Multisystemic Therapy Program

Scott W. Henggeler, Ph.D.
(Contact) Marshall E. Swenson, MSW, MBA,
                Manager of Program Developement
MST Services
710 Johnnie Dodds Blvd.
Mt. Pleasant, SC 29464
(843) 856-8226 ext. 215     Fax: (843) 856-8227
ms@mstservices.com

Multisystemic therapy (MST) is an intensive family-based treatment that addresses the known determinants of serious antisocial behavior in adolescents and their families. As such, MST treats those factors in the youth's environment that are contributing to his or her behavior problems. Such factors might pertain to individual characteristics of the youth (e.g., poor problem solving skills), family relations (e.g., inept discipline), peer relations (e.g., association with deviant peers), and school performance (e.g., academic difficulties). On a highly individualized basis, treatment goals are developed in collaboration with the family, and family strengths are used as levers for therapeutic change. Specific interventions used in MST are based on the best of the empirically validated treatment approaches such as cognitive behavior therapy and the pragmatic family therapies. The primary goals of MST are to reduce rates of antisocial behavior in the adolescent, reduce out-of- home placements, and empower families to resolve future difficulties.

Several programmatic features are crucial to the success of MST. The use of a home-based model of service delivery (i.e., low caseloads, time limited duration of treatment) removes barriers of access to care and provides the high level of intensity needed to successfully treat youths presenting serious clinical problems and their multi-need families. Second, the philosophy of MST holds service providers accountable for engaging the family in treatment and for removing barriers to successful outcomes. Such accountability clearly promotes retention in treatment and attainment of the treatment goals. Third, outcomes are evaluated continuously, and the overriding goal of supervision is to facilitate the clinicians' attempts to attain favorable outcomes. Fourth, MST programs place great emphasis on maintaining treatment integrity, and as such, considerable resources are devoted to therapist training, ongoing clinical consultation, service system consultation, and other types of quality assurance.

Rigorous evaluation is a hallmark of MST. Well designed randomized clinical trials with chronic and violent juvenile offenders have demonstrated the capacity of MST to reduce long-term rates of criminal activity, incarceration, and concomitant costs. Other randomized trials have demonstrated that favorable outcomes are linked to therapist adherence to the MST treatment protocol. Current studies are examining the effectiveness of MST in treating a variety of serious clinical problems, evaluating variables that predict the successful dissemination of MST, and assessing the clinical and cost effectiveness of an MST-based continuum of care.

Implementation Costs:

Multisystemic Therapy (MST) is conducted by therapists who are part of a MST "team." Two to four MST therapists and their on-site supervisor make up a MST team which works together for purposes of group and peer supervision, and to support the 24 hour/7 day/week on-call needs of the team's client families. MST therapists are full-time Master's-level or highly clinically-skilled Bachelor's-level mental health professionals. MST supervisors are typically assigned to the program a minimum of 50% time and may carry a small caseload if assigned full-time. MST supervisors are either doctoral-level or highly competent Master's-level professionals.

MST staff must be highly accessible to their clients and often have both pagers and cellular phones. Typically MST programs budget for mileage reimbursement to cover 8,000 to 12,000 miles a year per therapist. Internet access for administrative staff is required for scoring of required Quality Control measures. It is recommended that a small amount of flexible funds be available to the MST team ($100 per client family) for occasional and/or emergency needs. An annual program-licensing fee is required and is based upon the size of the MST program.

Training Costs:

Program support and training in MST is provided on-site by MST Services, Inc. using essentially the same protocol that has been used in successful clinical trials of MST with violent and chronic juvenile offenders. Therapists and supervisors receive training in MST in three ways. First, five days of intensive on-site orientation training are provided. Second, 1.5-day "booster" sessions occur on-site on a quarterly basis. Third, treatment teams and their supervisors receive weekly telephone consultation from MST experts.

In addition to the elements of clinical training, the package of program support and training services includes a pre-training site assessment, assistance with program specification and design (including the development of quality control and outcome tracking system), and ongoing assistance with overcoming barriers to achieving successful clinical outcomes. The cost of program support and training is based on an all-inclusive annual per team fee. Fees range from $15,000 to $24,000 per team, plus travel expenses based upon the nature and size of the program.

Staff training in MST is an on-going process. A primary objective of MST Services is to assist organizations in building capacity to provide for part or all of their MST program's long-term training needs. In this context, program support and training expenses should be viewed as the annual cost of a Quality Assurance (QA) program. Based upon an average annual service capacity of 15 families per therapist per year, the total long-term QA costs (program support and training) is usually in the range of $400 to $550 per youth served.