Social Programs That Work

Multisystemic Therapy

Updated: Jul 22, 2020
Evidence Rating:
Suggestive Tier

Highlights

  • Program:

    An intensive family- and community-based treatment program for youth with severe conduct problems, that seeks to address the multiple causes of antisocial behavior.

  • Evaluation Methods:

    Seven well-conducted randomized controlled trials (RCTs), carried out in the United States, United Kingdom, Canada, and Sweden. Other RCTs of MST have been conducted, but do not meet this website’s criteria due to key study limitations.

  • Key Findings:

    Of the well-conducted RCTs, three found large, statistically significant reductions in youth criminal activity over follow-up periods ranging from 2 to 22 years. The other four RCTs found no statistically significant effects on youth crime or other key behavioral outcomes. There are several possible reasons for the discrepant findings, as discussed in this summary, but these are only hypotheses as we believe additional research is needed to determine the conditions and populations in which MST is effective.

Multisystemic Therapy (MST) is an intensive, manualized, licensed program for youth with severe conduct problems (e.g., violence, substance misuse, school expulsion) and their families. MST therapists work with the young person and family members using a variety of techniques, tailored to each family’s specific needs, that are aimed at improving parenting skills, enhancing family relationships, increasing support from social networks, developing skills and resources, addressing communication problems, encouraging school attendance and achievement, and reducing the young person’s association with delinquent peers. MST is delivered by a team of specially trained therapists under the supervision of an MST supervisor. The therapists are available to the youth and his or her family 24 hours a day, seven days a week, and each therapist carries a small caseload of four to six families. The treatment typically lasts three to five months. Estimates of the program cost range from roughly $4,000 to 7,000 per family in 2019 dollars.

Click here for the website of MST Services, the organization dedicated to disseminating MST.

To see our full evidence summary:
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Top Tier

Programs shown in well-conducted RCTs, carried out in typical community settings, to produce sizable, sustained effects on important outcomes. Top Tier evidence includes a requirement for replication – specifically, the demonstration of such effects in two or more RCTs conducted in different implementation sites, or, alternatively, in one large multi-site RCT. Such evidence provides confidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original studies.

Near Top Tier

Programs shown to meet almost all elements of the Top Tier standard, and which only need one additional step to qualify. This category primarily includes programs that meet all elements of the Top Tier standard in a single study site, but need a replication RCT to confirm the initial findings and establish that they generalize to other sites. This is best viewed as tentative evidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original study.

Suggestive Tier

Programs that have been evaluated in one or more well-conducted RCTs (or studies that closely approximate random assignment) and found to produce sizable positive effects, but whose evidence is limited by only short-term follow-up, effects that fall short of statistical significance, or other factors. Such evidence suggests the program may be an especially strong candidate for further research, but does not yet provide confidence that the program would produce important effects if implemented in new settings.

References

Study 1- Missouri

Sawyer, Aaron and Charles M. Borduin. “Effects of Multisystemic Therapy through midlife: A 21.9 year follow-up to a randomized controlled trial with serious and violent juvenile offenders.” Journal of Consulting and Clinical Psychology, 2011, Vol. 79, No. 5, pp. 643-652.

Schaeffer, Cindy M. and Charles M. Borduin.  “Long-Term Follow-Up to a Randomized Clinical Trial of Multisystemic Therapy With Serious and Violent Offenders.”  Journal of Consulting and Clinical Psychology, 2005, Vol. 73, No. 3, pp. 445-453.

Borduin, Charles, Barton J. Mann, Lynn T. Cone, Scott W. Henggeler, Bethany R. Fucci, David M. Blaske, and Robert A. Williams. “Multisystemic Treatment of Serious Juvenile Offenders: Long-Term Prevention of Criminality and Violence.”  Journal of Consulting and Clinical Psychology, 1995, Vol. 63, No. 4, pp. 569-578.

Henggeler, Scott W., Charles M. Borduin, Gary B. Melton, Barton J. Mann, Linda A. Smith, James A. Hall, Lynn Cone, and Bethany R. Fucci.  “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, 1991, vol. 1, pp. 40-51.

