56. Henggeler, S.W., Mihalic, S.F., Rone, L., Thomas, C., & Timmons-Mitchell, J. (1998). Blueprints for violence prevention multisystemic therapy. D. S. Elliott, (Series Ed.), University of Colorado at Boulder, Center for the Study and Prevention of Violence. Blueprints Publications.
75. Lipovsky, J.A., Swenson, C.C., Ralston, M.E., & Saunders, B.E. (1998). The abuse clarification process in the treatment of intra familial child abuse. Child Abuse and Neglect, 22(7), 729-741.
80. Swenson, C.C., & Brown, E.J. (2002). Cognitive-behavioral group treatment for physically-abused children: A case study.Cognitive and Behavioral Practice.
83. Henggeler, S.W. (1999). Multisystemic therapy: An overview of clinical procedures, outcomes, and policy implications. Child Psychology & Psychiatry Review, Vol. 4, 2-10.
84. Schoenwald, S.K., Brown, T.L., & Henggeler, S.W. (2000). Inside Multisystemic therapy: Therapists, supervisory, and program practices. Journal of Emotional and Behavioral Disorders, 8, 113-127.
87. Cunningham, P.B., & Henggeler, S.W. (1999). Engaging multiproblem families in treatment: Lessons learned throughout the development of multisystemic therapy. Family Process, 38, 265-286.
90. Schoenwald, S.K.,& Rowland, M.D. (2002). Multisystemic therapy as an alternative to out of home placement. In B.J. Burns, K. Hoagwood, & M. English (Eds.),Community-based interventions for youth with severe emotional disorders.(pp. 91-116). Oxford University Press.
91. 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, 451-467.
93. Henggeler, S.W. (1999).Multisystemic treatment of serious clinical problems in children and adolescents. Clinician's Research Digest, Supplemental Bulletin 21.
94. Burns, B.J.,Schoenwald, S.K., Burchard, J.D.,Faw, L.,Santos, A.B.,(2000).Multisystemic therapy and the wraparound process. Journal of Child and Family Studies, 9, 283-314.
95. Schoenwald, S. K., Henggeler, S. W., Brondino, M. J.,Rowland, M.D.,(2000).Multisystemic therapy: Monitoring treatment fidelity. Family Process, 39, 83-103.
96. Rowland, M.D., Henggeler, S. W., Gordon, A.M., Pickrel, S.G., Cunningham, P.B., Edwards, J.E., (2000).Adapting multisystemic therapy to serve youth presenting psychiatric emergencies: Two case studies. Child Psychology & Psychiatry Review, 5, 30-43.
99. Henggeler, S.W.& Schoenwald, S.K., (1999). The role of quality assurance in achieving outcomes in MST programs. Journal of Juvenile Justice and Detention Services, 14(2),1-17.
208. Cunningham, P.B., Henggeler, S. W. (2001). Implementation of an empirically based drug and violence prevention and intervention program in public school settings. Journal of Clinical Child Psychology,30(1), 221-232.
210. Edwards, D. L., Schoenwald, S.K., Henggeler, S.W., & Strother, K.B. (2001). A multi-level perspective on the implementation of multisystemic therapy (MST): Attempting dissemination with fidelity. In G.A. Bernfield, D.P. Farrington, & A.W. Leschied (Eds.), Offender rehabilitation in practice: Implementing and evaluating effective programs (pp. 97-120). London: Wiley.
242. Schoenwald, S.K., Sheidow, A.J., & Letourneau, E.J. (2004). Toward effective quality assurance in evidence-based practice: Links between expert consultation, therapist fidelity and child outcomes. Journal of Clinical Child and Adolescent Psychology, 33(1), 94-104.
244. Schoenwald, S.K., Halliday-Boykins , C.A. , & Henggeler, S.W. (2003). Client-level predictors of adherence to MST in community service settings. Family Process, 42(3), 345-359.
