Provided by the National Institute of Mental Health
Not all children enjoy the "carefree" days of
childhood. Unfortunately, when things start to go wrong, people often despair of
being able to repair the damage. NIMH has made research on diagnosis, early
intervention, and treatment of children an absolute priority.
Arguments are waged as to the management of children who attempt suicide, commit
crimes or even those who are abandoned and neglected. Our society has
impoverished resources to answer such questions and while some hospitals are
available, all too often the answer is prison. Research has demonstrated,
however, that children do not need to be hospitalized or incarcerated to get the
help they need. A home-based model of therapy, called Multisystemic Therapy or
MST, offers treatment services to young people and their families in their
homes. Youth with serious emotional or behavioral problems, such as antisocial
behaviors, substance abuse, delinquency, or severe depression and suicidality,
have been successfully treated through MST.
This approach shows a more hopeful and positive approach and focuses on how to
help parents assist their children and how to teach young people to deal with
their schools and communities. This program has been found to be an effective
alternative to hospitalization and to jails.
The magnitude of the problem is this: 1 in 10 children and adolescents suffer
from mental illness severe enough to cause some level of impairment.1
Nonetheless, fewer than 1 in 5 of these ill children receives treatment. 2 There
is heated debate in our society about the proper roles of medications and
psychotherapies for children at risk and children already suffering. But, one
thing is clear: children who go untreated, suffer, cannot learn, and may not
form healthy relationships with peers and family. Some children are placed on a
trajectory for jail rather than college at a very early age.
MST is a mental health service that focuses on changing how youth function in
their natural settings—that is, at home, in school, and in their
neighborhoods.3,4,5 It is designed to promote positive social behavior while
decreasing problematic behavior, including delinquency, depression, or substance
abuse. MST therapists focus on strengthening the ability of parents or
caretakers to raise children who have complex problems. Therapists working in
the home identify strengths in the families and use these strengths to develop
natural support systems and to improve their parenting. Therapy is approached as
a collaboration between the family and the MST therapist. The family sets
treatment goals and the therapist suggests strategies to accomplish them.
Specific treatments are used within MST. The interventions are individualized to
the family's strengths and weaknesses and address the needs of the child,
family, school, peers, and neighborhood. Therapists working in the home have
small caseloads and are available 24 hours a day, 7 days a week. Treatment teams
usually consist of professional counselors, crisis caseworkers, and
psychiatrists or psychologists who provide clinical supervision.
In a series of randomized clinical trials, MST has proven effective in reducing
long-term rates of criminal offending in serious juvenile offenders and in
reducing their rates of out-of-home placements. For these youths, long term
effects of MST even 4 years post-treatment, were found. MST reduced long-term
rates of re-arrest by 25 to 70 percent compared with control groups.
MST has recently been found to be an effective alternative to psychiatric
hospitalization with children in a psychiatric emergency. In the most recent
randomized trial, MST was found to significantly decrease behavior problems,
increase family cohesion, and increase school attendance compared with
hospitalization. MST also reduced symptoms of internalizing distress and
depression. Importantly, families who received MST were significantly more
satisfied with their treatment than were families whose children were
hospitalized.
In addition, MST was successful in preventing a significant proportion of
adolescents from being hospitalized. Further, the use of hospitalization was not
offset by increases in the use of other restrictive placement options. Youth in
the hospitalization condition had almost double the number of days in other
out-of-home placements in comparison with youths in the MST condition.
Studies comparing the costs of MST for serious juvenile offenders to traditional
services have found that MST results in costs savings by decreasing out-of-home
placement costs and costs of incarceration.
A complete manual for MST is available from Multisystemic Therapy Services
(address below). MST has stringent quality assurance mechanisms to assure
treatment fidelity. Following the treatment guidelines is critical as research
has shown that strong adherence to the model is correlated with strong case
outcomes, and poor adherence is associated with substantially poorer outcomes.
Training, which is key to the success of the model, is intensive and ongoing.
On-site clinical supervision is necessary to ensure that therapists adhere to
the MST program.
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For More Information
Please visit the following link for information about organizations that focus
on child and adolescent mental health.
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All material in this fact sheet is in the public domain and may be copied or
reproduced without permission from the Institute. Citation of the source is
appreciated.
NIH Publication No. 01-4587
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References
1Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule
for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence
rates, and performance in the MECA Study. Methods for the Epidemiology of Child
and Adolescent Mental Disorders Study. Journal of the American Academy of Child
and Adolescent Psychiatry, 1996; 35(7): 865-77.
2Burns BJ, Costello EJ, Angold A, et al. Data watch: children's mental health
service use across service sectors. Health Affairs, 1995; 14(3): 147-59.
3Henggeler SW, Schoenwald SK, Borduin CM, et al. Multisystemic treatment of
antisocial behavior in children and adolescents. New York: Guilford Press, 1998.
4Borduin CM, Mann BJ, Cone LT, et al. Multisystemic treatment of serious
juvenile offenders: long-term prevention of criminality and violence. Journal of
Consulting and Clinical Psychology, 1995; 63(4): 569-78.
5Henggeler SW, Melton GB, Smith LA. Family preservation using multisystemic
therapy: an effective alternative to incarcerating serious juvenile offenders.
Journal of Consulting and Clinical Psychology, 1992; 60(6): 953-61.
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