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This chapter provides an overview of the multisystemic approach to treating serious antisocial behavior in adolescents and builds a case for using multisystemic therapy (MST) (Henggeler and Borduin 1990) in the treatment of substance-abusing adolescents. As such, sections in the chapter focus on similarities between delinquency and substance use in their identified correlates, recalcitrance to treatment, and service delivery issues; results from controlled outcome studies supporting the effectiveness of MST and future directions in the validation and diffusion of MST; and an overview of clinical interventions used in MST.
A leading researcher of child psychopathology characterized the field of family therapy as “a rather sad sack relying for its status largely on assertion, self congratulations, guruism, and denigration of alternatives” (Werry, 1989, p. 380). Although this view contains much truth, the field of family therapy includes many theories and researchers who are dedicated to validation of a treatment approach that, in our opinion, is extremely promising. This chapter emphasizes the myriad contributions of such persons to the development of effective treatments for psychosocial problems experienced by children, adolescents, and their families.
Multisystemic therapy (Henggeler & Borduin, 1990) is a family-based therapeutic approach that has been viewed as a highly promising treatment for complex psychosocial problems in children and adolescents (see Culbertson, 1990; Miller & Prinz, 1990). This chapter discusses the application of multisystemic therapy to the treatment of serious juvenile offenders and their multiproblem families. In our discussion, we address the empirical rationale for the application of this particular therapy as well as the clinical features of multisystemic therapy that make it especially well suited for treating anti-social behavior in adolescents. More specifically, we address the following issues: 1) we show that serious juvenile offenders experience numerous psychosocial difficulties and present significant problems to their communities and that there are is a dire need to develop effective interventions for such offenders and their families; (2) we show that there are multiple correlates and causes of delinquency and that the key correlates pertain to characteristics of the social systems (i.e., family, peers, school) in which these offenders are involved; (3) we argue that the identified correlates of delinquency are consistent with a social –ecological model of behavior, which represents the theoretical foundation of multisystemic therapy; (4) we summarize findings from controlled evaluations of multisystemic therapy and argue that the efficacy of multisystemic therapy is largely due to its considerations of the multiple factors associated with delinquency ; and (5) we provide a brief description of the clinical features of multisystemic therapy and delineate nine principles for designing multisystemic interventions.
38. Treatment of serious antisocial behavior
Research findings regarding the causes and treatment of delinquency, youth violence, and adolescent substance abuse provide important information for public policy decisions and community planning. These contributions come at a critical time, as the continued increase of these problems and rising public concern have prompted renewed debate over how to respond. This paper examines the individual and societal costs of serious antisocial behavior in adolescents, the correlates and causes of such behavior, recent advances in the treatment of serious antisocial behavior, and the implications of this research for public policy and health care reform.
(from the chapter) This chapter focuses on treatment and service-system innovations that have demonstrated clinical and cost effectiveness with serious juvenile offenders. Emphasis is placed on treatments that have been subjected to controlled clinical trials. Models of service delivery that appear to hold promise for this population are also described, and issues related to their evaluation are discussed. Innovative treatments discussed include multisystemic treatment, adventure programming with families, and therapeutic foster care. Three models of community-based service delivery are examined: family preservation, individualized care, and intensive case management.
42. Multisystemic therapy: an effective violence prevention approach for serious juvenile offenders
This article provides an overview of a treatment approach, Multisystemic Therapy (MST), that has demonstrated long-term reductions in criminal activity and violence among youth at high-risk for perpetrating violence. Importantly, central prevention in the United States. Moreover, as demonstrated from the findings of controlled clinical trials evaluating MST with serious juvenile offenders, the viability of the public health approach is supported.
48. Mulitsystemic therapy: Changing the natural and service ecologies of adolescent and families
(from the chapter) Recent research findings suggest the causes and treatment of such serious antisocial behavior as delinquency and adolescent substance abuse clearly point to the need for ecologically based interventions. Therefore, this chapter examines the implications of this research for the development of effective ecological treatments for serious antisocial behavior. More specifically, the authors examine Multisystemic Therapy (MST), an ecological approach that has proven effective with chronic and violent juveniles in several clinical trials, and highlight the MST approach to reconnecting families of juvenile offenders with schools, and vice versa. Research regarding casual models and treatments of delinquency are also discussed.
Delinquency refers to illegal activities committed by a minor. Such acts can be diverse in their seriousness and their effects on others. At the low end of seriousness continuum are status offenses, which are behaviors that are not illegal if performed by an adult (e.g., truancy, running away). At the upper end of the continuum are serious criminal offenses such as robbery, rape and aggravated assault. In the middle range are illegal activities such as burglary, disorderly conduct, and petty larceny. This chapter focuses on the criminal activities found in the middle to upper range of seriousness continuum.
