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Multisystemische therapie (MST), gegeven vanuit een geestelijk gezondheidscentrum, werd vergeleken met de gebruikelijke hulpverlening door een Department of Youth Services bij de behandeling van 84 zware jeugdige delinquenten en hun gezinnen die met vele problemen te kampen hebben. Delinquenten werden at random ingedeeld in de behandelingsgroepen. Met behulp van testbatterijen, die bij aanvang en beëindiging van de behandeling werden afgenomen bij de jongere en een van de ouders, weden evaluaties verricht van gezinarelaties, relaties met leeftaijdegenoten, symptomatologie, sociale vaardigheden, en zelfvermelde delinquentie. Verder werden er 59 weken na verwijzing archiefgegvens verzameld over nieuwe arrestaties en inhechtenisnemigen. In vergelijking met jongeren die de gebruikelijke hulpverlening ontvingen, werden jongeren in de MST-groep minder vaak gearresteerd, rapporteerden ze minder misdrijven te plegen, en hadden ze gemiddeld tien weken minder in de gevangenis gezeten. Bovendien vertoonden gezinnen in de MST-groep een toename van de gezinscohessie en een afname van de agressivizeit van MST werd niet beinvloed door demografishe kenmerken of psychosociale variabelen.
A Terapia Multissistémica (Henggeler & Borduin, 1990; Henggeler Schoenwald, Borduin, Rowland & Cunningham, 1998; Henggeler, Schoenwald, Rowland & Cunningham, 1998; Henggeler, Schoenwald, Rowland & Cunningham, no prelo) constitui um tratamento baeado na família e na comunidade que tem produzido resulados clínicos favoráveis, a longo prazo, bem como uma redução de custos, com os jovens que apresentam problemas clínicos graves e com as suas famílias. Revendo a literatura publica nas áreas da saúde mental da criança e do adolescente (Burns, Hoagwood & Mrazek, 1999; U. S. Department of Health and Human Services, 1999; Kazdin & Weisz, 1998), violência juvenil (Elliott, 1998; Farrington & Welsh, 1999; U.S. Public Health Service, 2001) e abuso de substâncias pelos adolescentes (Centro de Prevenção do Abuso de Substâncias, 2001; McBride, VanderWaal, Terry & VanBuren, 1999; Instituto Nacional de Abuso de Droga, 1999; Stanton & Shadish, 1997), alguns autores concluíram que a Terapia Multissistémica (TMS) dá garantias de ser um tratamento eficaz nestas áreas. O objectivo deste artigo é fornecer uma visão geral das principais características clínicas da TMS, dos estudos antigos ou em curso sobre a eficácia da TMS, e das implicações dos resultados relativos à TMS para a saúde mental e para a política de justiça juvenil.
A Terapia Multissistémica (TMS) (Henggeler & Borduin, 1990; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) é um tratamento baseado na família e na comunidade, que tem produzido resultados clinicos a longo termo, bem como uma redução dos custos na terapia em jovens com comportamentos anti-sociais e suas famílias. Este trabalho apresent: (1) uma visão geral da história da TMS; (2) uma descição dos obectivos da TMS; (3) uma revisão dos fundamentos teóricos e empíricos do modelo; e, (4) um resumo da investigação relativa aos efeitos desta terapia.
Background: MST is an intensive home- and community-based intervention for youths with serious antisocial behavior and other serious clinical problems that has been effective at reducing out-of-home placements and producing favorable long-term clinical outcomes in the U.S. The aims of the study were to determine the degree to which these outcomes would be replicated in Norway for youths with serious behavior problems and to conduct a randomized trial of MST by an independent team of investigators.
Method: Participants were 100 seriously antisocial youths in Norway who were randomly assigned to Multisystemic Therapy (MST) or usual Child Welfare Services (CS) treatment conditions. Data were gathered from youths, parents, and teachers pre- and post-treatment.
Results: MST was more effective than CS at reducing youth internalizing and externalizing behaviors and out-of-home placements, as well as increasing youth social competence and family satisfaction with treatment.
Discussion: This is the first study of MST outside of the US and one of the first not conducted by the developers of MST. The findings replicate those obtained by MST's developers and demonstrate the generalisability of short-term MST effects beyond the US.
