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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: "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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