Bronfenbrenner’s (1979) theory of social ecology provides the underlying theoretical rationale of multisystemic therapy (MST). A key assumption of the theory of social ecology is that behavior is multidetermined from the interplay of individual characteristics and the multiple, interrelated systems in which individuals are embedded. For children and adolescents, these systems include the family, peers, school, neighborhood, community (including social support network), and the larger macrosystem (e.g., the organizational culture, political climate). A second assumption is that interpersonal behavior is reciprocal and bidirectional. That is, individuals and systems influence each other in an ongoing and recursive fashion.
The assumptions underlying the theory of social ecology have important clinical implications-implications that are critical to the central thrusts of MST. For example, the first assumption suggests that to understand the determinants of identified problems as well as characteristics of the family, peer, school, and community systems that involve the child. Moreover, the second assumption suggests that multiple vantage points must be considered when determining the “fit” of problems to their systemic context.
Clinical symptoms resulting from children’s exposure to psychosocial hazards have multiple causes and are linked (directly or indirectly) with children’s lives and social ecologies (Kazdin, 1995). Unfortunately, recognition of this reality has rarely translated into ecologically valid treatment strategies for children. Existing treatments are often narrowly focused, targeting a limited number of environmental factors linked to maladaptive symptoms in children. In response to this narrow focus, a central tenet of this chapter is that treatment strategies systematically addressing the multiple etiological factors associated with children’s psychosocial difficulties are needed to make positive changes in at–risk children’s developmental progress. Focusing on children with identified problems with delinquency or substance abuse and children who have been abused or neglected, this chapter examines briefly the epidemiology (prevalence and incidence), etiology, and risk factors of these problems. Additionally, this chapter summarizes the current treatment literature on delinquency, substance abuse, and child abuse and neglect and presents several “model” empirically based treatment programs. The model program sections focus primarily on multisystemic therapy (MST), a family- and community-based treatment approach that explicitly targets the multiple risk factors in the natural environments of children and families. MST has been implemented effectively with each of the three target groups discussed in this chapter: youth people with substance abuse problems, and children and adolescents who have been abused or neglected.
Multisystemic therapy (MST) (Henggeler, & Borduin, 1990; Henggeler, Schoenwald, et al., 1998) is a family- and community-based treatment that has produced favorable long-term clinical outcomes and cost savings with youths presenting serious clinical problems and their families. The purpose of this paper is to provide brief overviews of the key clinical features of MST, previous and ongoing studies of the effectiveness of MST, and the implications of MST-related findings for mental health and juvenile justice policy.
Multisystemic therapy (MST) is a family- and community-based treatment that addresses the multiple determinants of serious clinical problems that place youth at high risk of out-of-home placement (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998b). Originally developed and empirically validated (Kazdin & Weisz, 1998) for youth engaged in serious antisocial behavior and their families, ongoing research is examining the effects of MST on youth with a variety of severe behavioral and emotional problems.
Mental health services researchers and policymakers agree that children’s mental health services are in great need of reform (Friesen & Koroloff, 1990; Wahsington State Institute for Public Policy, 1998). More than three-quarters of the funds spent on mental health services for children and adolescents are directed toward out-of-home placements (Burns, 1991), which have little empirical support for being effective (Kiesler, 1993; Sondheimer, Schoenwald, & Rowland, 1994) and may even have iatrogenic effects (Weithorn, 1988). Identifying and disseminating effective community-based treatments, therefore, are greatly needed.
Multisystemic therapy (MST) (Henggeler & Borduin, 1990; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) has been identified as a highly promising treatment model by reviewers in the fields of substance abuse (e.g., McBride, VanderWaal, VanBuren, & Terry, 1997; National Institute on Drug Abuse, 1999; Stanton & Shandish, 1997), adolescent violence (e.g., Elliott, 1998; Farrington & Welsh, 1999; Tate, Repucci, & Mulvey, 1995), and mental health (e.g., Fraser, Nelson, & Rivard, 1997; Kazdin & Weisz, 1998). MST is a family- and community-based intervention for children and adolescents with serious clinical problems that has been effective in reducing out-of-home placements and producing favorable long-term clinical outcomes (Henggeler, 1999). The most fundamental goal of MST is to decrease youth problem behavior by improving family functioning. Unlike treatment provided through office-based and institutional settings, MST treats youth s within their social ecological contexts. This chapter is an overview of the theory, practice, and supporting evidence of MST.
Multisystemic therapy (MST; Henggeler & Borduin, 1990; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham , 1998) is a family-and community-based treatment that has reduced long-term rates of recidivism and out-of-home placement for violent and chronic juvenile offenders and improved adolescent and family functioning. Such outcomes are significant in light of the myriad personal and social problems presented and experienced by serious juvenile offenders (Sampson & Laub, 1990, 1993). This chapter will describe the bases of the success of MST, the specific outcomes that can be expected when MST is delivered with integrity, and the principles that guide the design of MST interventions.
