Multi-Systemic Therapy

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Multi-Systemic Therapy

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Multi-Systemic Therapy:

The Advocacy Foundation, Inc. Atlanta | Philadelphia (878) 222-0100 Voice | Data | SMS www.TheAdvocacy . Foundation © The Advocacy Foundation, Inc. 2006-2016 (All Rights Reserved) Multi-Systemic Therapy

Biblical Authority:

Biblical Authority Galatians 6:1 Proverbs 15:22 Hebrews 3:13 Proverbs 11:14 Proverbs 13:10 2

Introduction:

Introduction Multisystemic Therapy (MST) is an intensive family- and community-based treatment program that focuses on addressing all environmental systems that impact chronic and violent juvenile offenders -- their homes and families, schools and teachers, neighborhoods and friends. MST recognizes that each system plays a critical role in a youth's world and each system requires attention when effective change is needed to improve the quality of life for youth and their families. MST works with the toughest offenders ages 12 through 17 who have a very long history of arrests . 3

Introduction:

Introduction MST clinicians go to where the child is and are on call 24 hours a day, seven days a week They work intensively with parents and caregivers to put them in control The therapist works with the caregivers to keep the adolescent focused on school and gaining job skills The therapist and caregivers introduce the youth to sports and recreational activities as an alternative to hanging out 4

Introduction:

Introduction MST Is Based on Evidence This means it has been proven to work and produce positive results with the toughest kids. It blends the best clinical treatments—cognitive behavioral therapy, behavior management training, family therapies and community psychology to reach this population.      5

Introduction:

Introduction After 30 years of research and 18 studies, MST repeatedly has been shown to: Keep kids in their home, reducing out-of-home placements up to 50 percent Keep kids in school Keep kids out of trouble, reducing re-arrest rates up to 70 percent Improve family relations and functioning Decrease adolescent psychiatric symptoms Decrease adolescent drug and alcohol use Parents and caregivers are given tools to handle difficulties. The MST therapist and the caregivers show the youth how to develop constructive ways to cope with family, school and peer problems. 6

Multi-Systemic Therapy:

Multi-Systemic Therapy Multisystemic Therapy (MST) is an intensive, family-focused and community-based treatment program for chronically violent youth. Reviews of clinical studies have been unable to establish a consensus as to its effectiveness in comparison to other interventions. But there is no evidence of harm. Multisystemic therapy (MST) is a home and community based intervention for families of youth with severe psychosocial and behavioral problems that assembles practices from strategic family therapy, structural family therapy, and cognitive behavior therapy in intensive interventions over four to six months. It is based in part on ecological systems theory. Treatment is individualized. 7

Multi-Systemic Therapy:

Multi-Systemic Therapy The MST method was developed at the Family Services Research Center (FSRC) of the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina. FSRC members were interested in improving mental health services for young criminals. They evaluated the literature for evidence-based practices and assembled the best ones into the MST method. The first multi-center clinical trial of the method by FSRC showed that quality of the training of those implementing MST, and their supervision by experts, had an "extremely weak but significant" effect on the effectiveness of the method 8

Multi-Systemic Therapy:

In 1996, MST Services, a private for-profit corporation, was formed to oversee dissemination of the method and provide supervision. At the same time, MST Institute, a nonprofit corporation, was formed, to be "responsible for setting quality assurance standards and monitoring the implementation of Multisystemic Therapy in all programs worldwide. Its information system is designed to provide policy makers and other stakeholders with the data necessary to assess the effectiveness of their MST programs and improve services to families and youth in their communities." MST Services has an exclusive license from the Medical University of South Carolina for intellectual property covering the assessment instruments, and the protocols used in MST. MST Services in turn grants sublicenses and trains teams to practice MST; as of 2008 there were about 250 such teams in North America and Europe. Multi-Systemic Therapy 9

Multi-Systemic Therapy:

Multi-Systemic Therapy Program Outcomes Close Relationships with Parents Conduct Problems Delinquency and Criminal Behavior Externalizing Illicit Drug Use Internalizing Mental Health - Other Positive Social/ Prosocial Behavior Prosocial with Peers Violence 10

Multi-Systemic Therapy:

Multi-Systemic Therapy Program Setting Home Juvenile Justice Setting Mental Health/Treatment Center School Social Services Transitional Between Contexts 11

Multi-Systemic Therapy:

Multi-Systemic Therapy Age Early Adolescence (12-14) - Middle School Late Adolescence (15-18) - High School Gender Male and Female Race/Ethnicity All Race/Ethnicity Endorsements Crime Solutions: Effective Blueprints: Model Plus OJJDP Model Programs: Effective SAMHSA: 2.9-3.2 12

Collected Works:

