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Lessons from a systematic review of effects of multisystemic therapy Julia H. Littell
Main results of the single largest, most rigorous experiment on MST arenot published in peer-reviewed journals or books
Authors are less likely to be critical of their own programs and studies than independent reviewers, particularly when additional funding for services and research is at stake. MST program developers authored or co-authored a number of prior reviews.
The author makes the accusation that knowledge derived from these sources appears to be based on authority and tradition, rather than the best available scientific methods.
The MST literature has paid too little attention to implementation, data collection, and analytic issues that can affect the internal validity of inferences drawn from findings of randomized experiments
How might they apply to the case of Billy?
Interventions are designed to invest the caregivers with the ability to address the family’s needs after the intervention is over. The caregiver is viewed as the key to long-term success. Family members drive the change process in collaboration with the MST therapist.
Intervention effectiveness is evaluated continuously from multiple perspectives with MST team members being held accountable for overcoming barriers to successful outcomes. MST does not label families as “resistant, not ready for change or unmotivated.” This approach avoids blaming the family and places the responsibility for positive treatment outcomes on the MST team.
An assessment is made to understand the "fit" between identified problems and how they play out and make sense in the entire context of the youth's environment. Assessing the “fit” of the youth's successes also helps guide the treatment process.
Interventions require daily or weekly effort by family members so that the youth and family have frequent opportunities to demonstrate their commitment. Advantages of intensive and multifaceted efforts to change include more rapid problem resolution, earlier identification of when interventions need fine-tuning, continuous evaluation of outcomes, more frequent corrective interventions, more opportunities for family members to experience success and giving the family power to orchestrate their own changes.
MST Therapists and team members emphasize the positives they find and use strengths in the youth’s world as levers for positive change. Focusing on family strengths has numerous advantages, such as building on strategies the family already knows how to use, building feelings of hope, identifying protective factors, decreasing frustration by emphasizing problem solving and enhancing caregivers’ confidence.
"I failed a math test"
"How does that feel?"
Interventions are set up to be appropriate to the youth’s age and fit his or her developmental needs. A developmental emphasis stresses building the adolescent’s ability to get along well with peers and acquire academic and vocational skills that will promote a successful transition to adulthood.
Interventions target sequences of behavior within and between the various interacting elements of the adolescent’s life—family, teachers, friends, home, school and community—that sustain the identified problems.
Interventions are designed to promote responsible behaviour and decrease irresponsible actions by family members.
Interventions deal with what’s happening now in the delinquent’s life. Therapists look for action that can be taken immediately, targeting specific and well-defined problems. Such interventions enable participants to track the progress of the treatment and provide clear criteria to measure success. Family members are expected to work actively toward goals by focusing on present-oriented solutions, versus gaining insight or focusing on the past. When the clear goals are met, the treatment can end.
"I failed a math test"
"I've hired a tutor"
"Whatever it takes" award
Meet Billy...
Meet Billy's Parent
#1 -Environment is the problem
#2 - Address the problems in the home context
#3 -Intervention happens at the ecological level
#1 -The youth is the problem
#2 - Removing youth from their negative situation is helpful
#3 -Intervention happens at the behavioural level
#4 - Treat everyone the same(aculturality)
#5 - professionals can fix kids
#4 - Treat situations uniquely
#5 - Families/communities support kids
#1 -The youth is the problem
#2 - Removing youth from their negative situation is helpful
#3 -Intervention happens at the behavioural level
#4 - Treat everyone the same(aculturality)
#5 - professionals can fix kids
What are out-of-home placements?
How does someone end up in an out-of home placement?
What I've learned about MST...
(if you can reconcile your moral objections)
Based on Jim Harvey's speech structures