Start a Multisystemic Therapy (MST) Program

Multisystemic Therapy (MST) is an evidence-based intervention for youth at risk of severe system consequences due to serious externalizing, anti-social, and/or delinquent behaviors (e.g., criminal activity, substance use) and their families. Youth and families receive treatment within the systems they are embedded in, such as their homes, schools, and communities, via licensed Multisystemic Therapy providers, which consist of a team (or teams) of 2–4 therapists and a supervisor. MST teams are on call 24/7 to provide treatment when and where it is needed—within any combination of these systems—and are dedicated to improving youth and family functioning.

MST is not a one-time training, but rather a licensed, ongoing intervention program. This is due to the fact that MST is an evidence-based program, so treatment model adherence is imperative. For organizations who become MST providers, staff hired to provide MST are required to attend an orientation training as well as quarterly booster trainings. Organizations will also work with MST Services to measure treatment outcomes and receive continuous support and consultation.

MST Services, licensed by the Medical University of South Carolina, is the organization responsible for disseminating Multisystemic Therapy with clinical fidelity. MST Services supports the implementation and ongoing fidelity of MST worldwide by charging standard fees for program development, intellectual property licensing, ongoing training, support, and quality assurance.

Multisystemic Therapy is for youth at risk of out-of-home placement due to antisocial, delinquent, or criminal behaviors. However, we also offer a handful of alternative treatment types for organizations that are focused on treating other specific clinical populations. Examples include MST for Child Abuse and Neglect (MST-CAN) and MST-Psych for youth with advanced psychiatric needs.

A variety of organizations provide MST, including behavioral health agencies, non-profits, government departments, etc. An organization must be able to support at least one team consisting of a supervisor and 2–4 therapists who hold master’s degrees in clinical or counseling psychology, social work, or a related mental health field and are dedicated to taking MST cases only. While youth and families do not receive treatment within an office or residential setting, an organization must still be within close proximity to its MST clients (see next question for more details). A normal caseload is 4–6 clients per therapist (5 on average), with treatment lasting 3–5 months. There are certain eligibility requirements to becoming and maintaining licensure as an MST provider.

MST’s target population is young people that are at risk of severe system consequences, including but not limited to out-of-home placement due to serious externalizing behavior. This could look like a young person with a recent arrest history for theft or drug possession, or a defiant youth with behavior problems at home and/or in school, or a teen returning from an out-of-home placement such as foster care.

A key component of a successful MST program is a clear pathway so that eligible youth and families can find their way into the program. Referral sources are at the forefront of this path, and it is imperative for MST teams to have a working relationship with these sources, which may include juvenile justice departments, child welfare departments, schools, psychiatric facilities, etc.

Location is best determined by geographic proximity to likely referrals. MST Services also requires clinicians to be within a 90-minute drive time to their clients. Questions to consider: Where are there currently the most instances of juvenile delinquency or risk of system involvement? Where is the highest population density? Where is there the biggest need in terms of service gaps for at-risk juveniles and/or youth displaying anti-social behaviors? MST Services can help identify a specific location, such as a behavioral health agency or “home base” for the clinicians to operate out of. Although treatment is not done within this setting, it gives clinicians and other MST staff a place to coordinate as a team.

It depends on several factors including the responsiveness of the provider agency and availability of funding. An expectation of 3 to 6 months for program development is reasonable.

Success is measured by the goals for each specific case tailored to the behaviors of the youth, and agreed upon by the young person, the family, and key participants. MST’s ultimate outcomes are to keep youth safely at home, in school or working, and out of trouble with the law. Treatment is not measured by the length of time a family has spent in MST.

The cost to implement MST varies from region and provider. As a rule of thumb, we tell agencies to budget for having 4 to 6 masters-level clinicians including salary, benefits, etc. Other significant expenses include office, equipment, therapist drive time, flex funds for families, and administrative overhead for the agency. We at MST Services will work with providers during program development to complete a pro-forma budget specific to the provider agency. We also support the provider to work with stakeholders and funders to provide the necessary funding for sustainable delivery of MST.

MST providers use a web-based data management tool (MSTI.org) to track case-level outcome data. At the time of discharge, MST measures three main outcomes for each youth receiving treatment:

1. Is the youth at home?

2. Is the youth in school or working?

3. Was the youth arrested during MST treatment?

Model fidelity is also tracked during treatment by gathering data from the primary caretaker of the family, who reports on how well the MST Therapist is adhering to treatment principles. Furthermore, the MST Therapist reports on their supervisor’s and consultant’s adherence. Supervisors also report on the consultant’s adherence. A Program Implementation Review that assesses the implementation of the model at the program level is conducted as well. Model fidelity is critically important as research demonstrates that proper adherence and supervision results in a 64% reduction in incarceration.