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4.  Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using Multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology, 60, 953-961.

13.  Henggeler, S. W., Melton, G. B., Smith, L. A., Schoenwald, S. K., & Hanley, J. H. (1993). Family preservation using Multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders. Journal of Child and Family Studies, 2, 283-293.

22.  Scherer, D. G., Brondino, M. J., Henggeler, S. W., Melton, G. B., & Hanley, J. H. (1994). Multisystemic family preservation therapy: Preliminary findings from a study of rural and minority serious adolescent offenders. Journal of Emotional and Behavioral Disorders, 2, 198-206.

25.  Borduin, C. M., Mann, B. J., Cone, L. T., Henggeler, S. W., Fucci, B. R., Blaske, D. M., & Williams, R. A. (1995). Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence. Journal of Consulting and Clinical Psychology, 63, 569-578.

40.  Henggeler, S. W., Pickrel, S. G., Brondino, M. J., & Crouch, J. L. (1996). Eliminating (almost) treatment dropout of substance abusing or dependent delinquents through home-based multisystemic therapy. American Journal of Psychiatry, 153, 427-428.

54.  Schoenwald, S.K., Ward, D.M., Henggeler, S.W., Pickrel, S.G., Patel, H. (1996). Multisystemic therapy treatment of substance abusing or dependent adolescent offenders: Costs of reducing incarceration, inpatient and residential placement. Journal of Child and Family Studies, 5, 431-444.

55.  Henggeler, S. W., Melton, G. B., Brondino, M. J., Scherer, D. G., & Hanley, J. H. (1997). Multisystemic therapy with violent and chronic juvenile offenders and their families: The role of treatment fidelity in successful dissemination. Journal of Consulting and Clinical Psychology, 65, (5), 821-833.

64.  Schoenwald, S.K., Ward, D.M., Henggeler, S.W., & Rowland, M.D. (2000). MST vs. hospitalization for crisis stabilization of youth: Placement outcomes 4 months post-referral. Mental Health Services Research, 2(1), 3-12.

71.  Brown, T. L., Henggeler, S. W., Schoenwald, S. K., Brondino, M.J., & Pickrel, G. (1999). Multisystemic treatment of substance abusing and dependent juvenile delinquents: Effects on school attendance at post treatment and 6- month follow-up. Children's Services: Social Policy, Research, and Practice, 2, 81-93.

85.  Henggeler, S.W., Pickrel, S.G., & Brondino, M.J. (1999). Multisystemic treatment of substance abusing and dependent delinquents: Outcomes, treatment fidelity, and transportability. Mental Health Services Research, 1, 171-184.

88.  Henggeler, S.W.,Rowland, M.D.,Randall, J., Ward, D.M.,Pickrel, S.G.,Cunningham, P.B.,Miller, S.L., Edwards, J.,Zealberg, J.J.,Hand, L.D., & Santos, A.B. (1999). Home based Multisystemic Therapy as an Alternative to the Hospitalization of Youths in Psychiatric Crisis: Clinical Outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 1331-1339.

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.

101.  Henggeler, S. W., Borduin, C. M., Melton, G. B., Mann, B. J., Smith, L., & Hall, J. A., Cone, L., & Fucci, B. R. (1991). Effects of multisystemic therapy on drug use and abuse in serious juvenile offenders: A progress report from two outcome studies. Family Dynamics of Addiction Quarterly, 1, 40-51.

102.  Borduin, C. M., Henggeler, S. W., Blaske, D. M. & Stein, R. (1990). Multisystemic treatment of adolescent sexual offenders. International Journal of Offender Therapy and Comparative Criminology, 35, 105-114. 103 Brunk, M., Henggeler, S. W., & Whelan, J. P. (1987). A comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect. Journal of Consulting and Clinical Psychology, 55, 311-318.

103.  Brunk, M., Henggeler, S. W., & Whelan, J.P. (1987). A comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect. Journal of Consulting and Clinical Psychology, 55, 311-318.

104.  Henggeler, S. W., Rodick, J. D., Borduin, C. M., Hanson, C. L., Watson, S. M., & Urey, J. R. (1986). Multisystemic treatment of juvenile offenders: Effects on adolescent behavior and family interactions. Developmental Psychology, 22, 132-141.

223.  Henggeler, S.W., Clingempeel, W.G., Brondino, M.J., Pickrel, S.G. (2002). Four-year follow-up of Multisystemic therapy with substance-abusing and substance-dependent juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 41(7), 868-876.

231.  Henggeler, S.W., Rowland, M.D., Halliday-Boykins, C.A., Sheidow, A.J., Ward, D.M., Randall, J., Pickrel, S.G., Cunningham, P.B., Edwards, J. (2003). One-Year follow-up of multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 543-551.

247.  Huey, S.J., Jr., Henggeler, S.W., Rowland, M.D., Halliday-Boykins, C.A., Cunningham, P.C., Pickrel, S.G., & Edwards, J. (2004). Multisystemic therapy effects on attempted suicide by youth presenting psychiatric emergencies. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 183-190.

248.  Ogden, T., & Halliday-Boykins, C, A. (2004). Multisystemic treatment of antisocial adolescents in Norway: Replication of clinical outcomes outside of the US. Child and Adolescent Mental Health, 9(2), 77-83.

253.  Sheidow, A.J., Bradford , W.D., Henggeler, S.W., Rowland, M.D., Halliday-Boykins, C., Schoenwald, S.K., Ward, D.M. (May 2004). Treatment costs for youths receiving Multisystemic therapy of hospitalization after a psychiatric crisis. Psychiatric Services, 55, 548-554.

255.  Curtis, N. M., Ronan, K. R., & Borduin, C. M. (2004). Multisystemic treatment: A meta-analysis of outcome studies. Journal of Family Psychology, 18, 411-419.

256.  Halliday-Boykins, C.A., Schoenwald, S.K., Letourneau, E.J. (2005).  Caregiver-therapist ethnic similarity predicts youth outcomes from an empirically based treatment.  Journal of Consulting & Clinical Psychology, 73 (5), 808-818.

261.  Schaeffer, C.M., & Borduin, C.M. (2005). Long-term follow-up to a randomized clinical trial of multisystemic therapy with serious and violent juvenile offenders. Journal of Consulting and Clinical Psychology, 73 (3),445-453.

262.  Rowland, M.D., Halliday-Boykins, C.A., Henggeler, S.W., Cunningham, P.B., Lee, T.G., Kruesi, M.J.P., & Shapiro, S.B. (2005). A randomized trial of multisystemic therapy with Hawaii 's Felix Class youths. Journal of Emotional and Behavioral Disorders, 13 (1).13-23.

