Multisystemic Therapy® (MST®) is an intensive family- and home-based treatment that strives to create healthier families and reduce recidivism among chronic, violent, or substance-abusing male and female juvenile offenders at risk of out-of-home placement. MST seeks to improve the real-world functioning of youth by changing their natural settings – home, school, and neighborhood – in ways that promote prosocial behavior while decreasing antisocial behavior. Therapists work with youth and their families to address the known causes of delinquency on an individualized, yet comprehensive basis. By using the strengths in each system (family, peers, school, and neighborhood) to facilitate change, MST addresses the multiple factors known to be related to delinquency across the key systems within which youth are embedded. The extent of treatment varies by family according to clinical need.
Master-level therapists maintain small caseloads of 4 to 6 families, providing most mental health services and coordinating access to other important services (e.g., medical, educational, and recreational). While the therapist is available to the family 24 hours a day, 7 days a week, the direct contact hours per family varies according to clinical need. Generally, the therapist spends more time with the family in the initial weeks of the program (daily if needed) and gradually tapers off (as infrequently as once a week) during a 3- to 5-month course of treatment.
MST has over 60 published studies, with most of the findings from randomized studies providing evidence that MST can produce short- and long-term reductions in criminal behavior and out-of-home placements for serious juvenile offenders. For example, in the Columbia, Missouri study, immediately after treatment, MST resulted in decreased behavior problems in MST youth, relative to controls. Additionally, MST families reported more cohesion, adaptability, and supportiveness, and less conflict-hostility than control families. At the four-year follow-up, 26.1% of the MST treatment group had been arrested at least once, compared to 71.4% of those in individual therapy. At 13.7 years and 21.9 years post-treatment, MST participants compared to control counterparts were less likely to be arrested, had fewer arrests and fewer days in confinement. At 25 years post-treatment, an evaluation of siblings of the original subjects found that siblings in the control group were significantly more likely to have been arrested at least once as compared to siblings in the treatment group.
An independent replication in Norway showed that MST, in comparison with usual services, decreased youth externalizing and internalizing symptoms and out-of-home placements, and that some effects were sustained for at least two years.
MST returns $1.62 for every dollar invested.
Return to Blueprints Bulletin Issue 7. July 2018.