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How to Start an MST Program

Executive Summary: MST is part of a growing number of “Evidence-Based Practices” (EBPs) – that is, practices supported by rigorous evaluations that demonstrated treatment effectiveness and sustained client outcomes.  Because EBPs are tested for specific, well defined populations, their implementation at the community level is often only supported for the population tested.  This is true of MST as well. Selecting the best program includes assuring the best fit for the needs of the intended population, the community context and the agency aiming to provide the service.  The MST Program Development Method ™ (PDM) aims to assure that MST programs are appropriately used, well developed and sustainable for the long term.

There are distinct stages of the MST Program Development Method ™ including:

  1. Initial information collection
  2. MST needs assessment
  3. MST critical issues session
  4. Site Readiness Review meeting
  5. Staff recruitment & orientation training
  6. Ongoing implementation support

Stage A: Initial information collection: Contact MST Services to answer any initial questions and to request an MST Program Development Overview Email.  Often with a few questions the interested agency or provider organization can either eliminate MST as an alternative, or decide to move forward with a complete MST needs (i.e., feasibility) assessment.  Sites developing proposals for funding may receive limited technical assistance at this stage as well.

Stage B: MST needs assessment: MST Services offers technical assistance at no charge during the feasibility study phase of development.  Once all criteria are met for a sustainable program, the applicant agency or provider organization would enter in a licensing agreement with MST Services and formal program development would begin.  The provider organization has the option to receive the formal technical assistance of program start-up and program support either from MST Services or from a licensed MST Network Partner organization that has been approved to provide this level of service.  The needs assessment includes:

  • Identifying community need – This involves (1) clearly defining the target population; (2) defining the geographic coverage area; and, (3) determining the number of potential referrals from that area by referral source.
  • Developing a financial plan – This involves collecting key information about program costs to develop a pro-forma program budget.  Then, determining if available funding sources are sufficient to recover the costs with a margin sufficient to cover contingencies such as a temporary reduction in referrals to the program, or to cover the loss of capacity from employee turnover.
  • Assuring Agency Commitment – This involves an overt agreement to implement MST with complete fidelity to the model, including participation in the quality assurance protocols associated with the model. 
  • Assuring Support from key community stakeholders – This involves identifying all of the key individuals and agencies needed to assure success for the program and for the youth and families participating in the program.  Primary support involves sufficient funding and referrals.  Secondary support involves the willingness to collaborate with MST to implement interventions aimed at long-term sustainable change on the part of the youth and his or her supporting ecology.

The “Go or “No-Go” decision – If there is an MST-appropriate target population in a sufficient number within a reasonable drive-time geographic area, and a funding source sufficient to cover the program costs, and, commitment from the provider agency, and commitment from the community stakeholders, then the provider agency is ready for implementation.

Stage C: MST critical issues session:  Once the “Go” decision has been made, the next step is to develop the critical program components.  The MST Services or MST Network Partner provides technical assistance to the agency’s development team for each element of this stage.  Critical components may include, but not be limited to:

  • Writing of a formal program description including a scope of services, evaluation and QA
  • Developing or adjusting agencies policies and procedures for MST compatibility
  • Developing a plan for the physical location and equipment
  • Developing an implementation timeline with critical milestones
  • Identifying and engaging key community stakeholders
  • Developing a MST Goals & Guidelines document that identifies:
    • Target population
    • Inclusion priority process
    • Exclusions from treatment
    • Referral process and procedures
    • Program-level goals
    • Guidelines for various procedures

Stage D: Site Readiness Review meeting:  Once the critical elements of the program are in place, and about 6-8 weeks prior to start-up, the MST Services program developer will conduct a Site Readiness Review consisting of a one-day on-site visit, including an overview presentation and a meeting with the key community stakeholders to review the final implementation plan.  This provides one last opportunity for the stakeholders to provide input before the plan is fully implemented.

Stage E: Staff recruitment & orientation training: This stage typically begins before the Site Readiness Review meeting, but continues until all key staff are hired.  An MST Expert will provide consultation for the recruitment of the initial team to make up for the limited experience with MST and the factors that contribute to the “best fit” of the employee.  The process includes:

  • writing MST-specific job descriptions
  • setting salary ranges appropriate to the job and the local market
  • advertising, interviewing and selecting the best candidates
  • 5-Day MST Orientation for all staff (on-site or at an approved training location)

 
Stage F: Ongoing program implementation support: The new MST program is open for business on the Monday following the orientation training week.  By this time, the office is open and equipped, policies and procedures are in place, and the referral process is working and has provided a minimum of two families for each therapist to begin treatment. Within four weeks, each therapist should receive two additional referrals.  As the first families apporach completion, the caseload may grow to the maximum of six.  Highly experienced therapists may maintain a caseload of six a greater percentage of time, but program capacity is usually based on an average of five at any given time.

This stage extends as long as the program is in operation as a licensed MST program.  Support includes weekly consultation with the team, quarterly booster trainings, and supervisor support and training as well as clinical development for each therapist.  In addition, the MST Expert assists with the implementation of the overall quality assurance protocol and reviews implementation data semi-annually.