Multisystemic Therapy (MST) is an effective approach to working with young people with antisocial behaviour and their families (Cunningham & Henggeler, 1999, Henggeler, et al., 1998; Henggeler, 1999). MST is an intensive family- and community-based treatment approach utilising evidence-based treatment approaches to produce long-term favourable outcomes and cost-savings for the young person and their family (Henggeler, 1999). MST acknowledges that working with families is integral to success with the young person. Research on MST is based on delivery to the young person in their own home. Youth Horizons Trust has integrated the framework and treatment approaches of MST into the residential and fostercare programme.
MST treatment theory is based on models of the cause of “delinquency”, Bronfenbrenner’s social-ecological model and family systems. The young person is viewed in relationship to his or her family, school, peers family and community. Scientifically proven treatment techniques that traditionally focused on a limited aspect of the youth’s ecology are widened to include the young person’s social ecology. Treatment is guided by nine principles as opposed to more traditional approaches that outline session-by-session treatment plans.
The nine principles are:
Principle 1: The purpose of assessment is to understand the fit between the identified problems and their broader systemic context.
Principle 2: Therapeutic interventions should emphasize the positive and should use systemic strengths as levers for change.
Principle 3: Interventions should be designed to promote responsible behaviour and decrease irresponsible behaviour among family members.
Principle 4: Interventions should be present-focused and action-oriented, targeting specific and well-defined problems.
Principle 5: Interventions should target sequences of behaviour within and between multiple systems that maintain identified problems.
Principle 6: Interventions should be developmentally appropriate and fit the developmental needs of the young person.
Principle 7: Interventions should be designed to require daily or weekly effort by family members
Principle 8: Intervention effectiveness is evaluated continuously from multiple perspectives, with providers assuming accountability for overcoming barriers to successful outcomes.
Principle 9: Interventions should be designed to promote treatment generalization and long-term maintenance of therapeutic change by empowering care givers to address family members’ needs across multiple systemic contexts.
Aim of Service Component
• To reduce frequency, severity and intensity of referral behaviours, namely violence, criminal offending and alcohol and drug abuse.
• To reduce the need for out of home placements.
• The major goal of MST is to empower parents with the skills and resources needed to independently address the difficulties that arise in raising teenagers, and to empower youth to cope with family, peer, school, and neighbourhood problems. Within a context of support and skill building, the therapist places developmentally appropriate demands on the adolescent and family for responsible behaviour. Intervention strategies are integrated into an environmental context and include strategic family therapy, structural family therapy, behavioural parent training, and cognitive behaviour therapies.
Schooling
MST aims to work with young people in their natural environment, strengthening the relationships between systems that support the youth. The MST therapist attempts to keep young people in their community which includes their local schools. When young people are unable to attend school the therapists looks at other resources in the community that are sustainable post-treatment.
Numbers
One team of four therapists can see up to 48 families a year.
Components of Treatment
MST is provided using a home-based model of service delivery. This model helps to overcome barriers to service access, increases family retention in treatment, allows for the provision of intensive services (i.e. therapists have low caseloads), and enhances the maintenance of treatment gains.
The usual duration of MST treatment is about 3-5 months.
It is recommended that readers refer to the book Multisystemic Treatment of Antisocial Behaviour in Children and Adolescents by Scott Henggeler, Sonja Schoenwald, Charles Bourduin, Melisa Rowland and Phillippe Cunningham (1998) for a more comprehensive account of the model in practise. Also information is available at www.mstnz.co.nz