| Adaptation Pilot Studies | Efficacy Trials | Effectiveness Trial(s) | Transportability Pilots | Mature Transport | Proactive Dissemination | PDF |
The purpose of this outline is to describe the general process by which standard MST (Henggeler et al., 1998) is adapted for use with other challenging clinical problems and eventually transported to community-based MST programs. The usual path to dissemination is as follows:
Adaptation Pilot >> Efficacy Trial(s) >> Effectiveness Trial(s) >> Transportability Pilots >> Mature Transport >> Proactive Dissemination
In the case of MST for serious juvenile offenders, for example, the initial pilot study was conducted by Henggeler in Memphis. The success of this work led to efficacy research conducted by Borduin in Missouri and effectiveness trials conducted by Henggeler in South Carolina. Success here led to early dissemination efforts (i.e., transportability pilots). Lessons learned from these early dissemination attempts have informed the large scale dissemination work of MST Services as well as the important independent replications of Leschied in Canada, Ogden in Norway, and Timmons-Mitchell in Ohio. The entire process took more than 20 years to complete!
As the effectiveness of MST in treating serious juvenile offenders became known to the larger practice and research communities in the 1990s, several groups of investigators have used standard MST as a platform for the development of adaptations to treat other serious clinical problems, including psychiatric problems, child abuse and neglect, substance abuse, problem sexual behaviors, and health care conditions such as diabetes, HIV infection, and obesity. Importantly, and as described next, each of these adaptations is progressing along the pilot study to dissemination continuum noted above. Although this carefully reasoned process will hopefully take fewer than 20 years to complete, we are primarily concerned with developing effective and sustainable interventions.
In cases where adaptations to the standard MST model might produce an effective intervention for a challenging clinical problem, relatively low cost pilot research is conducted to determine the feasibility and preliminary effects of the adaptation. Ellis and Naar-King have conducted a number of pilots on adaptations for youth failing to adhere to medical health care recommendations (MST-HC) in a number of domains such as treating poorly controlled type 1 diabetes, obesity, asthma and HIV+ youths. Similarly, the Building Stronger Families Project, currently being piloted in Connecticut, is integrating MST-CAN and Reinforcement Based Therapy (RBT), which is an evidence-based treatment of parental substance abuse. If outcomes from the pilot are favorable, such work is used to support efforts to obtain funding for a more rigorous evaluation of the MST adaptation. Importantly, for reasons of program fidelity, all research on MST adaptations includes researchers who developed the adaptations.
The purpose of a controlled efficacy trial is to determine whether the adaptation can achieve desired clinical outcomes under relatively favorable intervention conditions. Thus, for example, Borduin’s efficacy trials have included him as the clinical supervisor and highly qualified doctoral students as the therapists within a university-based program. Likewise, Rowland’s adaptations for psychiatric problems included considerable supervision from MST-trained psychiatrists at the Family Services Research Center. If results from the efficacy trials are positive, the adaptation is ready for rigorous evaluation in community treatment settings.
The purpose of controlled effectiveness trials is to examine the effectiveness of the adaptation in more usual practice settings and to identify barriers to such effectiveness. For example, Swenson has recently examined the effectiveness of MST- CAN provided by an MST team based in a community mental health center, and Bor and McDermott are conducting an effectiveness replication in Australia. Similarly, an effectiveness trial for psychiatric problems was recently completed in Hawaii, and an effectiveness trial for problem sexual behavior is currently being conducted in Chicago.
The purpose of the transportability pilots is to test the feasibility of the adaptation in several MST community programs. The pilots are kept very structured, under close oversight by adaptation developers (e.g., Swenson for MST-CAN, Borduin for problem sexual behavior, Rowland for psychiatric problems), and, if appropriate, protocols for broader dissemination are developed under the leadership of MST Services.
As with MST for serious juvenile offenders, broader dissemination of the adaptation will occur when (a) we are reasonably confident that the intervention protocols will achieve the desired outcomes if implemented with fidelity, and (b) the training and quality assurance procedures are sufficient to support the effective implementation of the intervention protocols. The transport experts, MST Services and its Network Partners, take the lead in national and international transport and implementation efforts.
The objective of dissemination strategies is to cultivate awareness of and interest in using a product or service. For MST and other evidence-based mental health and substance abuse treatments, the development/evaluation of effective strategies to proactively disseminate the model (that is, to encourage adoption of the model) is in its infancy.