264.  Ogden, T., & Hagen , K.A. (2006). Multisystemic therapy of serious behavior problems in youth: Sustainability of therapy effectiveness two years after intake. Child and Adolescent Mental Health, 11 (3), 142-149.

268.  Ellis, D.A., Frey, M.A., Naar-King, S., Templin, T., Cunningham, P.B., Cakan, N. (2005). Use of multisystemic therapy to improve regimen adherence among adolescents with Type 1 diabetes in chronic poor metabolic control: A randomized controlled trial. Diabetes Care, 28 (7), 1604-1610.

270.  Henggeler, S.W., Halliday-Boykins, C.A., Cunningham, P.B., Randall, J., Shapiro, S.B., Chapman, J.E. (2006).  Juvenile drug court: Enhancing outcomes by integrating evidence-based treatments.  Journal of Consulting and Clinical Psychology, 74 (1), 42-54.

271.  Cunningham, P.B., Narr-King, S., Ellis, D.A., Pejuan, S., Secord, E. (2006). Achieving adherence to antiretroviral medications for pediatric HIV disease using empirically supported treatment: A case report. Journal of Developmental and Behavioral Pediatrics, 27(1), 44-50.

272.  Ellis, D.A., Narr-King, S., Cunningham, P.B., Secord, E. (2006). Use of multisystemic therapy to improve antiretroviral adherence and health outcomes in HIV-infected pediatric patients: Evaluation of a pilot program. AIDS, Patient Care, and STD's, 20(2), 112-121.

274.  Huey, S.J., Henggeler, S.W., Rowland, M.D., Halliday-Boykins , C.A. , Cunningham, P.B., & Pickrel, S.G. (2005). Predictors of treatment response for suicidal youth referred for emergency psychiatric hospitalization. Journal of Clinical Child and Adolescent Psychology, 34(3), 582-589.      

278.  Ellis, D. A., Naar-King, S., Frey, M., Templin, T., Rowland, M.D., Cakan, N. (2005).  Multisystemic treatment of poorly controlled type 1 diabetes:  Effects on medical resource utilization.  Journal of Pediatric Psychology, 30(8), 656-666.

291. Timmons-Mitchell, J., Bender, M.B., Kishna, M.A., & Mitchell, C.C. (2006).  An independent effectiveness trial of multisystemic therapy with juvenile justice youth. Journal of Clinical Child and Adolescent Psychology, 35(2), 227-236.

294.  Borduin, C. M., & Schaeffer, C. M. (2001). Multisystemic treatment of juvenile sexual offenders: A progress report. Journal of Psychology & Human Sexuality, 13, 25-42.

297.  Ellis, D.A., Templin, T., Naar-King, S., Frey, M.A., Cunningham, P.B., Podolski, C., Cakan, N. (2007). Multisystemic therapy for adolescents with poorly controlled type 1 diabetes: Stability of treatment effects in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 75, 168-174.

299.  Ellis, D.A., Yopp, J., Templin, T., Naar-King, S., Frey, M.A., Cunningham, P.B., Idalski, A., Niec, L.N. (2007). Family mediators and moderators of treatment outcomes among youths with poorly controlled type 1 diabetes: Results from a randomized controlled trial. Journal of Pediatric Psychology, 32(2), 194-205.

303.  Stambaugh, L.F., Mustillo, S.A., Burns, B.J., Stephens, R.L., Baxter, B., Edwards, D., DeKraai, M. (2007). Outcomes from wraparound and multisystemic therapy in a center for mental health services system-of-care demonstration site. Journal of Emotional and Behavioral Disorders, 15 (3), 143-155.

312.  Ogden, T., Hagen, K.A., Anderson, O. (2007). Sustainability of the effectiveness of a programme of multisystemic treatment (MST) across participant groups in the second year of operation. Journal of Children's Services, 2(3), 4-14.

317.  Huey, S.J., Jr., Plol, A.J. (2008). Evidence-based psychosocial treatments for ethnic minority youth. Journal of Clinical Child & Adolescent Psychology, 37(1), 262-301.

319.  Saldana, L., Henggeler, S.W. (2008). Improving outcomes and transporting evidence-based treatments for youth and families with serious clinical problems. Journal of Child & Adolescent Substance Abuse, 17(3), 1-10.

320.  Rowland, M.D., Chapman, J.E. & Henggeler, S.W. (2008). Sibling outcomes from a randomized trial of evidence-based treatments with substance abusing juvenile offenders. Journal of Child and Adolescent Substance Abuse, 17(3), 11-26.

330.  Sundell, K., Hansson, K., Lofholm, C.E., Olsson, T., Gustle, L-H., Kadesjo, C. (2008). The transportability of multisystemic therapy to Sweden: Short-term results from a randomized trial of conduct-disordered youths.

335.   Borduin, C.M., Schaeffer, C.M., & Heiblum, N. (2009). A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: Effects on youth social ecology and criminal activity. Journal of Consulting & Clinical Psychology, 77, 26-37.

336.   Letourneau, E.J., Henggeler, S.W., Schewe, P.A., Borduin, C.M., McCart, M.R., Chapman, J.E., & Saldana. (2009). Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial. Journal of Family Psychology, 23, 89-102.

341.  Curtis, N.M., Heiblum, N., Ronan, K.R., & Crellin, K. (2009). Dissemination & effectiveness of multisystemic treatment in New Zealand: A benchmarking study. Journal of Family Psychology, 23(2), 119-129.

343.  Ellis, D.E., Naar-King, S., Templin, T., Frey, M.A., & Cunningham, P.B. (2007). Improving health outcomes among youth with poorly controlled type I diabetes: The role of treatment fidelity in a randomized clinical trial of multisystemic therapy. Journal of Family Psychology, 21(3), 363-371.

345.  Henggeler, S.W., Letourneau, E.J., Chapman, J.E., Borduin, C.M., Schewe, P.A., & McCart, M.R. (2009). Mediators of change for multisystemic therapy with juvenile sexual offenders. Journal of Consulting and Clinical Psychology, 77, 451-462.

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

354.  Cunningham, P. B., Ellis, D. A., & Naar-King, S. (2010). Treating pediatric obesity using an empirically supported treatment: A case report. Journal of Clinical Child and Adolescent Psychology, 39(1), 141-150.

357.  Ellis, D. A., Naar-King, S., Frey, M., Templin, T., Rowland, M. & Greger, N. (2004) Use of multisytemic therapy to improve regimen adherence among adolescents with type 1 diabetes in poor metabolic control: A pilot investigation. Journal of Clinical Psychology in Medical Settings, 11(4), 315-324.

