be influencing the behavior; rewards for positive changes in behavior and environment to ultimately empower caregivers; and many thorough quality assurance mechanisms that focus on completing objectives set in treatment [1]

Medical uses

A 2017 meta-analysis of family-based treatments for serious juvenile offenders found "long-lasting, treatment effects" in reducing antisocial behavior and improving other outcomes when compared with conventional community services. [2] A meta-analysis of MST in 2014 reported small improvements in delinquency, psychological problems, and substance use, particularly with younger juveniles. [3]

In 2012 a literature review compared common treatments including cognitive behavioral therapy, 12-step facilitation, multisystemic therapy, psychoeducation, and motivational interviewing in an attempt to identify the best treatments for substance-abusing adolescents with conduct problems. The authors concluded that family-based interventions produced superior outcomes, and that MST had "the most compelling evidence," noting that the providers are often well trained and supervised. [4] Family-based interventions such as MST may have farther reaching impacts as well when compared to other interventions. Specifically, Wagner et al. (2013) and Dopp et al (2017) conducted follow-up studies with clients and their families who had participated in either MST or IT (Individual Therapy) 20–25 years earlier; they found that caregivers and siblings of clients who participated in MST were themselves less likely to have been convicted of a felony. [5] [6]

Methods

Multisystemic therapy (MST) is a home and community based intervention for juvenile offenders and is used predominately to address violent offending, sex offending, delinquency, and substance abuse. [7] In this intensive intervention, at least one team of two to four therapists and a therapist supervisor provides around 60 to 100 hours of direct services, typically over the course of three to six months. [7] [8] MST draws upon many practices from strategic family therapy, structural family therapy, and cognitive behavior therapy. It is based in part on ecological systems theory; therapists address individual, family, peer, school, and neighborhood risk factors that lead to antisocial behavior. [9] MST also is informed by the theory that the family is the key to affecting change. [10] MST works to improve parenting practices and family relationships and functioning in order to reduce antisocial behavior. [7]

Therapists follow a process called the MST Analytic Process (or “Do Loop”) in which they work with the client and family to identify and address “drivers,” or factors which could contribute to antisocial behaviors. [11] “Drivers” could include many factors that affect the client, such as caregiver unemployment, substance use, or lack of supervision, and client association with deviant peers and lack of involvement in school. [7] [10] [11] Treatment depends on the "drivers" and often may involve establishing a behavior plan at home, increasing caregiver monitoring of behavior, addressing disputes with parents and teachers, reducing the client’s interactions with deviant peers, and helping the client establish prosocial behaviors and peer groups. [7] [10] [11] [8] Overall, treatment is individualized depending on the social systems surrounding the youth. [12] Although treatment is highly variable, it always includes nine core principles. These are: [13]

  1. The client exists within a series of systems [13]
  2. Practitioners use existing positive systems to help client create change [13]
  3. Interventions should include increased responsibility of family members [13]
  4. MST is present-focused and action-oriented [13]
  5. Each interventions targets a specific behavior [13]
  6. MST interventions should match the developmental age of the child for which they are created [13]
  7. Family members are needed to enact interventions [13]
  8. Evaluation of interventions occur from multiple perspectives [13]
  9. Each intervention is made to be used long term and in multiple settings [13]

In addition, adaptations to MST have been created that provide intensive family and community-based treatment for a variety of challenges that face youth. These include MST-CAN (Child Abuse and Neglect), MST-Psychiatric, for youth with psychotic behavior or who are at risk of suicide or homicide, and MST-HC (Health Care), for youth with chronic health conditions and challenges with treatment adherence. [7]

History

The MST method was originally a collection of procedures practiced by Dr. Scott Henggeler in the 1970s. He soon brought in Charles Borduin and Molly Brunk, two of his doctoral students, to help with the theory’s documentation. [14] To bring their project to fruition, Henggeler, Borduin, and Brunk combined evidence-based practice models with the positive aspects of other behavior theories, and created the calling card of MST by emphasizing family preservation and strengthening of relationships among juvenile delinquents. [15] Since then, there have been a few tweaks to the original design, and in 1990 MST as it is known today was born. [16] For being so new, MST has been tested many times in many settings, and in most it has shown to have the longest lasting positive effects for troubled youth and their families. [17]

After the finalization of the MST method, the MST Institute was founded as a nonprofit corporation to be "responsible for setting quality assurance standards and monitoring the implementation of Multisystemic Therapy in all programs worldwide" [18]