When children are the objects of sexual aggression or sexual abuse, one of the images most readily brought to the public mind is that of the inveterate male predatory pedophile with a long history of abusive behaviors, perhaps beginning with his own sexual abuse and leading from there into increasingly victimizing sexual behaviors during childhood, adolescence, and finally, adulthood. Yet, despite generations of clinical acceptance of a “victim-to-victimizer cycle of child abuse” and notions that sexually abusive behavior toward children is inherently compulsive, progressive, and incurable, much of the best evidence available suggests that, although these assumptions may be true in particular cases, in general they are overstated or inaccurate. Even within developmental levels (i.e., childhood, adolescence, and adulthood), one sees enormous diversity in the types and patterns of behavior, in personality and demographic characteristics, and in environment and background. This diversity translates into critical differences in risk and prognosis, with differences becoming sharper between developmental levels. Yet, to a significant extent, our treatment and public policy efforts have underappreciated this diversity and these developmental differences. In this charter, we will examine sexually abusive behavior from a developmental perspective. We will begin with a short review of what is known about the developmental course of sexually abusive behavior, then move on to discuss characteristics, assessment, treatment, and public policy issues for each of three developmental groups: adult sex offenders, adult or juvenile sex offenders (JSOs), and children with sexual behavior problems (CSBPs). In reviewing the literature, we will focus primarily on the sexual abuse of children, where possible, rather than sex offenses or sexual behavior problems in general. We will argue that intervention models, whether emphasizing treatment or criminal justice, should generally view these three developmental groups as very different and very heterogeneous populations, and we suggest that separate and often qualitatively different interventions and policies need to be devised for each developmental level.
The purpose of this chapter is to review those family-based treatments of conduct disorder and delinquency in adolescents that have been identified by federal entities and leading reviewers as efficacious, and to suggest implications for clinical practice and future research. Treatment research regarding adolescent substance abuse and conduct disorder in children is examined in other chapters in this volume (chapteers 3 and 4 respectively).
A Terapia Multissistémica (Henggeler & Borduin, 1990; Henggeler Schoenwald, Borduin, Rowland & Cuningham, 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.
260. Community-Based Treatments
Recent syntheses of intervention research have concluded that treatments for juvenile delinquency procedure quite divergent results, but that community-based treatments are showing greater promise than most other approaches. For example, Lipsey and Wilson’s 1998 meta-analysis of intervention studies for serious juvenile offenders found an overall average effect size of .12 for recidivism, indicating a difference between treatment and control groups of only about one tenth of a standard deviation unit. However, effect sizes ranged from as high as .52 (i.e., one half of a standard deviation unit) to as low as -.17 (i.e., the treatment group fared worse than the control group). Likewise, other recent reviews have supported the view that community-based interventions are the most promising treatments available for juvenile offenders. For example, of the more than 500 programs reviewed in the Office of Juvenile Justice and Delinquency Prevention’s (OJJDP) Blueprints for Violence Prevention Initiative (Mihalic, Irwin, Elliott, Fagan, & Hansen, 2001), the model programs identified as effective for treating juvenile offenders were all family- and community-based.
This chapter examines the community-based treatment models for juvenile offending that have established effectiveness or are promising. Specifically, brief summaries of their clinical procedures, findings from clinical trials, and cost related outcomes are provided. In addition, parallels among these community-based models and corresponding implications for clinical practice and future research are discussed.
Multisystemic Therapy (MST) is a family and community-based approach to treating youths who have serous clinical problems. Based on an extensive body of controlled clinical research, MST has been identified as an effective treatment of youth antisocial behavior and substance abuse (National Institute on Drug Abuse, 1000; President’s New Freedom Commission on Mental Health, 2003). The intervention targets youths with serious clinical problems who are at imminent risk for out-of-home placement. Descriptions of the MST model are provided in comprehensive clinical volumes pertaining to the treatment of antisocial behavior (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) and serious emotional disturbance (Henggeler, Schoenwald, Rowland, & Cunningham, 2003) in adolescents and their families.
Multisystemic therapy (MST) is a family and community-based approach to treating youth who have serious clinical problems and their families. Specifically, MST was designed to intervene with youth engaging in antisocial activities. More recently, however, MST has been identified as a potentially effective means of treating juvenile sexual offending behaviors (Borduin, Henggeler, Blaske & Stein, 1990; Borduin & Schaeffer, 2002). A thorough description of the MST model and techniques is found in a treatment manual (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) and is based on nine treatment Principles (Table 1). A supplement is being developed to describe the adaptations made when working with youth who have sexually abused others. The present chapter; (a) describes the theoretical underpinnings of MST; (b) summarizes the empirical support for MST; (c) explains the rationale for applying MST to juvenile sexual offending behavior; (d) presents outcomes of randomized controlled trials applying MST to youth who have sexually abused others; (e) summarizes the clinical aspects of MST; and (f) illustrates via a case example, the use of MST with juveniles who exhibit sexual offending behavior.