Borduin, Charles. “Disseminating Evidence Based Practices Four States Speak-out on MST.”  Presentation at National Council for Community Behavioral Healthcare (March 30-April 1, 2003).

Study 2 – Missouri (Juvenile Sex Offenders)

Borduin, Charles M., Cindy M. Schaeffer, and Naamith Heiblum.  “A Randomized Clinical Trial of Multisystemic Therapy With Juvenile Sexual Offenders:  Effects on Youth Social Ecology and Criminal Activity.”  Journal of Consulting and Clinical Psychology, 2009, vol. 77, no. 1, pp. 26-37.

Study 3 – London, England

Butler, Stephen, Geoffrey Baruch, Nicole Hickey, and Peter Fonagy.  “A randomized controlled trial of Multisystemic Therapy and a statutory therapeutic intervention for young offenders.” Journal of the American Academy of Child & Adolescent Psychiatry, 2011, vol. 50, no. 12, pp. 1220-1238.

Cary, Maria, Stephen Butler, Geoffrey Baruch, Nicole Hickey and Sarah Byford, “Economic Evaluation of Multisystemic Therapy for Young People at Risk for Continuing Criminal Activity in the UK,” PLOS One, 2013, vol. 8, issue 3.

Study 4 – Multiple Sites in England

Fonagy, Peter, Stephen Butler, David Cottrell, Stephen Scott, Stephen Pilling, Ivan Eisler, Peter Fuggle, Abdullah Kraam, Sarah Byford, James Wason, Rachel Ellison, Elizabeth Simes, Poushali Ganguli, Elizabeth Allison & Ian M. Goodyer, “Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): a pragmatic, randomised controlled, superiority trial.” The Lancet Psychiatry, 2018, vol. 5, issue 2, pp. 119-133.

Study 5 – Ontario, Canada

“Randomized Study of MST in Ontario, Canada:  Final Results.”  Center for Children and Families in the Justice System, 2006.

Leschied, Alan and Alison Cunningham.  “Seeking Effective Interventions for Serious Young Offenders: Interim Results of a Four-Year Randomized Study of Multisystemic Therapy in Ontario, Canada.” National Crime Prevention Center, 2002.

Study 6 – Sweden

Löfholm, Ceilia Andrée, Tina Olsson, Knut Sundell, and Kjell Hansson. “Multisystemic Therapy with Conduct-Disordered Young People:  Stability of Treatment Outcomes Two Years After Intake.” Evidence & Policy, 2009, vol. 5, no. 4, pp. 373-397.

Sundell, Knut, Kjell Hansson, Cecilia Andrée Löfholm, Tina Olsson, Lars-Henry Gustle, and Christina Kadesjo. “The Transportability of Multisystemic Therapy to Sweden:  Short-Term Results From a Randomized Trial of Conduct-Disordered Youths.” Journal of Family Psychology, 2008, vol. 22, no. 3, pp. 550-560.

Study 7 – Southeastern U.S. City

Weiss, Bahr, Susan Han, Vicki Harris, Thomas Catron, Victoria K. Ngo, Annalise Caron, Robert Gallop, and Carol Guth.  “An Independent Randomized Clinical Trial of Multisystemic Therapy With Non-Court-Referred Adolescents With Serious Conduct Problems.”  Journal of Consulting and Clinical Psychology, 2013, vol. 81, no. 6, pp. 1027-1039.

Other Studies

Asscher, Jessica J., Maja Deković, Willeke A. Manders, Peter H. van der Laan, Pier J. M. Prins and Dutch MST Cost-Effectiveness Study Group4. “A randomized controlled trial of the effectiveness of multisystemic therapy in the Netherlands: post-treatment changes and moderator effects.” Journal of Experimental Criminology, 2013, vol. 9, pp. 169 – 187.

Asscher, Jessica J., Maja Deković, Willeke Manders, Peter H. van der Laan, Pier J. M. Prins, Sander van Arum, and Dutch MST Cost-Effectiveness Study Group. “Sustainability of the effects of multisystemic therapy for juvenile delinquents in The Netherlands: effects on delinquency and recidivism,” Journal of Experimental Criminology, 2014, vol. 10, pp. 227-243.