358.  Ellis, D. A., Naar-King, S., Templin, T., Frey, M., Cunningham, P., Sheidow, A., Cakan, N., Idalski, A. Multisystemic therapy for adolescents with poorly controlled type 1 diabetes. Diabetes Care, 31(9), 1746-1747.

378.  Letourneau, E. J., Chapman, J. E., Schoenwald, S. K., (2008). Treatment outcome and criminal offending by youth with sexual behavior problems. Child Maltreatment, 13(2), 133-144. doi: 10.1177/1077559507306717

380.  Ellis, D. A., Naar-King, S., Templin, t., Grey, M. A., Cunningham, P. B., Sheidow, A., Cakan, N. (2008). MST for adolescents with poorly controlled type 1 diabetes: Reduced DKA admissions and related costs over 24 months. Diabetes Care, 31(9), 1746-7.

382.  Swenson, C. C., Schaeffer, C. M., Henggeler, S. W., Faldowski, R., Mayhew, A.M. (2010). Multisystemic therapy for child abuse and neglect: A randomized effectiveness trial. Journal of Family Psychology, 24(4), 497-507.

384.  Halliday-Boykins, C. A., Schaeffer, C. M., Henggeler, S. W., Chapman, J. E., Cunningham, P. B., Randall, J., Shapiro, S.B. (2010). Predicting nonreponse to juvenile drug court interventions. Journal of Substance Abuse Treatment, 39, 318-328.

388. Chapman, J. E., & Schoenwald, S. K. (2011). Ethnic similarity, therapist adherence, and long-term Multisystemic Therapy outcomes. Journal of Emotional and Behavioral Disorders, 19, 3-16.

396.  Sawyer, A. M., Borduin, C. M. (2011). Effects of multisystemic therapy through midlife: A 21.9-year follow-up to a randomized clinical trial with serious and violent juvenile offenders. Journal of Consulting and Clinical Psychology, 79(5), 643-652.

397.   Holth, P., Torsheim, T., Sheidow, A. J., Ogden, T., Henggeler, S. W. (2011). Intensive quality assurance of therapist adherence to behavioral interventions for adolescent substance use problems. Journal of Child and Adolescent Substance Abuse, 20, 289-313.

399.  Trupin, E. J., Kerns, S. E. U., Walker, S. C., DeRobertis, M. T., &  Stewart, D. G. (2011). Family integrated transitions: A promising program for juvenile offender with co-occurring disorders. Journal of Child & Adolescent Substance Abuse, 20, 421-436.

405.  Schechter, J. C., Brennan, P. A., Cunningham, P. B., Foster, S. L. & Whitmore, E. (2012). Stress, cortisol, and externalizing behavior in adolescent males: An examination in the context of multisystemic therapy. Journal of Abnormal Child Psychology, 40, 913-922.

407.   Henggeler, S. W., McCart, M. R., Cunningham, P. B., & Chapman, J. E. (2012). Enhancing the effectiveness of juvenile drug courts by integrating evidence-based practices. Journal of Consulting and Clinical Psychology, 80, 264-275.

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.

411.  Sheidow, A. J.,  McCart, M. R., Zajac, K., Davis, M. (2012). Prevalence and impact of substance use among emerging adults with serious mental health conditions. Psychiatric Rehabilitation Journal, 35, (3), 235-43.

412.  Ellis, D. A., Naar-King, S., Chen, X., Moltz, K., Cunningham, P. B., & Idalski-Carcone, A. (2012). Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: Findings from a randomized controlled trial. Annals of Behavioral Medicine. Published online May 30.

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.

419.  Boxer, P. (2011). Negative peer involvement in multisystemic therapy for the treatment of youth problem behavior: Exploring outcome and process variables in “real-world” practice. Journal of Clinical Child & Adolescent Psychology, 40(6), 848-854.

420.  Boonstra, C., Jonkman, C., Soeteman, D., & van Busschbach, J. (2009). Multi-systemic therapy for seriously antisocial and delinquent juveniles: two-year follow-up study. Systemic Therapy, 21, 94-104.

430.  Danielson, C. K., McCart, M. R., Walsh, K., de Arellano, M. A., White, D., & Resnick, H. S. (2012). Reducing substance use risk and mental health problems among sexually assaulted adolescents: A pilot randomized controlled trial. Journal of Family Psychology, 26(4), 628-635, PMCID: PMC3419329

440.  Danielson, C. K., McCart, M. R., de Arellano, M. A., Macdonald, A., Silcott, L., & Resnick, H. (2010).  Risk reduction for substance use and trauma-related psychopathology in adolescent sexual assault victims: Findings from an open trial. Child Maltreatment, 15(3), 261-268, PMCID: PMC3105119

466     Tiernan, K., Foster, S.L., Cunningham, P. B., Brennan, P., & Whitmore, E. (2014). Predicting early positive change in Multisystemic Therapy with youth exhibiting antisocial behaviors. Psychotherapy.


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Outcome Abstracts
 
4.  Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders

Multisystemic therapy (MST) delivered through a community mental health center was compared with usual services delivered by Department of Youth Services in the treatment of 84 serious juvenile offenders and their multiproblem families. Offenders were assigned randomly to treatment conditions. Pretreatment and posttreatment assessment batteries evaluating family relations, peer relations, symptomatology, social competence, and self-reported delinquency were completed by the youth and a parent, and archival records were searched at 59 weeks postreferral to obtain data on rearrest and incarceration. In comparison with youths who received usual services, youths who received MST had fewer arrests and self-reported offenses and spent an average of 10 fewer weeks incarcerated. In addition, families in the MST condition reported increased family cohesion and decreased youth aggression in peer relations. The relative effectiveness of MST was neither moderated by demographic characteristics nor mediated by psychosocial variables.

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13.  Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders

In a randomized clinical trial, multisystemic family preservation was shown to significantly reduce rates of criminal activity and incarceration in a sample of 84 serious juvenile offenders and their multi-need families. In the current study, archival records were searched for re-arrest an average of 2.4 years post-referral. Survival analysis showed that youths who received multisystemic family preservation were less likely to be re-arrested than were youths who had received usual services. Such results represent the first controlled demonstration that family preservation, when delivered via a clearly specified treatment model, has lasting effects with serious juvenile offenders. Implications for family preservation and juvenile justice research are discussed.

