Multisystemic Therapy

What is Multisystemic Therapy (MST)?

Multisystemic Therapy (MST) is an intensive family- and community-based treatment program. It addresses all aspects and natural environments of a high-risk youth’s life, including home, family functioning, school, community, and peers.  

MST clinicians:

• Spend time in the patient’s environment 
• Are on-call 24/7
• Empower parents, extended family, and other caregivers
• Focus on helping the patient succeed in school and gain job skills
• Introduce alternative recreational activities

MST’s goal is to prevent young people with serious clinical problems, including violent tendencies, serious antisocial behavior, substance abuse, or criminal behavior, from continuing to get into trouble. This is achieved through intense involvement and contact with the patient and their family and extended support system. 

MST services uncover and assess the origins of the issues experienced by chronic juvenile offenders. Together, the patient and their support system work to change their environment to promote prosocial conduct and reduce behavior problems.

Strategies include:

• Individual therapy
• Family therapy
• Cognitive behavioral therapy
• Treatment for drug use or other substance use
• Tools to promote behavior change
• Follow-up when issues arise 

Is Multisystemic Therapy Evidence Based?

Yes.

MST is an evidence-based therapy developed by the Medical University of South Carolina’s Family Services Research Center. The goal was to provide mental health services to teens with delinquent behavior and offer their families support.

As part of the MST treatment, patients and their therapists set specific, measurable goals tailored to the particular situation. The therapist’s goal is to keep the patient safe at home, at school, and at work and ensure they stay out of trouble with the law. Success is not measured by the length of time a patient or family is in the program. When a patient is released from the program, therapists consider:

• Is the patient still living at home?
• Is the patient still attending school or working?
• Was the patient arrested during treatment?

Case studies done on MST show that the program improves recidivism rates by about 20 percent. Participants spend less time incarcerated, and when program participants commit crimes, they are significantly less severe.

Program participants also experience significantly higher instances of family cohesion and less peer aggression.

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How Does MST Work?

MST programs use a patient, family, and community-based treatment model. A masters-level therapist facilitates them. They work with the patient and their family in a home placement and at school, and in the community. Patients see their therapists several times a week for intensive treatment. Programs usually last about three to five months. Therapists are also on call for crises.

Therapists work with everyone in the patient’s life. They try to understand challenges and partner with the caregivers, family members, and other systems to develop and implement interventions that lead to positive changes. 

MST therapists help everyone gain skills and find resources that support the patient’s challenges and the challenges faced by their loved ones. 

Who Benefits From MST?

The primary participants in MST are youth ages 12 to 17 with serious problem and antisocial behavior. Many MST members also experience mental health problems. Most serious juvenile offenders crimes might include:

• Problems at school, including truancy
• Disrespectful or disobedient behavior
• Aggressiveness
• Drug and/or alcohol problems
• Criminal behavior
• Running away

Patients in the program benefit, but so do their families, caregivers, peers, educators, and the community.

How Is Success Measured With MST?

The success of MST is measured by the goals for each specific case customized to the child's behaviors and agreed upon by the individual, the family, and critical participants.

MST’s primary outcomes are to keep young people safely at home, in education or working, and out of trouble with the law. Treatment is not measured by the timeframe a family has spent in MST.

How Does MST Assess Fidelity and Quality Assurance?

Throughout MST treatment, several adherence measures are tracked. The primary caregiver of the family reports how efficiently the MST therapist is following MST’s treatment principles. Additionally, the MST team's clinicians report how successfully the therapists, supervisors, and consultants adhere to the treatment model.

Sticking to the model is essential as research shows that precise adherence and supervision lead to a 64 percent reduction in incarceration during and post-treatment. MST providers use the website MSTI.org to track case-level outcome data.

How Much is MST Counseling?

When evaluating the cost of MST counseling, it is essential to consider the alternative price of not providing early intervention. Studies show that the approximate cost to society for a single lifetime of crime is as much as $1.5 million.

Understanding how expensive it is to enable behavioral problems, substance abusing, and other issues that put someone into the juvenile justice system makes it easier to understand why it is essential to invest in programs like MST that reduce the likelihood of criminal activity.

MST offers long-term savings, which means the future cost for taxpayers and victims is less now than it would cost later to deal with crime.

One study conducted by Charles M. Borduin, one of MST’s developers, found that evidence-based therapies are cost-effective. MST involves a therapist working with chronic juvenile offenders in the home and working with family members and the school system. 

An MST intervention can reduce the cost of crime by tens of thousands of dollars. The study specifically showed a cost reduction of more than $35,000 per offender and nearly $8,000 per sibling in each family. The investment in intensive individual, community, and family therapy for juvenile offenders pays off in the long-run.

Overall, according to Bourduin’s study, every dollar invested in MST counseling recovered more than $5 in savings for taxpayers and crime victims in the quarter-century after treatment.

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