IN FOCUS
The latest evidence on Multi-Systemic Therapy (MST)
Also in this issue
- IN COMMENTARY
Disruptive behaviours: The numbers, the causes and the costs of not intervening - IN REVIEW
Addressing disruptive behaviours - IN FOCUS
The latest evidence on Multi-Systemic Therapy (MST) - IN PRACTICE
Applying the research evidence
What is MST?
MST is a family-based treatment for children with significant behaviour, emotional and social problems. It is designed to address known determinants of children’s behaviour problems at the individual, family and community levels. Master- and doctoral-level therapists, with small caseloads, are available to program participants 24 hours a day during treatment which typically lasts four to six months. MST is a home-based intervention intended to facilitate access to services and to promote using new skills in children’s natural environments.
Treatment is individualized to the specific needs of children and families. MST begins with family members identifying goals. Interventions are then designed collaboratively with input from the MST therapist and family members. Therapeutic modalities are adapted and integrated from treatments with empirical support including strategic family therapy, structural family therapy, behavioural parent training and cognitive-behavioural therapy. Parents are assisted in developing increased family structure and in using natural reinforcers to improve behaviour. Children are encouraged to decrease involvement with delinquent peers and to increase association with prosocial peers. Family empowerment is emphasized and the use of natural child, family and community resources is encouraged.
It will be crucial to carefully evaluate any new implementations of MST in Canadian settings
Examining the studies
Littell, Popa and Forsythe1 recently published a systematic review of licensed MST programs. Applying rigorous (Cochrane) methodological standards, the authors accepted eight studies in their review, all RCTs.1 Participants included children between the ages of 10 and 17 with all but one study focusing on children engaging in disruptive behaviours. Characteristics of participants and interventions are described in the table below. All participants were high-risk.
1 The included studies were conducted between 1985 and January 2003 and were therefore beyond the specified dates for inclusion in our own In Review article.
Characteristics of Study Participants & MST Interventions
| Study | Targeted Sample (Country) | Sex | Ethnicity | MST duration | Comparison Group (direct contact hrs) |
| Borduin 1990 |
Juvenile sex offenders (US) | 100% male | 38% AA 62% C |
37 hours | Individual therapy (45) |
| Borduin 1995 |
Juvenile sex offenders (US) | 68% male | 30% AA 70% C |
23 hours | Individual therapy (28) |
| Henggeler 1992 |
Juvenile sex offenders (US) | 77% male | 56% AA 42% C |
33 hours | Usual probation services (--) |
| Henggeler 1997 |
Juvenile sex offenders (US) | 82% male | 81% AA 19% C |
117-123 days | Usual probation services (--) |
| Henggeler 1999a |
Juvenile sex offenders (US) | 79% male | 50% AA 47% C |
40 hours | Usual probation services* (--) |
| Henggeler 1999b |
Juvenile sex offenders (US) | 65% male | 65% AA | 92 hours | Psychiatric hospitalization (--) |
| Leschied 2002 |
Juvenile offenders (Canada) | 74% male | 13% Aboriginal | 34 sessions | Usual probation services (--) |
| Ogden 2004 |
Children with behaviour problems† (Norway) | 65% male | -- | -- | Usual child welfare services (--) |
AA = African American | C = Caucasian | -- = not reported
* 22% of children received substance use &/or other mental health services
† including emotional disturbance, substance abuse, criminal offences,
harm to self/others, domestic violence
MST produced inconclusive results
Mixed results were found in the eight studies examining the effectiveness of MST. In five of the studies (conducted in the US), MST significantly reduced at least one measure of disruptive behaviour including incarceration rates and length, arrests, self-reported delinquency or externalizing behaviours. As well, in three of these studies (Borduin 1990, 1995; Henggeler, 1992) all measures related to disruptive behaviour significantly favoured MST (even if findings were not statistically significant). In contrast, in the one Canadian study , done in Ontario, there were no significant differences in disruptive behaviour outcomes between the MST and usual services groups. In addition, when the data from all studies were combined, MST was no more effective than usual services for any variables related to disruptive behaviours.
Because of methodological limitations, including limited statistical power (making it difficult to detect significant group differences), the authors could only conclude that MST is not consistently more effective than usual services. MST was still recognized as having several advantages including: comprehensive services; strong theoretical foundation; and no evidence of any harmful effects. The review authors also commented on the possible reasons for MST not being more effective than usual services in Canadian children. Canadian ‘s usual health, social and educational services for children were identified as being relatively more extensive and robust than services in the US. Given these findings, it will be crucial to carefully evaluate any new implementations of MST in Canadian settings.
References
1. Littell et al. Multisystemic Therapy for social, emotional, and behavioral problems in youth aged 10-17. Cochrane Database of Systematic Reviews 2006, Volume 2.