Collected Works Judge Steven Teske Speaking at the MST Pre-conference   Posted by Lori Cohen, MST Services Feb 26, 2016 9:30:00 AM 13

Collected Works:

Collected Works The Georgia justice system was, to put it mildly, not stellar. The state had gotten on the tough-on-crime bandwagon in the early 90s. That led to the number of prisoners in state lockups jumping from 20,000 in 1990 to 50,000 14 years later. The numbers looked even worse when you considered that a 2009 Pew study determined that one in 13 Georgians were either in jail, on probation or parole. This gave Georgia the dubious distinction of having the highest such rate in the country. Throw into this mix that although blacks were only 31 percent of the state’s population, they accounted for 58 percent of prisoners. 14

Collected Works:

Collected Works But things have been changing as the attitude of sweep up offenders, even ones who commit lesser crimes, and throw them into prison has changed. Judge Steven C. Teske has been at the forefront of that movement. He is a highly respected jurist who started his career in the justice- system trenches as Atlanta’s Chief Parole Officer, working his way up to chief judge of Clayton County’s juvenile court.  Along the way, he saw close up what the state was doing wrong and became a firm believer that the reliance on juvenile prisons should be reduced. Instead, an emphasis on alternative ways to handling youthful offenders was imperative. 15

Collected Works:

Collected Works One such approach was developed as Second Chance Court, a program where kids stayed at home and went to school under close supervision. At the same time, some were put into evidence-based programs (EBPs), such as Multisystemic Therapy (MST). It took only nine months after Second Chance and similar programs were made available that the counties using them enjoyed a 62-percent drop in kids placed out of the home. That meant instead of spending $90,000 a year for each offender, the price tag was between $6,000 and $8,000.  Judge Teske served on the governor’s Criminal Justice Reform Council, which was instrumental in getting programs like Second Chance funded. As he saw it, if kids are sent to prison, “I guarantee you prison would be in their life forever.” 16

Collected Works:

Collected Works The judge will be addressing the MST pre-conference April 11 in Denver. Among other topics, he will talk about the importance of turning judges in advocates when it comes to juvenile-justice reform. Getting them to see that locking up kids is detrimental to the juveniles, families and community. There are better ways to handle youthful criminals. Judges might take a look at a survey of Georgia probation officers who said they want MST to be used more, that it is the evidence-based practice they want implemented.  Judge Teske is a regular contributor to Juvenile Justice Information Exchange and Youth Today. His book, Reform Juvenile Justice Now, is a collection of essays on juvenile-justice issues. He served two terms on the Federal Advisory Committee for Juvenile Justice. This is a man who know whereof he speaks. 17

Collected Works:

Collected Works Other Topics Include: How to Sustain an Evidence-Based Practice Like MST Social Programs That Work Multisystemic Therapy for Juvenile Offenders A Day In The Life of ... An MST Therapist 18

Cognitive Behavioral Therapy:

Cognitive Behavioral Therapy Cognitive behavioral therapy (CBT) is a form of psychotherapy. It was originally designed to treat depression, but is now used for a number of mental disorders. It works to solve current problems and change unhelpful thinking and behavior. The name refers to behavior therapy, cognitive therapy, and therapy based upon a combination of basic behavioral and cognitive principles. 19

Cognitive Behavioral Therapy:

Cognitive Behavioral Therapy Most therapists working with patients dealing with anxiety and depression use a blend of cognitive and behavioral therapy. This technique acknowledges that there may be behaviors that cannot be controlled through rational thought, but rather emerge based on prior conditioning from the environment and other external and/or internal stimuli. 20

Cognitive Behavioral Therapy:

Cognitive Behavioral Therapy CBT is "problem focused" (undertaken for specific problems) and "action oriented" (therapist tries to assist the client in selecting specific strategies to help address those problems), or directive in its therapeutic approach. It is different from the more traditional, psychoanalytical approach, where therapists look for the unconscious meaning behind the behaviors and then diagnose the patient. Instead, behaviorists believe that disorders, such as depression, have to do with the relationship between a feared stimulus and an avoidance response, resulting in a conditioned fear, much like Ivan Pavlov. 21

Cognitive Behavioral Therapy:

Cognitive Behavioral Therapy Cognitive therapists believed that conscious thoughts could influence a person’s behavior all on its own. Ultimately, the two theories were combined to create what is now known as cognitive behavioral therapy. CBT is effective for a variety of conditions, including mood, anxiety, personality, eating, addiction, dependence, tic, and psychotic disorders. 22

Cognitive Behavioral Therapy:

Cognitive Behavioral Therapy The basic steps in a Cognitive-Behavioral Assessment include Step 1: Identify critical behaviors   Step 2: Determine whether critical behaviors are excesses or deficits   Step 3: Evaluate critical behaviors for frequency, duration, or intensity (obtain a baseline)   Step 4: If excess, attempt to decrease frequency, duration, or intensity of behaviors; if deficits, attempt to increase behaviors. 23