Multisystemic Therapy (MST) is an intensive family-and community-based treatment that has been applied to a wide range of serious clinical problems presented by youths, including chronic and violent criminal behavior, substance abuse, sexual offending, psychiatric emergencies (i.e., homicidal, suicidal, psychotic), and, recently, serious health care problems. Youths with these types of serious clinical problems present significant personal and societal (e.g., crime victimization) costs, and due to their high rates of expensive out-of-home placements, consume a grossly disproportionate share of the nation’s mental health treatment resources. Across these clinical populations, the overarching goals of MST programs are to decrease rates of antisocial behavior and other clinical problems, improve functioning (e.g., family relations, school performance), and reduce use of out-of-home placements (e.g., incarceration, residential treatment, hospitalization).
Multisystemic therapy (MST) is a well-validated, evidenced-based treatment for serious clinical problems presented by adolescents and their families. Using a family and community-based treatment approach, MST targets youth with serious clinical problems who are at risk for out-of-home placement. Based on an extensive body of controlled clinical research, MST has been identified as an effective treatment of youth antisocial behavior, including substance abuse (National Institute on Drug Abuse, 1999; President's New Freedom Commission on Mental Health, 2003; U.S. Public Health Service, 2001). This chapter begins by outlining the empirical bases of MST for treating adolescent substance use and is followed by a brief overview of the MST treatment model. The remainder of the chapter summarizes the empirical findings from clinical trials using MST to treat substance use disorders in adolescents, and describes current efforts that aim to enhance substance use outcomes with families of adolescent and adult substance abusers.
Multisystemic therapy (MST) and other evidence-based treatments of juvenile offenders (e, g., Multidimensional Treatment Foster Care) include substantive school-related intervention components for both empirical and pragmatic reasons. Empirically, considerable research has shown that school-related difficulties (e.g., dropout, poor performance, low commitment) are important predictors of antisocial behavior in adolescents. Hence, the evidence-basedtreatments of antisocial behavior, each of which focuses comprehensively on multiple risk factors, explicitly address the role of school-related difficulties in the maintenance of antisocial behavior. Pragmatically, the school environment is critical to promoting keyaims of MST. For example, MST interventions often aim to decrease youths' associations with deviant peers while promoting prosocial peer contacts. School provides numerous opportunities (e.g., sports, clubs) to engage problem youths with primarily prosocial peers under adult supervision.
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 review examines the emerging outcomes of juvenile drug courts and, within the context of the much more extensive adult drug court literature, suggests priorities for juvenile drug court research. Particular attention is devoted to the potential for evidence-based treatments of adolescent substance abuse to enhance the effectiveness of juvenile drug courts.
Multisystemic therapy (MST) has been identified as an effective treatment of youth antisocial behavior, including substance abuse. This article provides an overview of the clinical application of MST, focusing on its implementation with alcohol and other drug using adolescents, and summarizes findings from clinical trials using MST to treat substance use disorders in adolescents.
Multisystemic therapy (MST) is a well-validated, evidence-based treatment for serious clinical problems presented by adolescents and their families. Using a family and community-based treatment approach, MST targets youth with serious clinical problems who are at risk of out-of-home placement (for example detention, incarceration, or residential treatment facility). Based on an effective treatment of youth antisocial behaviour, including substance abuse (National Institute on Drug Abuse, 1999; National Institutes of Health, 2006; President's New Freedom Commission on Mental Health, 2003; US Public Health Service, 2001). This chapter begins by outlining the empirical bases of MST for treating adolescent substance use and is followed by a brief overbiew of the MST treatment model. The remainder of the chapter summarises the empirical findings from clinical trials using MST to treat substance use disorders in adolescents, and describes current efforts that aim to enhance substance use outcomes with families of adolescent and adult substance abusers.
Multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) is an intensive family-and community-based treatment that has been applied to a wide range of serious clinical problems presented by youths, including chronic and violent criminal behavior, substance abuse, sexual offending, psychiatric emergencies, and, recently, serious healthcare problems. Youths with these types of serious clinical problems present significant personal and societal (e.g., crime victimization) costs, and due to their high rates of expensive out-of-home placements, consume a grossly disproportionate share of the nation's mental health treatment resources. Across these clinical populations, the overarching goals of MST programs are to decrease rates of antisocial behavior and other clinical problems, improve functioning (e.g., family relations, school performance), and reduce use of out-of-home placements (e.g., incarceration, residential treatment, hospitalization).