Background: Multisystemic Therapy (MST) is an intensive home-and-community based intervention for youths with serious behavior problems. The overall aim of the clinical outcome study was to examine the effectiveness of MST compared to regular service (RS) two years after intake to therapy. The main objectives were to investigate whether MST was successful at preventing placement out of home, and to examine reductions in behavior problems in multi-informant assessments.
Method: Participants were 75 adolescents who were randomly assigned to MST or Regular Child Welfare Services (RS) at 4 sites across Norway. Data were gathered from youths, caregivers and teachers.
Results: MST was more effective than RS in reducing out of home placement and behavioral problems including internalizing and externalizing behaviour.
Discussion: The sustainability of MST effects was evident, supporting the MST approach to therapy of serious behavioral problems in youth. Site differences and the moderating effects of age and gender are discussed.
Key words: Serious behavior problems, Multisystemic Therapy, Follow up study
Die Multisystemische Therapie (MST) ist eine Behandlungsform mit hoher Intensität, die in der Familie und dem sozialen Umfeld des betoffenen Jugendlichen verankert ist, und die bereits bei einem breiten Spektrum psychotherapeutischer Probleme bei Jugendlichen erprobt wurde. Die Anwendungsgebiete umfassen kriminelles und gewalttätiges Verhalten, Substanzmissbrauch, unakzeptables sexuelles Verhalten, psychiatrische Notfälle (psychotische Symptome, selbstgefährdendes und fremdgefährdendes Verhalten) und Probleme im Umgang mit schweren köperlichen Erkrankungen. Jugendliche mit dieeser Art von Verhaltensproblemen erzeugen hohe direkte und indirekte Kosten für die Gesellschaft. Insbesondere durch teuere Klinikaufenthalte und Unterbringungsmaßnahmen entstehen hohe Kosten für die Krankenkassen und die Sozialkassen. Übergreifende Ziele des MST Programms sin des, antisoziales Verhalten und Krankheitssymptome zu vermindern, das Funktionsniveau zu verbessern und stationäre Behandlung und Unterbringungsmaßnahmen überflüssig zu machen. Dies gilt für alle Formen von Störugen.
This paper addresses several issues that we encountered when implementing a randomized experiment to evaluate a promising intervention for serious juvenile delinquents, multi-systemic therapy (MST). The issues overlap with issues others experienced when trying to conduct randomized experiments in clinical practice, but are complicated because MST takes place in a legal context. The complex juvenile justice system makes it difficult to come up with a simple system of randomization. Problems encountered are the complexity of the referral process in this type of intervention, legal issues and the ethical concerns raised by clinicians. Our experiences might be useful to others planning to carry out a randomized efficacy study within the juvenile justice system. Firstly, other researchers might feel supported if they realize that others experience similar problems, and, secondly, we provide some concrete suggestions concerning the following: selecting the procedures and determining the moment of randomization, dealing with and overcoming the resistance of institutions involved, maintaining the cooperation of both the institution and the sample, and keeping turnover of research staff to a minimum.
I denne artikkelen kommenterer vi den systematiske forskningsoversikten og meta-analysen av MST fra Nordic Campell Center. Studien vekker oppsikt, - og har dermed bidratt til fornyet diskusjon om bruk av MST og evidensbaserte metoder. For ifølge Nordisk Campell Center er det ikke noe..." der tyder på, at MST er bedre for de unge end alternative bedhandlingsformer. Der er dog heller ikke tegn på, at MST er dårligere". Men kan det være at det er selve meta-analysen som er prematur, - og at den derfor egner set dårlig som grunnlag for å vurdere hvor effektiv MST er i arbeidet med alvorlige atferdsproblemer, og da særlig i der nordiske landene?
In order to examine the sustainability of programme effectiveness, we investigated whether the effects of multisystemic treatment (MST) on a second group of adolescents would match those reported in an earlier randomised controlled trial (RCT). Pre-and post-treatment assessments were analysed in a participant group of 105; 55 youths were referred to MST in the programme's second year of operation (MST2), and 50 youths were included in the RCT the first year in which 30 were randomly assigned to MST (MST1) and 20 to regular services (RS).
At two project sites, MST clinical outcomes in the second year of programme operation matched and, for key indices of anti-social behaviour, surpassed those achieved during the first year. In addition the MST treatment delivered in the second year was more effective than regular child welfare services in preventing out of home placement and reducing internalising behaviour. Together, these results demonstrated sustained effectiveness of the programme as well as indication of programme maturation effects. No group differences were registered for social competence. MST youths treated in the second year were significantly younger than those referred to treatment in the first year (MST1) but age had no moderating effect on the outcomes.