Glisson, Charles, Sonja K. Shoenwald, Anthony Hemmelgarn, Philip Green, Denzel Dukes, Kevin S. Armstrong and Jason E. Chapman, “Randomized Trial of MST and ARC in a Two-Level Evidence-Based Treatment Implementation Strategy,” Journal of Consulting and Clinical Psychology, 2010, vol. 78, no. 4, 537 – 550.

Henggeler, Scott W., W. Glenn Clingempeel, Michael J. Brondino, and Susan G. Pickrel, “Four-Year Follow-up of Multisystemic Therapy With Substance-Abusing and Substance-Dependent Juvenile Offenders,” Journal of the American Academy of Child Adolescent Psychiatry, 2002, vol. 41, no. 2, 868 – 874.

Henggeler, Scott W., Gary B. Melton, and Linda A. Smith, “Family Preservation Using Multisystemic Therapy: An Effective Alternative to Incarcerating Serious Juvenile Offenders,” Journal of Consulting and Clinical Psychology, 1992, vol. 60, no. 6, pp. 953 – 961.

Henggeler, Scott W., Gary B. Melton, Linda A. Smith, Sonja K. Schoenwald, and Jerome H. Hanley, “Family Preservation Using Multisystemic Treatment: Long-Term Follow-Up to a Clinical Trial with Serious Juvenile Offenders,” Journal of Child and Family Studies, 1993, vol. 2, no. 4, pp. 283 – 293.

Henggeler, Scott W., Susan G. Pickrel, and Michael J. Brondino, “Multisystemic Treatment of Substance-Abusing and –Dependent Delinquents: Outcomes, Treatment Fidelity, and Transportability,” Mental Health Services Research, 1999, vol. 1, no. 3, 171 – 184.

Letourneau, Elizabeth J., Scott W. Henggeler, Charles M. Borduin, Paul A. Schewe, Michael R. McCart, Jason E. Chapman, and Lisa Saldana, “Multisystemic Therapy for Juvenile Sexual Offenders: 1-Year Results from a Randomized Effectiveness Trial,” Journal of Family Psychology, 2009, vol. 23, no. 1, pp. 89-102.

Letourneau, Elizabeth J., Scott W. Henggeler, Michael R. McCart, Charles M. Borduin, Paul A. Schewe, and Kevin S. Armstrong, “Two-Year Follow-Up of a Randomized Effectiveness Trial Evaluating MST for Juveniles Who Sexually Offend,” Journal of Family Psychology, 2013, vol. 27, no. 6, pp. 978 – 985.

Miller, Marsha. “The Multisystemic Therapy Pilot Program in Delaware: Final Evaluation.” Evaluation funded by the State of Delaware, 1998.

Ogden, Terje and Colleen A. Halliday-Boykins, “Multisystemic Treatment of Antisocial Adolescents in Norway: Replication of Clinical Outcomes Outside of the US,” Child and Adolescent Mental Health, 2004, vol. 9, no. 2, pp. 77 – 83.

Ogden, Terge and Kristine Amlund Hagen, “Multisystemic Treatment of Serious Behaviour Problems in Youth: Sustainability of Effectiveness Two Years after Intake,” Child and Adolescent Mental Health, 2006, vol. 11, no. 3, pp. 142-149.

Scherer, David G., and Michael J. Brondino. “Multisystemic Family Preservation Therapy: Preliminary Findings from a Study of Rural and Minority Serious Adolescent Offenders,” Journal of Emotional & Behavioral Disorders, 1994, vol. 2, issue 4.

Swenson, Cynthia Cupit, Cindy M. Schaeffer, Scott W. Henggeler, Richard Faldowski, and Amy Marie Mayhew, “Multisystemic Therapy for Child Abuse and Neglect: A Randomized Effectiveness Trial,” Journal of Family Psychology, 2010, vol. 24, no. 4, pp. 497-507.

Timmons-Mitchell, Jane, Monica B. Bender, Maureen A. Kishna, and Clare C. Mitchell. “An Independent Effectiveness Trial of Multisystemic Therapy with Juvenile Justice Youth.” Journal of Clinical Child and Adolescent Psychology, 2006, vol. 35, no. 2, pp. 227-236.

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