*** Henggeler, S.W., Schoenwald, S.K., Borduin, C.M., Rowland, M.D., and Cunningham, P.B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents. New York : Guilford Press. Also published in Norwegian (2000). Multisystemisk behandling av barn og unge med atferdsproblemer. Oslo , Norway : Kommuneforlaget. http://www.guilford.com
*** Henggeler, S.W., Schoenwald, S.K., Rowland, M.D., and Cunningham, P.B. (2002). Serious emotional disturbance in children and adolescents: Multisystemic therapy. New York : Guilford Press. http://www.guilford.com
*** Swenson, C.C., Henggeler, S.W., Taylor , I.S., and Addison , O.W. (2005). Multisystemic therapy and neighborhood partnerships: Reducing adolescent violence and substance abuse . New York : Guilford Press. http://www.guilford.com
276. Schoenwald, S.K., Letourneau, E.J., Halliday-Boykins, C.A. (2005). Predicting therapist adherence to a transported family-based treatment for youth. Journal of Clinical Child and Adolescent Psychology, 34(4), 658-670.
292. Cunningham, P.B., Randall, J., Henggeler, S.W., Schoenwald, S.K. (2006). Multisystemic therapy supervision: A key component of quality assurance. In T. Kirby Neill (Eds.), Helping Others Help Children: Clinical Supervision of Child Psychotherapy (pp. 137-160). American Psychological Association: Washington, DC.
344. Schoenwald, S.K., Sheidow, A.J., & Chapman, J.E. (2009). Clinical supervision in treatment transport: Effects on adherence and outcomes. Journal of Consulting and Clinical Psychology, 77, 410-421.
351. Foster, S. L., Cunningham, P. B., Warner, S. E., McCoy, D. M., Barr, T. S., & Henggeler, S. W. (2009)."Therapist behavior as a predictor of black and white caregiver responsiveness in multisystemic therapy. Journal of Family Psychology, 23, 626-635. doi: 10.1037/a0016228
352. Naar-King, S., Ellis, D., Kolmodin, K., Cunningham, P.B., Jen, C., Saelens, B. & Brogan, K. (2009). A randomized pilot study of Multisystemic therapy targeting obesity in african-american adolescents. Journal of Adolescent Health, 45(4), 317-319. doi: 10.1016/j.jadohealth.2009.03.022
353. Naar-King, S., Ellis, D., Kolmodin, K., Cunningham, P.B., & Secord, E. (2009). Feasibility of adapting multisytemic therapy to improve illness management behaviors and reduce asthma morbidity in high risk african american youth: A case series. Journal of Child and Family Studies, 18(5), 564-573. doi: 10.1007/s10826-009-9259-9
359. Cunningham, P. B. & Randall, J. (2008). Multisystemic approaches to supervision: Tales of woe (cultural nonconnect in supervision and understanding the fit).In C. A. Falender & E. P. Shafranske (Eds.), Casebook for Clinical Supervision: A Competency-Based Approach (pp.181-195). Washington, DC: American Psychological Association.
360. Letourneau, E. J., Ellis, D. A., Naar-King, S., Cunningham, P. B., & Fowler, S. L. (2010). Case study: Multisystemic therapy for adolescents who engage in HIV transmission risk behaviors. Journal of Pediatric Psychology, 35(2), 120-127.
361. Donohue, B., Tracy, K., & Sheidow, A. J. (2010). Substance use disorders. In J. Thomas & M. Hersen (Eds.), Handbook of clinical psychology competencies: Volume III: Intervention and treatment for children and adolescents (pp. 1461-1480). New York: Springer-Verlag.
376. Cunningham, P. B., Foster, S. L., Warner, S. E. (2010). Culturally relevant family-based treatment for adolescent delinquency and substance abuse: Understanding within-session processes. Journal of clinical Psychology: In Session, 66(8), 830-846.
392. Schoenwald, S. K., Garland, A. F., Chapman, J. E., Frazier, S. L., Sheidow, A. J., Southam-Gerow, M. A. (2011). Toward the effective and efficient measurement of implementation fidelity. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 32-43.
393. Schoenwald, S. K. (2011). It’s a bird, it’s a plane, it’s . . . fidelity measurement in the real world. Clinical Psychology: Science and Practice, 18, 142-147.