The purpose of this article is to consider, throught the lenses of theory and research on technology transfer and the adoption and implementation of innovation, the international transport of evidence-based psychosocial treatments for youth, using Multisystemic Therapy (MST) as an example. MST is a well-validated family and community-based approach originally developed in the United States to treat serious juvenile offenders. This artical describes challenges to MST transport internationally by virtue of the political, legal, economic, and cultural contexts in different nations. Modicications used to address these challenges and facilitate the international implementation of MST ar described and pertain to pre-implementation processes, clinical staff, training materials and procedures, and clinical service delivery.
The purpose of the present study was to compare symptom load in youth groups treated with three Swedish Blueprint programmes-Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC)-to see if symptom load matches the intensity of the treatment model as expected. These youth groups were also compared with in- and outpatients from child and adolescent psychiatry, and a normal comparison group. In addition, we compared the symptom load of their mothers. Symptom load was measured by the Achenbach System of Empirically Based Assessment (ASEBA) in the adolescents, and by the Symptom Checklist 90 in their mothers. The results showed that youth in the MST and MTFC studies had a higher symptom load than in the FFT study, and the same pattern of results was found in their mothers. It is concluded that there seems to be a reasonable correspondence between the offered resources and the symptom load among youth and parents; treatment methods with higher intensity have been offered to youth with higher symptom load. The correlation between internalized and externalized symptoms was high in all study groups. The MST and MTFC groups had an equally high total symptom load as the psychiatric inpatient sample.
The successful nationwide transport and evaluation of Multisystemic Therapy (MST) programs in Norway is described. This description is provided within the context of the nation's movement towards the adoption of evidence-based practices (EBPs) during the past decade, the conduct of a multisite randomized clinical trial to examine the effectiveness of MST in Norway, and the development of a center for effectively implementing and researching EBPs for child and adolescent problems. Data on Norwegian adolescent substance use, treatment, and research is summarized. Finally, challenges that have been addressed and overcome in achieving the large-scale adoption and implementation of MST are presented from context of innovation diffusion. Systemlevel barriers and strategies regarding language, cultural appropriateness, caseload and compensation issues, and background and skill deficits. The Norwegian approach, in many ways, serves as an excellent model for importing and sustaining EBPs on a large-scale basis.
The implementation of new treatment methods in social work practice is warranted. Moreover, little is known about professionals' attitudes toward the introduction of evidence-based practices into their communities. Therefore, this article reports on the implementation of a Swedish research project that evaluated Multisystemic Therapy (MST). All investigating social workers in a community-based social work practice and their supervisors completed a questionnaire concerning attitudes toward the research project, as well as attitudes toward MST as a treatment method. A large majority of participants were positive toward the research project, felt sufficiently informed, and thought that the implementation occurred at an appropriated pace. Likewise, participants felt positively toward the adoption MST as a treatment method, toward evidence-based research in general, and in their affinity toward community-family-based services. On the other hand, investigating social workders differed in their practice attitudes. Potential reasons for these discrepancies, including the influence of top-down implementation, differences in experience, and differences due to the position held ar discussed.
This randomized clinical trial assessed the effectiveness of multisystemic therapy (MST) for 156 youths who met the diagnostic criteria for conduct disorder. Sweden's 3 largest cities and 1 small town served as the recruiting area for the study. A mixed factorial design was used, with random allocation between MST and treatment as usual groups. Assessments were conducted at intake and 7 months after referral. With an intention-to-treat approach, results from multiagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behaviors among participants across treatments. There were no significant differences in treatment effects between the 2 groups. The lack of treatment effect did not appear to be caused by site differences or variations in program maturity. MST treatment fidelity was lower than that of other studies, although not clearly related to treatment outcomes in this study. The results are discussed in terms of differences between Sweden and the United States. One difference is the way in which young offenders are processed (a child welfare approach vs. a juvenile justice system approach). Sociodemographic differences (e.g., rates of poverty, crime, and substance abuse) between the 2 countries may also have moderating effects on the rates of rehabilitation among young offenders.