Cognitive Behavioral Therapy:

Cognitive Behavioral Therapy Therapists or computer-based programs use CBT techniques to help individuals challenge their patterns and beliefs and replace "errors in thinking such as overgeneralizing , magnifying negatives, minimizing positives and catastrophizing " with "more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior." These errors in thinking are known as cognitive distortions. Cognitive distortions can be either a pseudo- discrimination belief or an over-generalization of something. 24

Behavior Management:

Behavior Management Behavior Management is similar to behavior modification. It is a less intensive version of behavior therapy. In behavior modification the focus is on changing behavior, while in behavior management the focus is on maintaining order. Behavior management skills are of particular importance to teachers in the educational system. Behavior management include all of the actions and conscious inactions to enhance the probability people, individually and in groups, choose behaviors which are personally fulfilling, productive, and socially acceptable. 25

Behavior Management:

Behavior Management B.F. Skinner and Carl Rogers have given two distinctly different approaches for addressing behavior. Skinner's approach says that anyone can manipulate behavior by first identifying what the individual finds rewarding. Skinner calls this "Positive Reinforcement Psychology". Rogers proposes that in order to effectively address behavior problems, individual must be persuaded to want to behave appropriately. This is done by teaching the individual the difference between right and wrong including why he or she should do what is right. Rogers believes that the individual must have an internal awareness of right and wrong. 26

Behavior Management:

Behavior Management In general behavior management strategies have been very effective in reducing classroom disruption. Usually, behavior management is applied at the group level by a classroom teacher as a form of behavioral engineering to produce high rates of student work completion and minimize classroom disruption. In addition, greater focus has been placed on building self-control. 27

Family Therapy:

Family Therapy Family Therapy, also referred to as Couple and Family Therapy, Marriage and Family Therapy, Family Systems Therapy, and Family Counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members. It emphasizes family relationships as an important factor in psychological health. 28

Family Therapy:

Family Therapy The different schools of family therapy have in common a belief that, regardless of the origin of the problem, and regardless of whether the clients consider it an "individual" or "family" issue, involving families in solutions often benefits clients. This involvement of families is commonly accomplished by their direct participation in the therapy session. The skills of the family therapist thus include the ability to influence conversations in a way that catalyses the strengths, wisdom, and support of the wider system. 29

Family Therapy:

Family Therapy Concurrently and somewhat independently, there emerged the various intergenerational therapies of Murray Bowen, Ivan Böszörményi -Nagy, James Framo , and Norman Paul, which present different theories about the intergenerational transmission of health and dysfunction, but which all deal usually with at least three generations of a family (in person or conceptually), either directly in therapy sessions, or via "homework", "journeys home", etc. 30

Family Therapy:

Family Therapy Family therapy uses a range of counseling and other techniques including: Structural therapy - Identifies and Re-Orders the organisation of the family system Strategic therapy - Looks at patterns of interactions between family members Systemic/Milan therapy - Focuses on belief systems Narrative Therapy - Restoring of dominant problem-saturated narrative, emphasis on context, separation of the problem from the person Transgenerational Therapy - Transgenerational transmission of unhelpful patterns of belief and behaviour . 31

Family Therapy:

Family Therapy The number of sessions depends on the situation, but the average is 5-20 sessions. A family therapist usually meets several members of the family at the same time. This has the advantage of making differences between the ways family members perceive mutual relations as well as interaction patterns in the session apparent both for the therapist and the family. These patterns frequently mirror habitual interaction patterns at home, even though the therapist is now incorporated into the family system. Therapy interventions usually focus on relationship patterns rather than on analyzing impulses of the unconscious mind or early childhood trauma of individuals as a Freudian therapist would do... 32

Family Therapy:

Family Therapy Family therapists are relational therapists: They are generally more interested in what goes on between individuals rather than within one or more individuals, although some family therapists—in particular those who identify as psychodynamic, object relations, intergenerational, or experiential family therapists (EFTs)—tend to be as interested in individuals as in the systems those individuals and their relationships constitute. 33

Community Psychology:

Community Psychology Community Psychology studies the individuals' contexts within communities and the wider society, and the relationships of the individual to communities and society. Community psychologists seek to understand the quality of life of individuals, communities, and society. Their aim is to enhance quality of life through collaborative research and action. 34

Community Psychology:

Community Psychology Closely related disciplines include ecological psychology, environmental psychology, cross-cultural psychology, social psychology, political science, public health, sociology, social work, applied anthropology, and community development. Community psychology grew out of the community mental health movement, but evolved dramatically as early practitioners incorporated their understandings of political structures and other community contexts into perspectives on client services. 35

