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Transcript: Multisystemic Therapy (MST) Stephanie Diaz What is MST? What is it? Family and community based treatment method Aimed at youth ages 12-17 who are at risk of an out of home placement due to antisocial and/or delinquent behaviors Focuses on adolescent and caregiver Goals Goals of MST 1. Effectively reduce youth's problematic behavior(s) 2. Empower caregivers Implementation - Team-based - Outside consultant, supervisor, clinical team of 2-4 therapists - Weekly team and individual supervision Treatment Details - Most convenient for the adolescent and their family - 3-5 months - Intensity varies, typically begins with 90 minute daily, biweekly or weekly sessions, eventually tapering - 24/7 staffed hotline Over 65 Research Studies (10+ RCT) - lower rates of re-arrest* - improved family cohesion - improved peer relationships - decrease in drug use - decrease in time spent in out of home treatment - increased functionality (in school, work & community) *as compared to IT Supporting Evidence Impact - 15 Countries - 34 states - over 2500 clinicians and - over 200,000 youth served Training 5 day training weekly consultation with outside expert quarterly booster trainings Training MST manual Providers in Pennsylvania - Public Health Management Corporation - Family Services of Northwest PA - K/S MST - Community Soluntions Inc. - Adelphoi Village - Hempfield Behavioral Health - Pennsylvania Counseling Services References CEBC. (2020). Retrieved August 16, 2020, from Evidence Based Programs. (2020). Retrieved August 16, 2020, from Henggeler, S. W. (1999). Multisystemic Therapy: An Overview of Clinical Procedures, Outcomes, and Policy Implications. Child Psychology and Psychiatry Review,4(1), 2-10. doi:10.1017/s1360641798001786 Huey, S. J., Henggeler, S. W., Brondino, M. J., & Pickrel, S. G. (2000). Mechanisms of change in multisystemic therapy: Reducing delinquent behavior through therapist adherence and improved family and peer functioning. Journal of Consulting and Clinical Psychology,68(3), 451-467. doi:10.1037/0022-006x.68.3.451 MST Services: Multisystemic Therapy for Juveniles. (2017). Retrieved August 16, 2020, from Welcome to EPIS. (2015). Retrieved August 16, 2020, from http://


Transcript: My Approach Collective responsibility. Roll: 291 Decile: 10 MST roll: 21 MST pointage: .5 Maori 2.4% Pasifika 0% SEN 21% ESOL 1% Student Voice 2014 Thought for the Day Albert Einstein Very little offering of any information. Little confidence / low self efficacy. Lack of understanding of vocabulary. A focus on the answer, and the right answer. "Is that the answer? Is it right? My Starting Point The Real Gains Student Voice Years 4 - 6 9 girls (9 European) 5 boys (5 European) Some students stayed with me for extra sessions. Stanley Bay is made up of... These students needed to have multiple opportunities to do similar style problems to cement what the language meant, how to approach the problem and the maths that was necessary to solve the problem. Many of these students were visual learners, and using pictures / diagrams / materials to support their explanations was a preferred method. Kelly Slater-Brown The majority of students found talking about maths in front of the class stressful or embarrassing. They liked working in pairs. The areas that were identified as the hardest were: GLOSS tests, fractions, remembering times tables and understanding word problems. The students who were part of ALIM thought they could get better at maths. Other students held much more of a fixed mindset, seeing maths ability as fixed. Will giving students rich problems encourage dialogue that will result in new learning? To use talk moves you need talk! Practice makes permanent Cohort 2 My Inquiry 1 well below moved to below 18 below moved to at standard 2 below moved to above "It’s not that I’m so smart, it’s just that I stay with problems longer." MST Stanley Bay Dyslexia - 7 pupils Processing speeds of less than 10% - 6 pupils Working memory issues Dyscalculia ‘A condition that affects the ability to acquire arithmetical skills. Dyscalculic learners may have difficulty understanding simple number concepts, lack an intuitive grasp of numbers, and have problems learning number facts and procedures. Even if they produce a correct answer or use a correct method, they may do so mechanically and without confidence.’ These students were too scared to share ideas and didn't like making mistakes. We matched the SOLO thinking tools to some talk frames to help students start formulating their ideas. Watched the clip from Khan Academy about learning, how you have to make mistakes etc (Jo Bowler). Identified together what you needed to be able to do to be a good mathematician (you cubed website). Used the "low floor to high ceiling" tasks (Bowler). Gave students time to rehearse what they wanted to say. Finally we started to get good quality talk. What was happening back in the classrooms? Results Years 3 - 6 6 girls (1 Maori, 5 European) 8 boys (8 European) Students understood through hard work, they could get better in maths. Students were taking to each other and questioning each other about their thinking. They had the confidence to while I was GLOSSING them, "I need to write down my ideas while I answer this question to help me keep track of my thinking." Mistakes were being made and learnt from. Get parents on board early. Share with students and parents where current progress is in terms of the National Standard and next steps. (Profiles) Involve students and parents in goal setting. Set parents up with home/school plan. (Whanau engagement) Use lots of games for home to keep maths 'fun'. Make language posters, to help students decode maths vocabulary to be met in problems. Focus on mult/div and fractions. "Most students would have spent the majority of their schooling stuck on add/sub," Hunter. Launching problems in so much detail that groups were set up for success. Modelling and actively encouraging using felt tip and paper as an "extension of ones memory." Choose authentic contexts and get student input for where to go next. Cohort 1 My groups learning challenges...


