Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Services Interventions
Treatment Interventions
Multisystemic Therapy
Multisystemic therapy programs within the juvenile justice system have
demonstrated effectiveness. MST is an intensive, short-term, home- and
family-focused treatment approach for youth with severe emotional disturbances.
MST was originally based on risk factors that were identified in the published
literature and was designed for delinquents. MST intervenes directly in the
youth’s family, peer group, school, and neighborhood by identifying and
targeting factors that contribute to the youth’s problem behaviors. The main
goal of MST is to develop skills in both parents and community organizations
affecting the youth that will endure after brief (3 to 4 months) and intensive
treatment. MST was constructed around a set of principles that were put into
practice and then expanded upon in a manual (Henggeler et al., 1998). Elaborate
training, supervision, and monitoring for treatment adherence make this an
exemplary approach. Furthermore, publication of an MST manual and the high level
of clinical training in MST distinguish this model from other types of family
preservation services.
The efficacy of MST has been established in three randomized clinical trials for
delinquents within the juvenile justice system. The first of these studies took
place in Memphis, Tennessee, and revealed that MST was more effective than usual
community services in decreasing adolescent behavioral problems and in improving
family relations (Henggeler et al., 1986). The second was conducted in
Simpsonville, South Carolina, and compared outcomes for 84 juvenile offenders
randomly assigned to either MST or usual services. At 59 weeks after referral,
youth who had received MST had fewer arrests and self-reported offenses and had
spent an average of 10 fewer weeks incarcerated than did the youth in usual
services. In addition, families served by MST reported increased family cohesion
and decreased youth aggression in peer relations (Henggeler et al., 1992). In
the third study, MST was compared with individual therapy in Columbia, Missouri,
and was found to be more effective in ameliorating adjustment problems in
individual family members. A 4-year followup of rearrest data indicated that MST
was more effective than individual therapy in preventing future criminal
behavior, including violent offenses (Borduin et al., 1995). Studies found
improved behavior, fewer arrests, and lower costs. These findings encouraged the
investigators to test the effectiveness of MST in other organizational settings
(e.g., child welfare and mental health), allowing them to target other clinical
populations, including youthful sex offenders (Borduin et al., 1990), abused and
neglected youth (Brunk et al., 1987), and child psychiatric inpatients (see
Inpatient Treatment section). Initial results are promising for youth receiving
MST instead of psychiatric hospitalizations (Henggeler et al., 1998). As
expected, some adjustments to MST are required to handle children who are
dangerous to themselves and who do not respond as quickly to treatment as the
delinquent youth in previous studies. The efficacy of MST was demonstrated in
real-world settings but only by one group of investigators; thus, the results
need to be reproduced by others and future effectiveness research needs to
determine whether the same benefits can be demonstrated with less support from
experts.
Back to the Mental Health: The Surgeon General's Report Table of Contents