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22.  Multisystemic family preservation therapy: Preliminary findings from a study of rural and minority serious adolescent offenders

The increase in the number of serious offenses by adolescents, particularly among minority populations, has drawn attention to these difficult-to-treat youths. This article provides preliminary findings from the Diffusion of Multisystemic Family Preservation (MFP) Services Project, which conducted work with rural African-American and White families who have a chronic or violent adolescent offender at imminent risk for incarceration. Analyses assessed the impact of multisystemic therapy on family functioning (parental monitoring, family communications, family structure, etc.) and on the problem behavior of the delinquent adolescent (conduct problems, aggression, and criminal activity). In general, the MFP group demonstrated improvements in amount of problem behavior and mother psychological distress, and in aspects of family functioning following treatment. These results generally replicate the previous successes that MFP has shown in the treatment of serious juvenile offenders in urban areas.

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25.  Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence

This article examined the long-term effects of multisystemic therapy (MST) vs. individual therapy (IT) on the prevention of criminal behavior and violent offending among 176 juvenile offenders at high risk for committing additional serious crimes. Results from multiagent, multimethod assessment batteries conducted before and after treatment showed that MST was more effective than IT in improving key family correlates of antisocial behavior and in ameliorating adjustment problems in individual family members. Moreover, results from a 4-year follow-up of rearrest data showed that MST was more effective than IT in preventing future criminal behavior, including violent offending. The implications of such findings for the design of violence prevention programs are discussed.

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40.  Eliminating (almost) treatment dropout of substance abusing or dependent delinquents through home-based multisystemic therapy

Objective: This study examined the effects of an innovative treatment model that was designed to reduce treatment dropout among substance abusing or delinquent juvenile offenders. Method: One hundred eighteen delinquents who met diagnostic criteria for substance abuse of dependence were randomly assigned to receive either home-based multisystemic therapy (N=58) or treatment that was provided by the usual community services (N=60). Results: In the multisystemic therapy condition , 98% (N=57) of the families completed a full course of treatment, which lasted an average of 130 days. In contrast, 78% (N=47) of the families assigned to treatment through the usual community services received no mental health or substance abuse treatment in the 5 months after referral. Conclusions: The serious and long-standing problem of high dropout rates in the substance abuse field can be greatly attenuated by services that increase accessibility and place greater responsibility for engagement on service providers.

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54.  Multisystemic therapy treatment of substance abusing or dependent adolescent offenders: Cost of reducing incarceration, inpatient, and residential placement

The development of more effective and less costly family- and community based services to serve as alternatives to out-of-home placements of children is an important priority in the reform of mental health services for children and adolescents. Within the context of a randomized trial with 118 substance abusing or dependent juvenile offenders, we examined the incremental costs of multisystemic therapy (MST) and related these costs to observed reductions in days of incarceration, hospitalization, and residential treatment at approximately 1 year postreferral. Results showed that the incremental costs of MST were nearly offset by the savings incurred as a result of reductions in days of out-of-home placement during the year. The need to validate effective treatments for youth with serious clinical problems and to link the cost of treatments.

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55.  Multisystemic therapy with violent and chronic juvenile offenders and their families: The role of treatment fidelity in successful dissemination

The effects of multisystemic therapy (MST) in treating violent and chronic juvenile offenders and their families in the absence of ongoing treatment fidelity checks were examined. Across 2 public sector mental health sites, 155 youths and their families were randomly assigned to MST versus usual juvenile justice services. Although MST improved adolescent symptomology at posttreatment and decreased incarceration by 47% at a 1.7-year follow-up, findings for decreased criminal activity were not as favorable as observed on other recent trials of MST. Analyses of parent, adolescent, and therapist reports of MST treatment adherence ratings were high. These results highlight the importance of maintaining treatment fidelity when disseminating complex family-based services to community settings.

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64.  Multisystemic therapy versus hospitalization for crisis stabilization of youth: Placement outcomes 4 months postreferral

Hospitalization and out-of-home placement data for 113 youth participating in a randomized trial comparing home-based multisystemic therapy (MST; n = 57) with hospitalization (n = 56) for psychiatric crisis stabilization were analyzed following the completion of MST treatment – approximately 4 months post approval for emergency hospitalization. Analyses showed that MST prevented any hospitalization for 57% of the participants in the MST condition and reduced the overall number of days hospitalized by 72%. Importantly, the reduction in use and length of hospitalization was not offset by increased use of other placement options, as MST reduced days in other out-of-home placements by 49%. The cost implications for the viability of MST as an alternative to hospitalization for youth presenting psychiatric emergencies are discussed.

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71.  Multisystemic treatment of substance abusing dependent juvenile delinquents: Effects on school attendance at posttreatment and 6 month follow-up

The effectiveness of multisystemic therapy (MST) in promoting school participation among substance abusing dependent juvenile offenders with high rates of psychiatric comorbidity was examined. Youth were randomly assigned to receive MST versus usual community-based services. Results indicated that MST (but not usual services) significantly increased school attendance at posttreatment , and that these treatment gains were maintained at the 6-month follow-up assessment. Explanations for the findings and directions for future research are discussed.

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85.  Multisystemic treatment of substance-abusing and–dependent delinquents: Outcomes, treatment fidelity, and transportability

The effectiveness and transportability of multisystemic therapy (MST) were examined in a study that included 118 juvenile offenders meeting DSM-III-R criteria for substance abuse or dependence and their families. Participants were randomly assigned to receive MST versus usual community services. Outcome measures assessed drug use, criminal activity, and days in out-of-home placement at posttreatment (T2) and at a 6-month posttreatment follow-up (T3); also treatment adherence was examined from multiple perspectives (i.e., caregiver, youth, and therapist). MST reduced alcohol, marijuana, and other drug use at T2 and total days in out-of-home placement by 50% at T3. Reductions in criminal activity, however, were not as large as have been obtained previously for MST. Examinations of treatment adherence measures suggests that the modest results of MST were due, at least in part, to difficulty in transporting this complex treatment model from the direct control of its developers. Increased emphasis on quality assurance mechanisms to enhance treatment fidelity may help overcome barriers to transportability.

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88.  Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: Clinical outcomes

Objective: The primary purpose of this study was to determine whether multisystemic therapy (MST), modified for use with youths presenting psychiatric emergencies, can serve as a clinically viable alternative to inpatient psychiatric hospitalization. Method: One hundred sixteen children and adolescents approved for emergency psychiatric hospitalization were randomly assigned to home-based MST or inpatient hospitalization. Assessments examining symptomatology, antisocial behavior, self-esteem, family relations, peer relations, school attendance, and consumer satisfaction were conducted at 3 times: within 24 hours of recruitment into the project, shortly after the hospitalized youth was released from the hospital (1-2 weeks after recruitment), and at the completion of MST home-based services (average of 4 months postrecruitment). Results: MST was more effective than emergency hospitalization at decreasing youths’ externalizing symptoms and improving their family functioning and school attendance. Hospitalization was more effective than MST at improving youths’ self-esteem. Consumer satisfaction scores were higher in the MST condition. Conclusions: The findings support the view that an intensive, well-specified, and empirically supported treatment model, with judicious access to placement, can effectively serve as a family- and community-based alternative to the emergency psychiatric hospitalization of children and adolescents.

