MST

MST Multisystemic Therapy :

By Dena Schreiner & Sarah Willis MST Multisystemic Therapy

MST Overview:

Multisystemic Therapy (MST) can be used to address a variety of mental health concerns. For our presentation we are going to focus on MST specifically for juvenile offenders. MST for juvenile offenders focuses on behavioral problems in troubled youth by addressing the issues by taking into account the multidimensional nature of the behavior. The primary goals of MST Decrease rates of antisocial behavior Decrease rates of other clinical problems Improve functioning Reduce the use of out-of-home placements such as incarceration, residential treatment, and hospitalization Provide empowerment to families to build a healthier environment through accessing pre-existing natural resources (e.g. family support, community support) MST Overview Resource: http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=26

Overview continued…:

Treatment focuses on a variety of factors in each youth’s social network that are contributing to his or her antisocial behavior. Other specific treatment techniques can be used and are based on empirically supported therapies, including : Behavioral Cognitive behavioral Pragmatic family therapies Overview continued…

MST Treatment Model:

MST Treatment Model http://www.mstservices.com/index.php/what-is-mst/treatment-model

Nine Principles of MST:

1. Finding the fit 2. Focusing on positives and strengths 3. Increasing responsibility 4. Present focused, action oriented and well defined 5. Targeting sequences 6. Developmentally appropriate 7. Continuous effort 8. Evaluation and accountability 9. Generalization Nine Principles of MST http://www.mstservices.com/index.php/what-is-mst/nine-principles

Target Population:

Target Population

Target Population:

http://www.mstservices.com/index.php/target-populations/juvenile-justice Target Population MST works with: Males & Females Age 12 to 17 With significant criminal histories

These kids don’t live in a vacuum. Therefore; you can’t treat them in one. :

These kids don’t live in a vacuum. Therefore; you can’t treat them in one. http://www.mstservices.com/index.php/target-populations/juvenile-justice

Treatment Setting:

Treatment Setting In their community & neighborhood With their friends In their homes With their families In their schools With their teachers http://www.mstservices.com/

From theory……… to outcome:

Ecological Systems MST works from a Strengths Perspective by identifying the juvenile’s strengths and helping them to build on those strengths. From theory……… to outcome Strengths Perspective MST follows the goals of Ecological Systems Theory by working with juveniles in their environment and by helping the client improve their “goodness of fit”.

The Do-Loop:

The Do-Loop

Linking Weekly Summary with Do Loop:

Linking Weekly Summary with Do Loop

The first steps:

The primary purpose of assessment is to understand the fit between the identified problems and their broader systemic context. Tools used to assess youths needs include: Genogram Identifying reasons for initial referral Fit circles These first steps are an important technique that sets the foundation for continued treatment The first steps

How to find the fit:

How to find the fit Put the struggle or success in the middle of the circle Behavior, interaction, factor Put in concrete terms (Truancy, Family Arguments) Must be something the family, caregivers, participants consider to be a problem 2) Fill in fit factors (drivers) of the struggle or success Full ecology (Individual, family, peers, school, neighborhood and community) Specific and concrete Include reliable evidence and multiple sources of evidence that each factor is present and occurring

Steps continued…:

Each factor should be logically connected to and is contributing to target behavior or interaction Include information detailed sequences within or between s systems involving the behavior/interaction Look for evidence of drivers that could be contributing to the behavior/interaction based on your knowledge of the literature and previous experience with MST 3) Develop hypotheses and prioritize targets for interventions 4)/5) Create fit circle and assess for comprehensiveness Steps continued…

The P’s of MST:

The P’s of MST To develop a strong hypotheses and identify and explore possible treatment interventions MST uses 7 P’s to guide the process Participants Goals Prerequisites Powerful Proximal Present-focused Proven Practical

Fit Circle Example:

Fit Circle Example The struggle/success in the center of the circle The ecological factors around the circle

Breaking the cycle :

Breaking the cycle

Evidence Based Treatment:

Compared with youth receiving treatment as usual, youth receiving MST were arrested about half as often in the post-treatment period. Recidivism rates were 42% for the MST-treated youth compared with 62% for youth receiving usual services. At the end of 4 years of follow-up, the rate of criminal recidivism (re-arrest) for the MST completers (22%) was less than one third the overall rate for IT completers (71%). At 13.7 years after treatment, MST participants (then aged 29 years) showed significantly lower rates of criminal recidivism (50%) than comparable youth (81%) Evidence Based Treatment http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=26

Evidence Based Treatment:

More than two thirds (68%) of youth in the usual-services group were incarcerated after treatment, compared with only 20% of the MST group. Almost 14 years after treatment, MST youth were sentenced to fewer than half as many days of incarceration as the comparison youth. Post-treatment assessments showed that family cohesion increased among families receiving MST and decreased among families in the usual-services condition. Evidence Based Treatment http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=26

Case Summary:

Case Summary

Case Summary Continued….:

Case Summary Continued….

Application of MST:

Application of MST

Application of MST:

Application of MST

Fit Circle from our session:

Fit Circle from our session

Key Points:

After session the therapist will meet and staff this case with supervisor and an MST consultant This is process is key to ensure drivers are addressed and goals are identified Key Points

Resources:

Charleston, SC: South Carolina Health and Human Services Finance Commission A step-by-step guide to completing the documentation used in MST supervision and consultation. Henggeler , S.W. (1994). Treatment manual for family preservation using multisystemic therapy. Juvenile Justice. (2010). Retrieved from http://www.mstservices.com/index.php/target-populations/juvenile-justice MST Services. (2004). Multisystemic therapy: An introductory training. (revised ed.). MST Services. (2003). Multisystemic therapy “Whatever it takes!” : Making paperwork work for you: MST Treatment Model Intensive Family Focused Therapy. (2010). Retrieved from http://www.mstservices.com/index.php/what-is-mst/treatment-model Multisystemic Therapy (MST) for Juvenile Offenders. (Date of Review: March2007). Retrieved from http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=26 Nine Principles of MST. (2010). Retrieved from http://www.mstservices.com/index.php/what-is-mst/nine-principles What is Multisystemic Therapy? (2010). Retrieved from http://www.mstservices.com/ Resources