HOW IS MST DIFFERENT?

· Research: Proven long-term effectiveness through rigorous scientific evaluations

· Treatment theory: A clearly defined and empirically grounded treatment theory

· Implementation: A focus on provider accountability and adherence to the treatment model

· Focus on long-term outcomes: Empowerment of caregivers to manage future difficulties

· MST is a well-validated treatment model (Kazdin & Weisz, 1998) with eight randomized clinical trials completed and several others underway. As of 1998, over $10 million dollars has been spent conducting research on the effectiveness of MST.

· Studies with violent and chronic juvenile offenders showed that MST reduced long-term rates of rearrest by 25% to 70% in comparison with control groups.

· Studies with long-term follow-ups showed MST reduced days in out-of-home placements by 47% to 64% in comparison with control groups.

· MST is detailed in a treatment manual (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) and operationalized through adherence to nine treatment principles.

· The treatment theory underlying MST draws upon causal modeling studies of serious antisocial behavior and social-ecological and family systems theories of behavior. MST leverages off the decades of research on the determinants of antisocial behavior. More than twenty research groups have conducted sophisticated causal modeling studies that illuminate interrelationships among the key risk and protective factors that contribute to serious behavioral problems in youth.

· MST places an extremely strong focus on provider accountability. The MST therapist, the MST team, and the entire host agency are responsible for removing barriers to service access and for achieving outcomes with every case (e.g., responsibility of the therapist to engage the family, accountability of the therapist and provider organization to achieve sustainable outcomes that the family can sustain after treatment ends).

· Treatment adherence is optimized by quality assurance mechanisms that are the most stringent in the field of mental health. These mechanisms include task-oriented on-site supervision, measurement of adherence to the treatment model using research-validated instruments, and intensive training for all MST staff including a 5 day orientation training, weekly case consultation with an MST expert, and quarterly booster training.

· In practice, MST is a very analytical yet pragmatic and task-oriented treatment. MST therapists are trained to always be aware of their understanding of each case and to always support their "hunches" with observable evidence. MST therapists focus on designing interventions that will have the most immediate and powerful impact on the problem behavior by leveraging off the strengths in the family and other indigenous systems. In order to assess the impact of an intervention, MST therapists are trained to anticipate the outcome of each intervention by describing the observable and measurable outcomes they are aiming for, and to document these anticipated outcomes prior to implementing the intervention. This information is used to assess the advances made or barriers encountered.

· Specific treatment methodologies used as part of MST interventions are empirically based (e.g., cognitive behavior therapies, behavioral parent training, and the pragmatic family therapies -- structural family therapy, strategic family therapy, etc.).

· The ultimate goal of MST is to empower the youth’s primary caregivers with the skills and resources needed to independently address the difficulties that arise in raising teenagers with behavioral problems and to empower youth to cope with family, peer, school, and neighborhood problems.

· MST focuses on changing the known determinants of offending, including characteristics of the individual youth, the family, peer relations, school functioning, and the neighborhood. This change is accomplished through the mobilization of indigenous child, family, and community resources.

· MST treatment plans are designed in collaboration with family members and are family driven rather than therapist driven.

How is MST similar to many other community-based programs?

• Services are provided to the family, although a variety of activities may be undertaken with or on behalf of individuals.
• Services are targeted to families with children at risk of out-of-home placement to foster care, group homes, residential treatment, or correctional facilities.
• Services are time-limited (one to five months).
• Services are flexibly scheduled to meet the family’s needs and are delivered in the home.
• Services are tailored to the needs of family members.
• Services are provided in the context of a family’s values, beliefs and culture.
• Services are available 24 hours a day, seven days a week.
• Workers have small case loads of between 2 to 6 families and may visit families many times a week. In many programs, families are seen between 2 and 15 hours per week. Hence the term "intensive" is sometimes used to describe family preservation services.

Citations

Kazdin, A. E. & Weisz, J. R. (1998). Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology, 66, 19-36.

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