Transcript: "Whatever it takes" award 9 Principles Out-of-Home Jeff gets sidetracked To understand where MST came from we need to understand Out-of-Home placement Evaluating MST A youth worker wanting to help youth overcome adversity but you don't actually want the youth to have any say in this? #1 -Environment is the problem "I failed a math test" "I've hired a tutor" Principle 1: Finding the fit MST Located in a rural environment Faux-secure custody Limited if any access to previous community 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. Uncritical analysis Principle 8: Evaluation and accountability Guidelines, Strategies, Techniques Meet Billy's Parent Perceived Outcomes Goals How does someone end up in an out-of home placement? It's actually a pretty brilliant idea (if you can reconcile your moral objections) Key to every intervention is CONTEXT Nothing new: Intervention strategies are integrated from other pragmatic, problem-focused treatment models (PFT, BT, CBT) Challenge the empirically identified determinants of anti-social behaviour Evidence based? Adaptability = Universality? It's flexible but what are the nature of it's goals? Your turn! MST now A therapist who doesn't like talking about feelings? Some went back to live with families Some aged out then went into community living Some went to prison Return Multisystemic Theory 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. Multisystemic Therapy might be for you! Isolation A Sales Pitch What role was I taking with the parent? Publication Bias MST Therapist 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. Out-of-home care has a mixed track record at best (downsides anyone?) Community therapy practice with anti-social behaviours suffers from "no-shows" and poor results Let's maybe try something else... Strengths Selling points... Research Findings It's Designed specifically for juvenile offenders (more of a cost saving scheme than therapy...) Spent the early 90s developing MST at the medical university of south Carolina In 1996 they went for it, and launched MST Services, a website that basically sells the therapeutic model running trainings all over the US and even going international at this point Meet Billy... Lets pick sides! Research on the client's perspective Want to create social change for marginalized individuals, but to you social change means helping people buy into the culture of majority? It's kind of offensive Prestigious sources #4 - Treat situations uniquely MST Award? Convenience: "It was easy for me because I didn't have to go to the person... They're coming into my home; it's my territory. I feel happy, I'm safe." Ecological approach: "to put in place a wider network of support for the parent, and to open up new possibilities for the young person in terms of education, employment, and more prosocial activities." Practical, solution focused approach Person centred, collaborative approach: "It was almost as if it was a hug... rather than a tablet.... it was almost as if she cared about us as a family. And because she cared that much I had to give it 100%. " 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. This hasn't worked so well... Principle 9: Generalization Are you... Principle 5: Targeting sequences Strengths and Limitations Principle 2: Focusing on positives and strengths Main results of the single largest, most rigorous experiment on MST arenot published in peer-reviewed journals or books What are out-of-home placements? Principle 6: Developmentally appropriate A comparison... 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 #2 - Address the problems in the home context Comparing Philosophies Meet with the Family in the home to get a sense the context of the youths behaviour Meet with the child/family/school daily if needed Develop specific goals, with plans, and with timelines to achieve them On-call 24 hours a day 7 days a week (low caseloads 4-5 allow for this) Take an active role in introducing and maintaining the youth's

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