Community Psychology:

Community Psychology In the 1950s and 1960s, many factors contributed to the beginning of community psychology in the US. Some of these factors include: A shift away from socially conservative, individual-focused practices in health care and psychology into a progressive period concerned with issues of public health, prevention and social change after World War II and social psychologists' growing interest in racial and religious prejudice, poverty, and other social issues The perceived need of larger-scale mental illness treatment for veterans Psychologists questioning the value of psychotherapy alone in treating large numbers of people with mental illness The development of community mental health centers and deinstitutionalization of people with mental illnesses into their communities 36

Community Psychology:

Community Psychology Ecological Levels of Analysis Adaptation Succession Cycling of Resources Interdependence 37

Community Psychology:

Community Psychology First-order and Second-Order Change First-Order Change : positively changing the individuals in a setting to attempt to fix a problem Second-Order Change : Attending to systems and structures involved with the problem to adjust the person–environment fit As an example of how these methods differ, consider homelessness. A first-order change to "fix" homelessness would be to offer shelter to one or many homeless people. A second-order change would be to address issues in policy regarding affordable housing. 38

Community Psychology:

Community Psychology Prevention and Health Promotion Empowerment Social Justice Diversity Individual Wellness Citizen Participation Collaboration and Community Strengths Psychological Sense of Community Empirical Grounding 39

Strategic Family Therapy:

Strategic Family Therapy Strategic Family Therapy seeks to address specific problems that can be addressed in a shorter time frame than other therapy modalities. It is one of the major models of both family and brief psychotherapy. Jay Haley of the The Strategic Family Therapy Center says that it is known as Strategic Therapy because "it is a therapy where the therapist initiates what happens during therapy, designs a specific approach for each person's presenting problem, and where the therapist takes responsibility for directly influencing people." 40

Strategic Family Therapy:

Strategic Family Therapy The therapist seeks to identify the symptoms within the family that are the cause of the family’s current problems, and fix these problems. In strategic family therapy the problems of the clients stem not from their family’s behaviors toward the client, but instead it is the symptoms of the family that need to be corrected. In strategic terms a symptom is “the repetitive sequence that keeps the process going. The symptomatic person simply denies any intent to control by claiming the symptom is involuntary.” 41

Strategic Family Therapy:

Strategic Family Therapy Concepts and Processes The Brief Therapy Stage seeks to observe the family’s interactions, create a calm and open mood for the session, and attempts to get every family member to take part in the session. The Problem Stage is where the therapist poses questions to the clients to determine what their problem is and why they are there. The Interactional Stage is where the family is urged to discuss their problem so the therapist can better understand their issues and understand the underlying dynamics within the family. Some of the dynamics that strategic family therapists seek to understand are: hierarchies within a family, coalitions between family members, and communication sequences that exist. 42

Strategic Family Therapy:

Strategic Family Therapy Concepts and Processes The Goal-setting Stage is used to highlight the specific issue that needs to be addressed, this issue is identified by both the family members and the therapist. In addition when discussing the presenting problem initially identified by the family, the family and the therapist work together to come up with goals to fix the problem, and better define the parameters for attaining those goals. The Final Stage of the initial session is the task-setting stage. In the task-setting stage the therapist wraps up the session by coming up with concrete homework assignments or directives the family can do outside of therapy to start to change their problems. Additional therapy sessions seek to further gain understanding to a family’s problems, dynamics, and to dig deeper in addressing their needs through a confident, controlling, and compassionate therapist. 43

Strategic Family Therapy:

Strategic Family Therapy Finally a paradoxical intervention is similar to prescribing the symptom, but is a more in depth intervention than prescribing the symptom. Initially the therapist tries to change the family’s low expectations to one where change within the family can happen. Second , the issue that the family wishes to fix is identified in a clear and concise manner. Third , and in line with the goal-setting stage, the therapist seeks to get the family to agree to exactly what their goals are in addressing their problem. 44

Strategic Family Therapy:

Strategic Family Therapy Fourth , the therapist comes up with very specific plans for the family to address their issue. Fifth , the therapist discredits whomever is the controlling figure of the issue. Next the therapist replaces the controlling figure with their own authority and issues a new directive to fix the family’s identified problem. The new directive for the family is usually to paradoxically do more of the problem symptom, and thereby to highlight it more within the family. Finally the therapist learns the outcome of the directive and seeks to push the paradox even further until the family rebels, or change occurs within the family. 45

Questions & Answers:

Questions & Answers 46

Thank You!:

Thank You! The Advocacy Foundation, Inc. Atlanta | Philadelphia (878) 222-0100 Voice | Data | SMS www.TheAdvocacy . Foundation © The Advocacy Foundation, Inc. 2006-2016 (All Rights Reserved)

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