394. McCart, M. R., Henggeler, S. W., & Hales, S. (2011). Multisystemic Therapy. In Brown, B. B., & Prinstein, M. J. (Eds.), Encyclopedia of adolescence, vol. 3 (pp. 202-209). San Diego, Academic Press.
395. Carcone, A. I., MacDonell, K. E., Naar-King, S., Ellis, D. E., Cunningham, P. B., Kaljee, L. (2011). Treatment engagement in a weight-loss intervention for African American adolescents and their families. Children’s Health Care, 40, 1-21.
403. Tuerk, E. H., McCart, M. R., & Henggeler, S. W. (2012). Collaboration in family therapy. Journal of Clinical Psychology: In Session, 68(2), 168-178.
408. Tighe, A., Pistrang, N., Casdagli, L., Baruch, G., & Butler, S. (2012). Multisystemic Therapy for young offenders: Families' experiences of therapeutic processes and outcomes. Journal of Family Psychology, 26, 187-197.
413. Dekovic, M., Asscher, J. J., Manders, W. A., Prins, P. J. M., & van der Laan, P. (2012). Within-intervention change: Mediators of intervention effects during Multisystemic Therapy. Journal of Consulting and Clinical Psychology. Published online May 7.
421. Cunningham, P. B., Foster, S. L. & Warner, S. E. (2010) Culturally relevant family-based treatment for adolescent delinquency and substance abuse: Understanding within-session processes. Journal of Clinical Psychology: In Session, 66(8) 830-846.
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Clinical Procedure Abstracts
75. The abuse clarification process in the treatment of intrafamilial child abuse
Objective: One aspect of treatment for child abuse and neglect addresses the attributions that the child victim offender, nonoffending parents, and other family members have about the occurrence of the maltreatment. This paper describes a formal approach for abuse clarification to be used with families in which maltreatment has occurred. The four primary components of the abuse clarification process are: (a) clarification of the abusive behaviors; (b) offender assumption of responsibility for the abuse; (c) offender expression of awareness of the impact of the abuse on the child victim and family; and (d) initiation of a plan to ensure future safety. The process of abuse clarification is described and suggestions made for appropriate use of the procedure.
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80. Cognitive behavioral group treatment for physically-abused children: A case study
The purpose of this case study was two-fold: (1) to assess the feasibility of implementing a multiple-module, 16-week cognitive-behavioral group treatment program for physically-abused children; and (2) to evaluate preliminary data from this group treatment program designed to address the multiple sequelae common to school-aged physically abused children (i.e., aggression and other behavioral problems, social skills deficits, and trauma-related symptoms). Results indicate that the multiple components of this group treatment were implemented successfully and allowed for flexibility across children, even within a group format. Preliminary pre-post data show decreases on self report measures of trauma-related emotional symptoms targeted by the group treatment. Increases were evident in parent ratings of children’s internalizing and externalizing behaviors. Interpretations of these findings and future research recommendations are discussed.
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83. Multisystemic therapy: An overview of clinical procedures, outcomes, and policy implications
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.
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84. Inside multisystemic therapy: Therapist, supervisor, and program practices
In this article, we highlight key features of Multisystemic Therapy (MST) and of the supervisory, consultation, and program practices that support therapist implementation of MST in community-based settings. The article begins with summary of the theoretical and empirical foundations of MST and of evidence supporting effectiveness of the model. The remaining sections of the manuscript focus on the therapist implementation of the model. The remaining sections of the manuscript focus on therapist implementation of the model, supervisory practices, the use of consultation, and program (e.g., organizational, interorganizational) practices.
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87. Engaging multiproblem families in treatment lessons learned throughout the development of multisystemic therapy
Multisystemic therapy (MST) is a family based treatment model that has achieved high rates of treatment completion with youths who present serious clinical problems, and their families. The success of MST in engaging challenging families in treatment is due to programmatic commitments to family collaboration and partnership as well as to a conceptual process that delineates barriers to family engagement, develops and implements strategies to overcome these barriers, and evaluates the success of these strategies. This article provides and overview of the nonspecific/universal engagement strategies used by MST therapists, frequently observed barriers to achieving therapist engagement, and specific strategies to overcome a sampling of these barriers.
