Multisystemic treatment (MST) is a family- and home-based therapeutic approach that has been found to be effective in treating antisocial youths and that has recently been applied to youths with serious emotional disturbances. In light of the increasing dissemination of MST, this review examines the effectiveness of MST by quantifying and summarizing the magnitude of effects (treatment outcomes) across all eligible MST outcome studies. Included in a meta-analysis were 7 primary outcome studies and 4 secondary studies involving a total of 708 participants. Results indicated that across different presenting problems and samples, the average effect of MST was d = .55; following treatment, youths and their families treated with MST were functioning better than 70% of youths and families treated alternatively. Results also showed that the average effect of MST was larger in studies involving graduate student therapists (i.e., efficacy studies; d = .81) than in studies with therapists from the community (i.e., effectiveness studies; d = .26). In addition, MST demonstrated larger effects on measures of family relations than on measures of individual adjustment or peer relations.
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"Findings across these studies have consistently favored MST in comparison with control conditions. A meta-analysis of MST trials (Curtis, Ronan, and Borduin, 2004) included seven of these studies (708 total participants, 35 MST therapists), and effect sizes averaged 0.50 for criminal behavior, 1.01 for arrest seriousness, and 0.29 for substance use. Further, these studies typically have been completed in field settings and included few exclusion criteria, features that strengthen support for treatment effectiveness of MST in real-world community practice settings. "
"These results suggest that interventions aimed at reducing criminal recidivism by addressing risk and/or protective factors may be less effective in juvenile offenders with substance use problems. This is consistent with findings of Henggeler and colleagues (1999, 2006) in which the well documented capacity of MST to reduce rearrest rates (Curtis et al., 2004; Henggeler, 1999) did not emerge in substance abusing juvenile offenders. These findings suggest that changing offending behavior may be more difficult with increasing levels of substance use problems. "
[Show abstract][Hide abstract] ABSTRACT: Little is known about the needs of substance-using juveniles in treatment aimed at reducing criminal recidivism. Therefore, we aimed to examine treatment needs of substance-using juvenile offenders.
Differences were examined between juvenile offenders who abstain from substance use (ASU; n=1974) and substance-using juvenile offenders without (SU; n=7000) and with substance use problems (SUP; n=3317), in the prevalence of risk/protective factors for criminal recidivism and strength of associations between risk/protective factors and criminal recidivism. We conducted secondary data analysis on recidivism risk assessments, collected with the Washington State Juvenile Court Assessment, and re-offending data. Analyses of variance and Partial correlations, adjusted for age, gender and ethnicity were applied, as well as Fisher's z tests and logistic regression analyses.
Results showed that substance-using offenders, especially those with substance use problems, had more risk factors and less protective factors than ASU youths in the domains of school, use of free time, relationships, family, attitude, aggression and skills. The associations between most of the risk/protective factors and recidivism were stronger in the ASU group than in the SUP group. Substance use uniquely predicted recidivism, net of risk factors.
These results suggest that general interventions for juvenile offenders addressing risk and protective factors with the aim to reduce recidivism may be less effective for offenders with substance use problems, and that substance use (problems) should be addressed, too.
Drug and alcohol dependence 10/2013; 134(1). DOI:10.1016/j.drugalcdep.2013.10.012 · 3.42 Impact Factor
"In the first RCT of MST to be conducted in the US without the direct involvement of the treatment developers, reoffending rates in the MST group remained high even though the intervention significantly reduced reoffending compared with TAU (66.7% versus 86.7%) . Effect sizes associated with efficacy are substantially higher in trials of MST that involved the developers (0.81) than in studies conducted without their close involvement (0.27) . This pattern of results leaves open the possibilities of ‘developer effects’ and that the relative success of MST may be due to the poor quality of the standard services for managing CD in the US. "
[Show abstract][Hide abstract] ABSTRACT: There is an urgent need for clinically effective and cost-effective methods to manage antisocial and criminal behaviour in adolescents. Youth conduct disorder is increasingly prevalent in the UK and is associated with a range of negative outcomes. Quantitative systematic reviews carried out for the National Institute for Health and Clinical Excellence have identified multisystemic therapy, an intensive, multimodal, home-based, family intervention for youth with serious antisocial behaviour, as one of the most promising interventions for reducing antisocial or offending behaviour and improving individual and family functioning. Previous international trials of multisystemic therapy have yielded mixed outcomes, and it is questionable to what extent positive US findings can be generalised to a wider UK mental health and juvenile justice context. This paper describes the protocol for the Systemic Therapy for At Risk Teens (START) trial, a multicentre UK-wide randomised controlled trial of multisystemic therapy in antisocial adolescents at high risk of out-of-home placement.Methods/designThe trial is being conducted at 10 sites across the UK. Seven hundred participants and their families will be recruited and randomised on a 1:1 basis to multisystemic therapy or management as usual. Treatments are offered over a period of 3 to 5 months, with follow-up to 18 months post-randomisation. The primary outcome is out-of-home placement at 18 months. Secondary outcomes include offending rates, total service and criminal justice sector costs, and participant well-being and educational outcomes. Data will be gathered from police computer records, the National Pupil Database, and interview and self-report measures administered to adolescents, parents and teachers. Outcomes will be analysed on an intention-to-treat basis, using a logistic regression with random effects for the primary outcome and Cox regressions and linear mixed-effects models for secondary outcomes depending on whether the outcome is time-to-event or continuous.
The START trial is a pragmatic national trial of sufficient size to evaluate multisystemic therapy, to inform policymakers, service commissioners, professionals, service users and their families about its potential in the UK. It will also provide data on the clinical and cost-effectiveness of usual services provided to youth with serious antisocial behaviour problems.Trial registrationISRCTN77132214.