Use in the Juvenile Justice System

Practitioners increasingly use Multisystemic Therapy to help youth within the juvenile justice system to reintegrate into society rather than standard probation or treatment as usual (TAU). MST differs from the usual tactics in that it targets criminogenic factors related to an individual's social environment, particularly within the family system. [19] It has been identified as a promising treatment model for juvenile offenders by the U.S. Surgeon General in reducing rates of recidivism. [20]

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Conduct disorder (CD) is a mental disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior that includes theft, lies, physical violence that may lead to destruction, and reckless breaking of rules, in which the basic rights of others or major age-appropriate norms are violated. These behaviors are often referred to as "antisocial behaviors", and is often seen as the precursor to antisocial personality disorder; however, the latter, by definition, cannot be diagnosed until the individual is 18 years old. Conduct disorder may result from parental rejection and neglect and can be treated with family therapy, as well as behavioral modifications and pharmacotherapy. Conduct disorder is estimated to affect 51.1 million people globally as of 2013.

Antisocial personality disorder is a personality disorder characterized by a limited capacity for empathy and a long-term pattern of disregard or violation of the rights of others. Other notable symptoms include impulsivity and reckless behavior, a lack of remorse after hurting others, deceitfulness, irresponsibility, and aggressive behavior.

<span class="mw-page-title-main">Juvenile delinquency</span> Illegal behavior by minors

Juvenile delinquency, also known as juvenile offending, is the act of participating in unlawful behavior as a minor or individual younger than the statutory age of majority. The term delinquent usually refers to juvenile delinquency, and is also generalised to refer to a young person who behaves an unacceptable way.

<span class="mw-page-title-main">Anger management</span> Therapy for anger prevention and control

Anger management is a psycho-therapeutic program for anger prevention and control. It has been described as deploying anger successfully. Anger is frequently a result of frustration, or of feeling blocked or thwarted from something the subject feels is important. Anger can also be a defensive response to underlying fear or feelings of vulnerability or powerlessness. Anger management programs consider anger to be a motivation caused by an identifiable reason which can be logically analyzed and addressed.

Antisocial behaviours are actions which are considered to violate the rights of or otherwise harm others by committing crime or nuisance, such as stealing and physical attack or noncriminal behaviours such as lying and manipulation. It is considered to be disruptive to others in society. This can be carried out in various ways, which includes, but is not limited to, intentional aggression, as well as covert and overt hostility. Anti-social behaviour also develops through social interaction within the family and community. It continuously affects a child's temperament, cognitive ability and their involvement with negative peers, dramatically affecting children's cooperative problem-solving skills. Many people also label behaviour which is deemed contrary to prevailing norms for social conduct as anti-social behaviour. However, researchers have stated that it is a difficult term to define, particularly in the United Kingdom where many acts fall into its category. The term is especially used in British English.

Criminal psychology, also referred to as criminological psychology, is the study of the views, thoughts, intentions, actions and reactions of criminals and suspects. It is a subfield of criminology and applied psychology.

A behavior modification facility is a residential educational and treatment institution enrolling adolescents who are perceived as displaying antisocial behavior, in an attempt to alter their conduct.

Oppositional defiant disorder (ODD) is listed in the DSM-5 under Disruptive, impulse-control, and conduct disorders and defined as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness". This behavior is usually targeted toward peers, parents, teachers, and other authority figures. Unlike conduct disorder (CD), those with ODD do not show patterns of aggression towards people or animals, destruction of property, theft, or deceit. One half of children with ODD also fulfill the diagnostic criteria for ADHD.

<span class="mw-page-title-main">Adventure therapy</span> Type of psychotherapy

Adventure therapy is a form of psychotherapy created as early as the 1960s. It is influenced by a variety of learning and psychological theories. Experiential education is the underlying philosophy.

<span class="mw-page-title-main">Residential treatment center</span> Live-in healthcare facility

A residential treatment center (RTC), sometimes called a rehab, is a live-in health care facility providing therapy for substance use disorders, mental illness, or other behavioral problems. Residential treatment may be considered the "last-ditch" approach to treating abnormal psychology or psychopathology.