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90. Multisystemic therapy as an alternative to out of home placement
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.
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91. Mechanisms of change in multisystemic therapy: Reducing delinquent behavior through therapist adherence and improved family and peer functioning
The mechanisms through which multisystemic therapy (MST) decreased delinquency behavior were assessed in 2 samples of juvenile offenders. Sample 1 included serious offenders who were predominately rural, male, and African American. Sample 2 included substance abusing offenders who were predominately urban, male, and Caucasian. Therapist adherence to the MST protocol (based on multiple respondents) was associated with improved family relations (family cohesion, family functioning, and parent monitoring) and decreased delinquent peer affiliation, which, in turn, were associated with decreased delinquent behavior. Furthermore, changes in family relations and delinquent peer affiliation mediated the relationship between caregiver-rated adherence and reductions in delinquent behavior. The findings highlight the importance of identifying central change mechanisms in determining how complex treatments such as MST.
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94. Comprehensive community-based interventions for youth with severe emotional disorders: Multisystemic therapy and the wraparound process
Two comprehensive community-based interventions for youth with severe emotional disorders are contrasted and compared. The interventions are multisystemic therapy (MST) a brief but intensive, clinician-provided, and home-based treatment; and wraparound a long term approach to planning and coordinating the provision of both formal and informal services in the community. Both approaches are spreading rapidly across the country. As this occurs, it is important for families, clinicians, and policymakers to have sufficient information to understand the requirements and the research base for each. This paper provides a description of both MST and wraparound across multiple dimensions (i.e., origin, theory, target population, principles, role of family, cultural competence, staffing, training, quality monitoring, costs and the evidence base). The respective similarities and differences are discussed and options for utilizing both for selected youth and families who require intensive and long-term care are explored briefly.
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95. Multisystemic therapy: Monitoring treatment fidelity
The challenges of specifying a complex and individualized treatment model and measuring fidelity thereto are described, using multisystemic therapy (MST) as an example. Relations between therapist adherence to MST principles and instrumental and ultimate outcome variables are examined, as are relations between clinical supervision and therapist adherence. The findings provide modest support for the associations between MST adherence measures and instrumental and ultimate outcomes. Results also show that adherence can be altered when clinical supervision and adherence monitoring procedures are fortified. The modest associations between adherence measures and youth outcomes argue for further refinement and validation of the MST adherence measure, especially in light of the well-established effectiveness of MST with challenging clinical populations and the increasing dissemination of MST programs.
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96. Adapting multisystemic therapy to serve youth presenting psychiatric emergencies: Two case studies
Multisystemic therapy (MST) is a highly individualized family- and home-based treatment that has successfully served as a clinically effective and cost-effective alternative to out-of-home placements (e.g., incarceration, psychiatric hospitalization) for youth presenting serious clinical problems. MST clinical procedures are reviewed and two extensive case summaries are used to explicate the MST intervention process for treating serious antisocial behavior and modifications in that process needed to safely and effectively serve youth presenting psychiatric emergencies.
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99. The role of quality assurance in achieving outcomes in MST programs
Multisystemic therapy (MST) is a family- and community-based treatment that has proven effective at reducing long- term rates of rearrest and out-of-home placement in clinical trials with children and adolescents presenting serious problems. A key feature of the success of MST and to the dissemination of MST programs across the nations is a well-specified quality assurance system. This paper describes the manualization of the components of the MST quality assurance system and the corresponding training protocols used to promote program fidelity. In addition, empirical support for central aspects of the quality assurance system and current research on this system are presented. Ultimately, the validation of quality assurance systems will be critical for the effective transport of evidence-based interventions in the fields of juvenile justice and mental health.