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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 delinquent 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 treatment such as MST contribute to ultimate outcomes.

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101.  Effects of multisystemic therapy on drug use and abuse in serious juvenile offenders: A progress report from two outcome studies

Although treatment approaches for adolescent substance abuse have proliferated, treatment efficacy has been rarely evaluated. This study presents a progress report, focusing on reductions in substance use and abuse, from two independent evaluations of the efficacy of multisystemic therapy (MST) in treating the antisocial behavior of serious juvenile offender, were assigned randomly either to MST or individual counseling conditions. Analyses of arrests data, which were collected for an average of 4 years posttreatment, indicated that youths who participated in MST had significantly lower rate of substance-related arrests than did youths who participated in individual counseling. In the Family and Neighborhood Solutions project, conducted in South Carolina, serious juvenile offenders were assigned randomly either to MST or usual juvenile justice services. Based on self-report measures of substance use collected pretreatment and posttreatment, youths in the MST condition reported a significant reduction in soft drug use relative to youths who received usual services. Together, these finding support the value of conducting a rigorous and more comprehensive evaluation of the efficacy of MST in treating substance-abusing delinquents and their families.

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102. Multisystemic treatment of adolescent sexual offenders

Abstract: This study compared the efficacy of multisystemic therapy (MST) and individual therapy (IT) in the outpatient treatment of adolescent sexual offenders. Sixteen adolescent sexual offenders were randomly assigned to either MST or IT conditions. Youths in the MST and IT conditions received an average of 37 hours and 45 hours of treatment, respectively. Recidivism data were collected on all subjects at an approximately 3-year follow up. Between groups comparisons showed that significantly fewer subjects in the MST condition had been rearrested for sexual crimes and that the frequency of sexual rearrests was significantly lower in the MST condition than in the IT condition. The relative efficacy of MST was attributed to its emphasis on changing behavior and interpersonal relations within the offender natural environment.

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103.  Comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect

This study evaluated the relative efficacy of two promising treatments of child abuse and child neglect: parent training and multisystemic therapy. Subjects included 18 abusive families and 15 neglectful families who were randomly assigned to the treatment conditions. Self-report and observational measures were used to evaluate the effects of treatment at three levels that have been associated with child maltreatment: individual functioning, family relations, and stress/social support. Statistical analyses revealed that families who received either treatment showed decreased parental psychiatric symptomology, reduced overall stress, and a reduction in the severity of identified problems. Analyses of sequential observational measures revealed that multisystemic therapy was more effective than parent training at restructuring parent-child relations. Parent training was more effective than multisystemic therapy at reducing identified social problems. The differential influences of the two treatments were probably associated with differences in their respective treatment contexts and epistemologies.

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104.  Multisystemic treatment of juvenile offenders: Effects on adolescent behavior and family interaction

The efficacy of a multisystemic approach to treatment was evaluated for juvenile offenders and their families. Subjects included 57 delinquent adolescents who received family-ecological treatment, 23 delinquent adolescents who received an alternative treatment, and 44 normal adolescents who served as developmental controls. Pretreatment and posttreatment assessments were conducted with the adolescent and his or her parent(s). Personality inventories, behavior ratings, and self-report and observational measures of family relations were included to evaluate changes at several systemic levels. Statistical analysis revealed that the adolescents who received family-ecological treatment evidenced significant decreases in conduct problems, anxious-withdrawn behaviors, immaturity, and association with delinquent peers. The mother-adolescent and marital relations in these families were significantly warmer, and the adolescent was significantly more involved in family interaction. In contrast, the families who received the alternative treatment evidenced no positive change and showed deterioration in affective relations. The normal families manifested relationship changes that are consistent with those identified by investigators of normal adolescent development. The findings support a multisystemic model of behavior disorders and treatment.

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247.  Multisystemic therapy effects on attempted suicide by youth presenting psychiatric emergencies 

Objective: To evaluate the efficacy of multisystemic therapy (MST) in reducing attempted suicide among predominately African American youths referred for emergency psychiatric hospitalization.  Method: Youths presenting psychiatric emergencies were randomly assigned to MST or hospitalization.  Indices of attempted suicide, suicidal ideation, depressive affect, and parental control were assessed before treatment, at 4 months after recruitment, and at the 1 year posttreatment follow up.  Results: Based on youth report, MST was significantly more effective than emergency hospitalization at decreasing rates of attempted suicide at 1-year follow-up; also, the rate of symptom reduction over time was greater for youths receiving MST.  Also, treatment differences in patterns of change in attempted suicide (caregiver report) varied as a function of ethnicity, gender, and age.  Moreover, treatment effects were found for caregiver-rated parental control but not for youth depressive affect, hopelessness, or suicidal ideation.  Conclusions: Results generally support MST's effectiveness at reducing attempted suicide in psychiatrically disturbed youngsters, whereas the effects of hospitalization varied based on informant and youth demographic characteristics.  J. Am. Child Adolescent Psychiatry, 2004; 43(2): 183-190. Key Words: attempted suicide, multisystemic therapy, hospitalization, treatment moderators.

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248.  Multisystemic treatment of antisocial adolescents in Norway: Replication of clinical outcomes outside of the US

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.

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253.  Treatment costs for youths receiving multisystemic therapy of hospitalization after a psychiatric crisis

Objectives: The authors conducted a cost analysis for Multisystemic therapy, an evidence-based treatment that is used as an intensive community-based alternative to the hospitalization of youths presenting with psychiatric emergencies. Methods: Data from a randomized clinical trial that compared Multisystemic therapy with usual inpatient services followed by community aftercare were used to compare Medicaid costs and clinical outcomes during a four-month period post referral and a 12-month follow-up period. Data were from 115 families receiving Medicaid (out of 156 families in the clinical trial). Results During the four months postreferral, Multisystemic therapy demonstrated better short-term cost-effectiveness for each of the clinical outcomes (externalizing behavior, internalizing behavior, and global severity of symptoms) than did usual inpatient care and community aftercare. The tow treatments demonstrated equivalent long-term cost-effectives. Conclusions: Among youths presenting with psychiatric emergencies, Multisystemic therapy was associated with better outcomes at a lower cost during the initial postreferral period and with equivalent cost and outcomes during the 12-month follow-up period.