The professional practice of behavior analysis is a domain of behavior analysis, the others being radical behaviorism, experimental analysis of behavior and applied behavior analysis. The practice of behavior analysis is the delivery of interventions to consumers that are guided by the principles of radical behaviorism and the research of both experimental and applied behavior analysis. Professional practice seeks to change specific behavior through the implementation of these principles. In many states, practicing behavior analysts hold a license, certificate, or registration. In other states, there are no laws governing their practice and, as such, the practice may be prohibited as falling under the practice definition of other mental health professionals. This is rapidly changing as behavior analysts are becoming more and more common.

Parent management training (PMT), also known as behavioral parent training (BPT) or simply parent training, is a family of treatment programs that aims to change parenting behaviors, teaching parents positive reinforcement methods for improving pre-school and school-age children's behavior problems.

Attachment-based therapy applies to interventions or approaches based on attachment theory, originated by John Bowlby. These range from individual therapeutic approaches to public health programs to interventions specifically designed for foster carers. Although attachment theory has become a major scientific theory of socioemotional development with one of the broadest, deepest research lines in modern psychology, attachment theory has, until recently, been less clinically applied than theories with far less empirical support. This may be partly due to lack of attention paid to clinical application by Bowlby himself and partly due to broader meanings of the word 'attachment' used amongst practitioners. It may also be partly due to the mistaken association of attachment theory with the pseudo-scientific interventions misleadingly known as attachment therapy. The approaches set out below are examples of recent clinical applications of attachment theory by mainstream attachment theorists and clinicians and are aimed at infants or children who have developed or are at risk of developing less desirable, insecure attachment styles or an attachment disorder.

Callous-unemotional traits (CU) are distinguished by a persistent pattern of behavior that reflects a disregard for others, and also a lack of empathy and generally deficient affect. The interplay between genetic and environmental risk factors may play a role in the expression of these traits as a conduct disorder (CD). While originally conceived as a means of measuring the affective features of psychopathy in children, measures of CU have been validated in university samples and adults.

The adolescent community reinforcement approach (A-CRA) is a behavioral treatment for alcohol and other substance use disorders that helps youth, young adults, and families improve access to interpersonal and environmental reinforcers to reduce or stop substance use.

Mode deactivation therapy (MDT) is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to the process of mode deactivation that is based on the concept of cognitive modes as introduced by Aaron T. Beck. The MDT methodology was developed by Jack A. Apsche by combining the unique validation–clarification–redirection (VCR) process step with elements from acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mindfulness to bring about durable behavior change.

Mendota Juvenile Treatment Center (MJTC) is a juvenile psychiatric facility of the Wisconsin Department of Health Services, located in the Lorenz Hall Annex on the grounds of the Mendota Mental Health Institute (MMHI) in Madison, Wisconsin. It has space for 29 patients. The inmates at Mendota usually have anti-social personality disorders who do not feel empathy, guilt, nor remorse. It uses the Mendota Juvenile Treatment Center Program.

Barbara L. Bonner is a clinical psychologist and expert on juvenile sex offenders. She is known for her research on the assessment and treatment of abused children, prevention of child fatalities due to neglect, and treatment of children and adolescents with problematic sexual behavior. Bonner is the CMRI/Jean Gumerson Endowed Chair and Professor of Pediatrics at the University of Oklahoma College of Medicine. She serves as the Director of the Child Abuse and Neglect at the University of Oklahoma Health Sciences Center.

J. David Hawkins is an American sociologist, academic, and author. He is Emeritus Endowed Professor of Prevention and founding director of the Social Development Research Group in the School of Social Work at the University of Washington. His research focuses on the prevention of behavior problems in children and adolescents. He developed the Communities That Care prevention system with Richard F. Catalano.