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208. Implementation of an empirically based drug and violence prevention and intervention program in public school settings
Describes the implementation of a collaborative preventive intervention project (Healthy Schools) designed to reduce levels of bullying and related antisocial behaviors in children attending two urban middle schools serving primarily African American students. These schools have high rates of juvenile violence, as reflected by suspensions and expulsions for behavioral problems. Using a quasi-experimental design, empirically based drug and violence prevention program. Bullying Prevention and Project ALERT, are being implemented at each middle school. In addition, an intensive evidence-based intervention, multisystemic therapy, is being used to target students at high risks of expulsion and court referral. Hence, the proposed project integrates both universal approaches to prevention and a model that focuses on indicated cases. Targeted outcomes, by which the effectiveness of this comprehensive school-based program will be measured are reduced youth violence, reduced drug use, and improved psychosocial functioning of participating youth.
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242. Toward effective quality assurance in evidence-based practice: Links between expert consultation, therapist fidelity and child outcomes
This study validated a measure of expect clinical consultation, therapist adherence, and youth outcomes in community-based settings. Consultant adherence to the multisystemic therapy (MST) consultation protocol was assessed through therapist reports, and therapist adherence to MST principles was assessed through caregiver reports in 2 samples of families (N1=178, N2=274) and therapists (N1=87, N2=162). Caregiver reports of youth behavior and functioning were obtained in the second sample pre-and posttreatment. Random effects regression models demonstrated associations between consultant behavior, therapist adherence, and posttreatment youth behavior problems and functioning. Instrumental aspects of consultation supported therapist adherence and improved youth outcomes; supportive aspects of consultation were negatively associated with adherence and outcomes. These findings suggest the availability to clinicians of expert consultation can impact clinician fidelity to a treatment model and child outcomes.
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244. Client-level predictors of adherence to MST in community service settings
This study examined the association of youth and family characteristics with therapist fidelity to an evidence-based treatment provided in real world practice settings. Participants were 233 families that reported on the 66 therapists organized into 16 teams in nine organizations providing Multisystemic therapy (MST). Therapist adherence ratings were lower for youths referred for both criminal offenses and substance abuse than for youths referred either for substance abuse or status offenses, and was negatively associated with pretreatment arrests and school suspensions. Adherence ratings were positively associated with educational disadvantage and caregiver-therapist ethnic match and marginally positively associated with economic disadvantage. The findings suggest directions for future research on the implementation of evidence-based treatments in community settings.
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276. Predicting therapist adherence to a transported family-based treatment for youth
This study examined relations between therapist, caregiver, and youth characteristics and therapist adherence to multisystemic therapy (MST). Participants were 405 therapists in 45 organizations and the 1,711 families they treated with MST. Therapist perceptions that the flexible hours required to implement MST are problematic predicted lower adherence. Therapist demographic variables, professional training and experience, endorsement of the MST model, perceived difficulty and rewards of doing MST, and perceived similarity of treatments previously used did not predict adherence. Therapist-caregiver similarity on ethnicity and gender predicted higher adherence. Low caregiver education and African American ethnicity predicted higher adherence. With the exception of youth psychosocial functioning, indicators of severity of youth problems did not predict adherence.
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292. Multisystemic therapy supervision: A key component of quality assurance
This chapter focuses on MST clinical supervision and on its functions within the broader, quality-assurance system, especially supervisor training and consultation, measurement of supervisor performance, common problems encountered by MST supervisors, and strategies for managing these problems, such as therapist drift and frustration.
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344. Clinical supervision in treatment transport: Effects on adherence and outcomes
This nonexperimental study used mixed-effects regression models to examine relations among supervisor adherence to a clinical supervision protocol, therapist adherence, and changes in the behavior and functioning of youths with serious antisocial behavior treated with an empirically supported treatment (i.e., multisystemic therapy [MST]) 1 year posttreatment. Participants were 1,989 youths and families treated by 429 clinicians across 45 provider organizations in North America. Four dimensions of clinical supervision were examined. Mixed-effects regression model results showed that one dimension, supervisor focus on adherence to treatment principles, predicted greater therapist adherence. Two supervision dimensions, Adherence to the Structure and Process of Supervision and focus on Clinician Development, predicted changes in youth behavior. Conditions required to test hypothesized mediation by therapist adherence of supervisor adherence effects on youth outcomes were not met. However, direct effects of supervisor and therapist adherence were observed in models including both of these variables.
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