Multisystemic therapy Health Article

Definition

Multisystemic therapy (MST) is an intensive family- and community-based treatment program designed to make positive changes in the various social systems (home, school, community, peer relations) that contribute to the serious antisocial behaviors of children and adolescents who are at risk for out-of-home placement. These out-of-home placements might include foster care, group homes, residential care, correctional facilities, or hospitalization.

Purpose

MST is licensed by MST Services, Inc., through the Medical University of South Carolina and operates with the fundamental assumption that parents (defined as guardians), or those who have primary caregiving responsibilities to children, have the most important influence in changing problem behaviors in children and adolescents.

The primary goals of MST are to:

• develop in parents or caregivers the capacity to manage future difficulties
• reduce juvenile criminal activity
• reduce other types of antisocial behaviors, such as drug abuse
• achieve these outcomes at a cost savings by decreasing rates of incarceration and other out-of-home placements

MST was created approximately 25 years ago as an intensive family- and community-based treatment program to focus on juvenile offenders presenting with serious antisocial behaviors and who were at-risk for out-of-home placement. The program has been shown to be effective with targeted populations that include inner-city delinquents, violent and chronic juvenile offenders, juvenile offenders who abuse or are dependent on substances and also have psychiatric disorders, adolescent sex offenders, and abusive and neglectful parents. A more recent focus (1994–1999) of MST has been to treat youths with psychiatric emergencies such as suicidal ideation, homicidal ideation, psychosis, or threat of harm to self or others due to mental illness. The results are promising and indicate that MST is an effective alternative to psychiatric hospitalization. Some treatment conditions and interventions were modified to take care of this population, including developing a crisis plan during the initial family assessment and adding child and adolescent psychiatrists, psychiatric residents, and crisis caseworkers to the MST treatment team. Supervision of the treatment team was initially increased from weekly to daily meetings. Caseloads of MST therapists were reduced from five to three families, increasing the intensity of the intervention. When some adolescents were hospitalized for safety, the MST staff maintained clinical responsibility for the adolescent who was insulated from the usual activities due to inpatient care.