References

  1. 1 2 Duncan, Melanie. "Dr". THE CALIFORNIA EVIDENCE-BASED CLEARINGHOUSE FOR CHILD WELFARE. Retrieved 26 March 2019.
  2. ↑ Dopp, Alex R; Borduin, Charles M; White, Mark H; Kuppens, Sofie (2017). "Family-based treatments for serious juvenile offenders: A multilevel meta-analysis". Journal of Consulting and Clinical Psychology. 85 (4): 335–354. doi:10.1037/ccp0000183. hdl: 10355/57157 . PMID   28333535. S2CID   25982122.
  3. ↑ van der Stouwe, Trudy; Asscher, Jessica J; Stams, Geert Jan JM; Deković, Maja; van der Laan, Peter H (August 2014). "The effectiveness of Multisystemic Therapy (MST): A meta-analysis". Clinical Psychology Review . 34 (6): 468–81. doi:10.1016/j.cpr.2014.06.006. PMID   25047448.
  4. ↑ Spas, J; Ramsey, S; Paiva, AL; Stein, LA (2012). "All might have won, but not all have the prize: optimal treatment for substance abuse among adolescents with conduct problems". Substance Abuse: Research and Treatment. 6: 141–55. doi:10.4137/SART.S10389. PMC   3498967 . PMID   23170066.
  5. ↑ Wagner, David V (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. doi:10.1037/a0035624. PMID   24417600.
  6. ↑ Johnides, Benjamin D. (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. doi:10.1037/ccp0000199. PMID   28333534. S2CID   10194802.
  7. 1 2 3 4 5 6 Henggeler, Scott W.; Schaeffer, Cindy M. (2016-07-02). "Multisystemic Therapy®: Clinical Overview, Outcomes, and Implementation Research". Family Process. 55 (3): 514–528. doi:10.1111/famp.12232. ISSN   0014-7370. PMID   27370172.
  8. 1 2 Weis, Robert (2018). Introduction to Abnormal Child and Adolescent Psychology. Thousand Oaks, CA: SAGE Publications. pp. 296, 297.
  9. ↑ Henggeler, Scott W. (2017). "Multisystemic Therapy". The Encyclopedia of Juvenile Delinquency and Justice: 1–5.
  10. 1 2 3 Henggeler, Scott W. (2012). "Empirically Supported Family-Based Treatments for Conduct Disorder and Delinquency in Adolescents". Journal of Marital and Family Therapy. 38 (1): 30–58. doi:10.1111/j.1752-0606.2011.00244.x. PMC   3270911 . PMID   22283380.
  11. 1 2 3 Zajac, Kristyn; Randall, Jeff; Swenson, Cynthia Cupit (2016). "Multisystemic Therapy for Externalizing Youth". Child and Adolescent Psychiatric Clinics of North America. 24 (3): 601–616. doi:10.1016/j.chc.2015.02.007. PMC   4475575 . PMID   26092742 – via PMC.
  12. ↑ Littell, JH; Popa, M; Forsythe, B (October 19, 2005). "Multisystemic Therapy for social, emotional, and behavioral problems in youth aged 10-17". The Cochrane Database of Systematic Reviews (4): CD004797. doi:10.1002/14651858.CD004797.pub4. PMID   16235382. S2CID   7409251.
  13. 1 2 3 4 5 6 7 8 9 10 "Xchange prevention registry | www.emcdda.europa.eu". www.emcdda.europa.eu. Archived from the original on 2021-04-28. Retrieved 2019-04-11.
  14. ↑ Saldana, Lisa (September 2005). "Dr" (PDF). Family Therapy Magazine: 26–29. Archived from the original (PDF) on 10 April 2019. Retrieved 10 April 2019.
  15. ↑ Claiborne, Christy Ann, "Multisystemic Therapy: Why there is a need for it, what it is, how it works, and an intern's experiences in a mental health agency utilizing multisystemic therapy" (2002). University of Tennessee Honors Thesis Projects. https://trace.tennessee.edu/utk_chanhonoproj/524
  16. ↑ Saldana, Lisa (September 2005). "Dr" (PDF). Family Therapy Magazine: 26–29. Archived from the original (PDF) on 10 April 2019. Retrieved 10 April 2019.
  17. ↑ Office of the Surgeon General (US); National Center for Injury Prevention and Control (US); National Institute of Mental Health (US); Center for Mental Health Services (US). Youth Violence: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2001. [Table, Multisystemic Therapy (MST)]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44295/table/A13142/
  18. ↑ "About MST Institute: our Purpose". MST Institute. Archived from the original on April 2, 2015. Retrieved March 17, 2015.
  19. ↑ van der Stouwe, Trudy; Asscher, Jessica J.; Stams, Geert Jan J.M.; Deković, Maja; van der Laan, Peter H. (August 2014). "The effectiveness of Multisystemic Therapy (MST): A meta-analysis". Clinical Psychology Review. 34 (6): 468–481. doi:10.1016/j.cpr.2014.06.006. ISSN   0272-7358. PMID   25047448.
  20. ↑ General (US), Office of the Surgeon; Control (US), National Center for Injury Prevention and; Health (US), National Institute of Mental; Services (US), Center for Mental Health (2001). "[Table, Multisystemic Therapy (MST)]". www.ncbi.nlm.nih.gov. Retrieved 2019-04-10.
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