The transportability of Multisystemic Therapy (MST) for the treatment of juvenile offenders in a community-based context was examined in the current study. Results of this New Zealand study showed that significant pre- to posttreatment improvements occurred on most indicators of ultimate (i.e., offending behavior) and instrumental (i.e., youth compliance, family relations) treatment outcomes. Reductions in offending frequency and severity continued to improve across the 6- and 12-month follow-up intervals. In comparison to benchmarked studies, the current study demonstrated a more successful treatment completion rate. Additionally, overall treatment effect sizes were found to be clinically equivalent with the results of previous MST outcome studies with juvenile offenders and significantly greater than the effect sizes found in the control conditions. The findings of this evaluation add to the growing body of evidence that supports MST as an effective treatment for antisocial youth.
This study explored how adolescents involve their families, friends and sex partners when making decisions about seeking HIV voluntary counseling and testing (VCT) and disclosing their HIV-status. The study is based on 40 qualitative in-depth interviews with 16 to 19 year olds who knew their HIV status in Ndola, Zambia. The findings show that: a) almost half of the youth turned to family members for advice or approval prior to seeking VCT; b) a disapproving reaction from family members or friends often discouraged youth from attending VCT until they found someone supportive; c) informants often attended VCT alone or with a friend, but rarely with a family member; and d) disclosure was common to family and friends, infrequent to sex partners, and not linked to accessing care and support services. Family members need access to information on VCT so they can support young peoples’ decisions to test for HIV and to disclose their HIV status. These results reinforce the need to provide confidential VCT services for adolescents and the need to develop and test innovative strategies to reach adolescents, their families and sex partners with VCT information and services.
The effectiveness of HIV voluntary counseling and testing (VCT) in reducing HIV risk behaviors in developing countries was assessed using meta-analytic methods. A standardized protocol was used for searching, acquiring, and extracting study data and meta-analyzing the results. Seven studies met the inclusion criteria. VCT recipients were significantly less likely to engage in unprotected sex when compared to behaviors before receiving VCT, or as compared to participants who had not received VCT [OR 1.69; 95%CI 1.25–2.31]. VCT had no significant effect on the number of sex partners [OR 1.22; 95%CI 0.89–1.67]. While these findings provide only moderate evidence in support of VCT as an effective prevention strategy, neither do they negate the need to expand access to HIV testing and counseling services. Such expansion, however, must be accompanied by rigorous evaluation in order to test, refine and maximize the preventive benefits of learning one’s HIV infection status through HIV testing and counseling.
Abstract A sample of 356 members of women’s groups, aged 18–49, in the Dominican Republic were interviewed by trained female interviewers. Data among 273 partneredwomen were analyzed. The dependent variable, a measure of HIV-related negotiation, was examined for associations with control of own money, level of women’s group participation, and ever having received a loan through a micro-credit program. Findings suggest control of own money to be significantly associated with HIV-related negotiation. Ever having received a loan and level of women’s group participation, however, were not significantly associated with HIV-related negotiation. Empowerment measured as control of own money may influence HIV protective behavior among partnered women in this setting.
Male partners of female sex workers are rarely targeted by HIV prevention interventions in the commercial sex industry, despite recognition of their central role and power in condom use negotiation. Social networks offer a naturally existing social structure to increase male participation in preventing HIV. The purpose of this study was to explore the relationship between social network norms and condom use among male partners of female sex workers in La Romana, Dominican Republic. Male partners (N ¼ 318) were recruited from 36 sex establishments to participate in a personal network survey. Measures of social network norms included 1) perceived condom use by male social network members and 2) encouragement to use condoms from social network members. Other social network characteristics included composition, density, social support, and communication. The primary behavioral outcome was consistent condom use by male partners with their most recent female sex worker partner during the last 3 months. In general, men reported small, dense networks with high levels of communication about condoms and consistent condom use. Multivariate logistic regression revealed consistent condom use was significantly more likely among male partners who perceived that some or all of their male social network members used condoms consistently. Perceived condom use was, in turn, significantly associated with dense networks, expressing dislike for condoms, and encouragement to use condoms from social network members. Findings suggest that the tight social networks of male partners may help to explain the high level of condom use and could provide an entry point for HIV prevention efforts with men. Such efforts should tap into existing social dynamics and patterns of ommunication to promote pro-condom norms and reduce HIV-related vulnerability among men and their sexual partners.