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256. Caregiver-therapist ethnic similarity predicts youth outcomes from an empirically based treatment

The effects of caregiver-therapist ethnic similarity on youth outcomes from multisystemic therapy (MST), as implemented in dissemination sites, were examined.  Consistent with hypothesis, findings confirmed that youths whose caregivers were ethnically matched with their therapists demonstrated greater decreases in symptoms, longer times in treatment, and increased likelihood of discharge for meeting treatment goals relative to youths whose caregivers and therapist were not ethnically matched.  In addition, for youths whose caregivers were of mixed ethnic heritage, caregiver-therapist ethnic match was associated with greater improvements in psychosocial functioning.  Ethnic match effects on both treatment length and discharge success were partially mediated by therapist adherence to MST.  This study shows the importance of examining the effects of both client and therapist ethnicity on outcomes from empirically based treatments.

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261.  Long-term follow-up to a randomized clinical trial of multisystemic therapy with serious and violent juvenile offenders

In this study, the authors examined the long-term criminal activity of 176 youths who had participated in either multisystemic therapy (MST) or individual therapy (IT) in a randomized clinical trial (C.M. Borduin et al. 1995). Arrest and incarceration data were obtained on average 13.7 (range = 10.2-15.9) years later when participants were on average 28.8 years old. Results show that MST participants had significantly lower recidivism rates at follow-up than did their counterparts who participated in IT (50% vs. 81%, respectively). Moreover, MST participants had 54% fewer arrests and 57% fewer days of confinement in adult detention facilities. This investigation represents the longest follow-up to date of a MST clinical trial and suggests that MST is relatively effective in reducing criminal activity among serious and violent juvenile offenders.

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262.  A randomized trial of multisystemic therapy with Hawaii’s felix class youths 

Examined 6-month post-recruitment clinical and placement outcomes for 31 youths with serious emotional disturbance (SED) at imminent risk of out-of-home placement in the Hawaii Continuum of Care (COC). Youths were randomly assigned to multisystemic therapy (MST) adapted for SED populations or to Hawaii’s existing COC services. Assessments were conducted at intake and 6 months after referral. In comparison with counterparts in the comparison condition, youths in the MST condition reported significant reductions in externalizing symptoms, internalizing symptoms, and minor criminal activity; their caregivers reported near significant increases in social support; and archival records showed that MST youths experienced significantly fewer days in out-of-home placement. The findings generally replicate the favorable short-term outcomes observed previously for MST with youths experiencing SED.

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264.  Multisystemic therapy of serious behavior problems in youth: Sustainability of therapy effectiveness two years after intake

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

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268. Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in chronic poor metabolic control a randomized controlled trial

OBJECTIVE—The aim of this study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could improve adherence and metabolic control and decrease rates of hospital utilization among adolescents with chronically poorly controlled type 1 diabetes.

RESEARCH DESIGN AND METHODS—A randomized controlled trial was conducted with 127 adolescents with type 1 diabetes and chronically poor metabolic control (HbA1c [A1C] 8% for the past year) who received their diabetes care in a children’s hospital located in a major Midwestern city. Participants randomly assigned to MST received treatment for 6 months. Data were collected at baseline and at 7 months posttest (i.e., treatment termination). Changes in A1C adherence, as measured by semistructured interviews and blood glucose meters and hospital admissions and emergency department visits, were assessed.

RESULTS—In intent-to-treat analyses, participation in MST was associated with significant improvements in the frequency of blood glucose testing as assessed by blood glucose meter readings (F[1,125] = 16.75, P = 0.001) and 24-h recall interviews (F[1,125] = 6.70, P = 0.011). Participants in MST also had a decreasing number of inpatient admissions, whereas the number of inpatient admissions increased for control subjects (F[1,125] = 6.25, P = 0.014). Per protocol analyses replicated intent-to-treat analyses but also showed a significant improvement in metabolic control for adolescents receiving MST compared with control subjects (F[1,114] = 4.03, P = 0.047).

CONCLUSIONS—Intensive, home-based psychotherapy improves the frequency of blood glucose testing and metabolic control and decreases inpatient admissions among adolescents with chronically poorly controlled type 1 diabetes.

Abbreviations: CPMC, chronically poor metabolic control, DKA, diabetic ketoacidosis, MST, multisystemic therapy

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270. Juvenile drug court: Enhancing outcomes by integrating evidence-based treatments

Evaluated the effectiveness of juvenile drug court for 161 juvenile offenders meeting diagnostic criteria for substance abuse or dependence and determined whether integration of evidence-based practices enhanced the outcomes of juvenile drug court.  Over a 1-yeard period, a four-condition randomized design evaluated outcomes for family court with usual community services, drug court with usual community services, drug court with multisystemic therapy, and drug court with multisystemic therapy enhanced with contingency management for adolescent substance use, criminal behavior, symptomalogy, and days in out-of-home placement.  In general, findings supported the view that drug court was more effective than family court services in decreasing rates of adolescent substance use and criminal behavior.  Possibly due to the greatly increased surveillance of youths in drug court, however, these relative reductions in antisocial behavior did not translate to corresponding decreases rearrest or incarceration.  In addition, findings supported the view that the use of evidence-based treatments within the drug court context improved youth substance-related outcomes.  Clinical and policy implication of these findings are discussed.

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271.  Achieving adherence to antiretroviral medications for pediatric HIV disease using an empirically supported treatment: A case report

Adherence to antiretroviral medication regimens among HIV+ children is influenced by a number of psychosocial factors including characteristics of the child, the caregiver, the medical team, and the medications.  To address these factors require treatment approaches that are flexible and comprehensive. One such treatment approach is Multisystemic therapy (MST), an empirically supported intensive home-based treatment approach that has been proven effective with other chronic pediatric conditions.  This case report describes the use of MST with a poorly adherent, perinatally infected adolescent.

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272.  Use of multisystemic therapy to improve antiretroviral adherence and health outcomes in HIV-infected pediatric patients: Evaluation of a pilot program

The purpose of the current study was to evaluate a clinical program that used multisystemic therapy (MST) to improve regimen adherence and health outcomes among children with perinatally acquired HIV who exhibited high viral loads in the absence of viral resistance. MST is an intensive, home-based family therapy previously used for the treatment of serious antisocial behavior. Goals of the study were to assess the feasibility of the MST program and its effectiveness for improving health outcomes among children who were treated. The study was conducted by retrospective chart review. Ninety percent of children and families referred to the program accepted the referral and 95% received a full dose of treatment, suggesting high program feasibility. Nineteen children participated in the program. General HIV knowledge on the part of caregivers improved significantly over the course of treatment. Although caregiver-reported adherence did not change, viral loads were found to significantly decrease from referral to the end of MST treatment, with the mean change reflecting a greater than 1 log10 decrease. The majority of children maintained these improvements during the 3 months after treatment termination. Results suggest that MST holds promise as an intervention for improving health outcomes among pediatric patients with HIV.

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274.  Predictors of treatment response for suicidal youth referred for emergency psychiatric hospitalization

This study evaluated factors that predicted poor treatment response for 70 suicidal youth (ages 10 to 17 years; 67% African American) who received either multisystemic therapy (MST) or inpatient psychiatric hospitalization.  Following treatment, suicidal youth were classified as either treatment responders or nonresponders based on caregiver or youth report of attempted suicide.  Overall, female gender, depressive affect, parental control, caregiver psychiatric distress, and caregiver history of psychiatric hospitalization were associated with suicide attempts.  However, controlling for other variables, only depressive affect and parental control predicted treatment non-response.  These results suggest the need to adapt existing treatments for suicidal youth to better address problems relating to youth depression.

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278.  Multisystemic treatment of poorly controlled type 1 diabetes:  Effects on medical resource utilization

Objective  To determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could decrease rates of hospital utilization and related costs of care among adolescents with poorly controlled type diabetes.  Methods  Thirty-one adolescents were randomly assigned to receive either MST or standard care.  MST lasted approximately 6 months, and all participants were followed for 9 months.  Rates of inpatient admissions and emergency room (ER) visits were calculated for a nine-month prestudy period and during the 9 months of study participation.  The relationship between changes in inpatient admissions and changes in metabolic control was also investigated.  Results  Intervention participants had a decreasing number of inpatient admissions from the baseline period to the end of the study, whereas the number of inpatient admissions increased for controls.  Use of the emergency room did not differ.  Related medical charges and direct care costs were significantly lower for adolescents receiving MST.  Correlational analysis conducted with a subset of participants indicated that decreases in inpatient admissions were associated with improved metabolic control for MST but not control participants.  Conclusions  Findings suggest that MST has the potential to decrease inpatient admissions among adolescents with poorly controlled type 1 diabetes.

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297.  Multisystemic therapy for adolescents with poorly controlled type 1 diabetes: Stability of treatment effects in a randomized controlled trial

The primary purpose of the present study was to determine whether multisystemic therapy (MST), anintensive, home-based psychotherapy, improved regimen adherence, metabolic control, and rates of hospitalization for diabetic ketoacidosis (DKA) among adolescents with chronically poorly controlled Type 1 diabetes 6 months after the completion of treatment. A randomized controlled trial was conducted with 127 adolescents and their families. Mean participant age was 13.2 years. Sixty-three percent of participants were African American, and 51% were female. Data were collected at baseline, treatment termination, and 6-month follow-up. Changes in glycated hemoglobin (HbA1c), frequency of blood glucose testing (BGT), and rate of DKA admissions were assessed. In intent-to-treat analyses, a main effect of MST on DKA admissions was found at both treatment termination and follow-up. Improvements in BGT were moderated by family composition; only 2-parent MST families maintained improvements at follow-up. Improvements in HbA1c for the MST group at treatment termination were lost at follow-up. Results show that intensive, home-based psychotherapy created stable reductions in serious lapses in adherence, as indexed by episodes of DKA, among youth with poorly controlled diabetes.

Keywords: multisystemic therapy, Type 1 diabetes, adolescents

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299.  Family mediators and moderators of treatment outcomes among youths with poorly controlled type 1 diabetes: Results from a randomized controlled trial

Objective To determine whether multisystemic therapy (MST) improved family relationships among youths with poorly controlled type 1 diabetes and whether these changes mediated MST effects on health outcomes. The moderating effect of family demographics on study outcomes was also assessed. Methods A randomized controlled trial was conducted with 127 youths. Changes in general family relationships and caregiver support for diabetes care from baseline to treatment completion were assessed. Structural equation modeling (SEM) was used to test whether changes in family relations mediated improvements in frequency of blood glucose testing (BGT) and metabolic control. Results MST increased support for diabetes care from both primary and secondary caregivers in two-parent but not in single-parent families. However, MST had the strongest effects on BGT and metabolic control in single-parent families. SEM did not support family relations as the mediator of improved BGT or metabolic control. Rather, MST had a direct effect on BGT for all participants. BGT mediated improvements in metabolic control among single-parent families. Conclusions MST improved family relationships for youths with diabetes in two-parent but not in single-parent families. Objective outcomes related to diabetes were strongest for single-parent families. Other processes such as increased parental monitoring may have been responsible for improved health outcomes among these families.

Key words diabetes; family functioning; multisystemic therapy.

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303.   Outcomes from wraparound and multisystemic therapy in a center for mental health services system-of-care demonstration site

This study examined outcomes for 320 youth in a Center for Mental Health Services system-of-care demonstration site. Youth received wraparound-only (n = 213), MST-only (n = 54), or wraparound + MST (n = 53). Participants were 12 years old on average and mostly White (90%), and 75% were Medicaid-eligible. Service use and functional and clinical outcomes were examined at 6-month intervals out to 18 months. All three groups improved over the study period. The MST-only group demonstrated more clinical improvement than the other groups. Functional outcomes did not differ significantly across groups. Youth in wrap + MST had higher baseline severity and experiences less clinical and functional change than the other two groups, despite more mental health services use. Targeted, evidence-based treatment may be more effective than system-level intervention alone for improving clinical symptoms among youth with serious emotional disorders served in community-based settings. New or amended approaches may be needed for youth with the most severe disorders.

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312.  Sustainability of the effectiveness of a programme of multisystemic treatment (MST) across participant groups in the second year of operation

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.

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317.  Evidence-based psychosocial treatments for ethnic minority youth

This article reviews research on evidence-based treatments (EBTs) for ethnic minority youth using criteria from Chambless et al. (1998), Chambless et el. (1996), and
Chambless and Hollon (1998). Although no well-established treatments were identified, probably efficacious or possibly efficacious treatments were found for ethnic minority youth with anxiety-related problems, attention-deficit/hyperactivity disorder, depression, conduct problems, substance use problems, trauma-related syndromes, and other clinical problems. In addition, all studies met either Nathan and Gorman's (2002) Type 1 or Type 2 methodological criteria. A brief meta-analysis showed overall treatment effects of medium magnitude (d=.44). Effects were larger when EBTs were compared to no treatment (d=.58) or psychological placebos (d=.51) versus treatment as usual (d=.22). Youth ethnicity (African American, Latino, mixed/other minority), problem type, clinical severity, diagnostic status, and culture-responsive treatment status did not moderate treatment outcome. Most studies had low statistical power and poor representation of less acculturated youth. Few tests of cultural adaptation effects have been conducted in the literature and culturally validated outcome measures are mostly lacking. Recommendations for clinical practice and future research directions are provided.

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319.  Improving outcomes and transporting evidence-based treatments for youth and families with serious clinical problems

This Special Issue presents several articles that represent the direction of recent and ongoing substance-related research conducted at the Family Services Research Center (FSRC), Medical University of South Carolina, and in collaboration with colleagues both nationally and internationally. The overarching mission of the FSRC is to increase the effectiveness of mental health and substance abuse services for children, adolescents, and their families by conducting rigorous research on the development, validation, and dissemination clinically-and cost-effective mental health and substance abuse services for youths presenting serious clinical problems and their families. As such, the FSRC has played leadership or supportive roles in the validation of multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) for serious juvenile offenders as well as in specifying and evaluating MST adaptations with other populations of youths and families presenting serious clinical problems (e.g., adolescent sexual offending, child abouse and neglect, serious emotional disturbance, substance abuse, and health care problems such as type 1 diabetes, HIV, and obesity). In addition, during the past several years the Center's research portfolio has focused increasingly on bridging the gap between science and practice (Compton et al., 2005) by conducting research on the transport of evidence-based treatments (e.g., MST, contingency management) to community-based practitioners and organizations (see www.musc.edu/fsrc for more information and publication list).

To provide a broader research context for the articles presented in this Special Issue, brief overviews of the MST clinical model and of MST substance-related outcomes published from randomized clinical trials are provided. This work has been the foundation for our efforts to enhance substance use outcomes by integrating other evidence-based treatments into MST protocols and to transport MST and other evidence-based practices to community settings effectively.

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320.  Sibling outcomes from a randomized trial of evidence-based treatments with substance abusing juvenile offenders

This study examined the substance use and delinquency outcomes for the nearest age siblings of substance abusing and delinquent adolescents that participated in a randomized clinical trial evaluating the effectiveness of integrating evidence-based practices into juvenile drug court. The sample of 70 siblings averaged 14.4 years of age, 50% were male, 71% were African-American, and 27% were White. Measures of sibling substance use and delinquency were collected at four points in time (i.e., pretreatment, 4 months, 12 months, 18 months). Multilevel Longitudinal Models were used to evaluate whether changes in sibling substance use and delinquency paralleled the treatment effects observed for their substance abusing delinquent brothers and sisters in the juvenile drug court study. Parallel sibling outcomes were obtained for substance use but not for criminal behavior, and possible reasons for the divergence in these results were discussed. The findings add meaningfully to the literature on the effects of evidence-and family-based treatments on siblings.

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330. The transportability of multisystemic therapy to Sweden: Short-term results from a randomized trial of conduct-disordered youths

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.

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335.  A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: Effects on youth social ecology and criminal activity

A randomized clinical trial evaluated the efficacy of multisystemic therapy (MST) versus usual community services (UCS) for 48 juvenile sexual offenders at high risk of committing additional serious crimes. Results from multiagent assessment batteries conducted before and after treatment showed that MST was more effective than UCS in improving key family, peer, and academic correlates of juvenile sexual offending and in ameliorating adjustment problems in individual family members. Moreover, results from an 8.9-year follow-up of rearest and incarceration data (obtained when participants were on average 22.9 years of age) showed that MST participants had lower recidivism rates than did UCS participants for sexual (8% vs. 46%, respectively) and nonsexual (29% vs. 58%, respectively) crimes. In addition, MST participants had 70% fewer arrests for all crimes and spent 80% fewer days confined in detention facilities than did their counterparts who received UCS. The clinical and policy implications of these findings are discussed.

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336. Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial

Despite the serious and costly problems presented by juvenile sexual offenders, rigorous tests of promising interventions have rarely been conducted. This study presents a community-based effectiveness trial comparing multisystemic therapy (MST) adapted for juvenile sexual offenders with services that are typical of those provided to juvenile sexual offenders in the United States. Youth were randomized to MST (n = 67) or treatment as usual for juvenile sexual offenders (TAU-JSO; n = 60). Outcomes through 12 months postrecruitment were assessed for problem sexual behavior, delinquency, substance use, mental health functioning, and out-of-home placements. Relative to youth who received TAU-JSO, youth in the MST condition evidenced significant reductions in sexual behavior problems, delinquency, substance use, externalizing symptoms, and out-of-home placements. the findings suggest that family- and community-based interventions, especially those with an established evidence-base in treating adolescent antisocial behavior, hold considerable promise in meeting the clinical needs of juvenile sexual offenders.

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341. Dissemination & effectiveness of multisystemic treatment in New Zealand: A benchmarking study

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.

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343.  Improving health outcomes among youth with poorly controlled type I diabetes: The role of treatment fidelity in a randomized clinical trial of multisystemic therapy

The purpose of the study was to assess whether therapist treatment fidelity was a predictor of treatment outcome in a randomized clinical trial of multisystemic therapy with 10- to 16-year-old youths with chronically poorly controlled Type I diabetes (N=40). Treatment fidelity was assessed by objective ratings of therapy sessions and questionnaires completed by caregivers and by therapists. Relationships between fidelity measures were assessed. Structural equation modeling (SEM) was used to test whether high fidelity would lead to improved regimen adherence and to improved metabolic control outcomes via regimen adherence. Objective ratings of treatment fidelity were significantly related to therapist-reported but not to caregiver-reported treatment fidelity. SEM results supported a completely mediated pathway between treatment fidelity and metabolic control, with regimen adherence mediating the relationship. Results suggest that conducting complex behavioral interventions with a high degree of fidelity can improve treatment outcomes among youths with chronic illnesses.

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345. Mediators of change for multisystemic therapy with juvenile sexual offenders

The mediators of favorable multisystemic therapy (MST) outcomes achieved at 12 months postrecruitment were examined within the context of a randomized effectiveness trial with 127 juvenile sexual offenders and their caregivers. Outcome measures assessed youth delinquency, substance use, externalizing symptoms, and deviant sexual interest/risk behaviors; hypothesized mediators included measures of parenting and peer relations. Data were collected at pretreatment, 6 months postrecruitment, and 12 months postrecruitment. Consistent with the MST theory of change and the small extant literature in this area of research, analyses showed that favorable MST effects on youth antisocial behavior and deviant sexual interest/risk behaviors were mediated by increased caregiver follow-through on discipline practices as well as decreased caregiver disapproval of and concern about the youth’s bad friends during the follow-up. These findings have important implications for the community-based treatment of juvenile sexual offenders.

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