Multisystemic Therapy (MST) for juvenile offenders

Multisystemic Therapy (MST) is an intensive, family- and community-based intervention for serious juvenile offenders in which two to four therapists meet youth offenders and their families weekly at home or school for three to five months. The intervention focuses on individual, family, peer, school, and community risk factors that contribute to juvenile antisocial behaviors. MST requires concrete, measurable effort from both youth and families, and builds on strengths in youths’ lives while altering problematic interactions with family and peers (, McCart 2016). Adaptations of MST have been applied to child health and psychiatric problems, youth substance abuse, problem sexual behavior, and child abuse and neglect (MST).

Expected Beneficial Outcomes (Rated)

  • Reduced recidivism

  • Reduced incarceration

Other Potential Beneficial Outcomes

  • Reduced delinquent behavior

  • Reduced substance abuse

  • Improved family functioning

  • Improved mental health

  • Reduced suicide

  • Reduced foster care use

  • Improved health outcomes

Evidence of Effectiveness

There is strong evidence that Multisystemic Therapy (MST) reduces the likelihood of recidivism and incarceration for serious juvenile offenders more than treatment as usual (Tan 2017, , , RAND-Fain 2014, Blueprints). MST can also reduce delinquent or antisocial behavior and alcohol and drug use among juvenile offenders (, , Zajac 2015, Blueprints, ).

MST can improve participating youths’ functioning at school, work, and home (, , Zajac 2015), and increase positive peer relationships (SAMHSA-NREPP, , ). MST may also improve family functioning (, Zajac 2015, Blueprints) and reduce out-of-home placement (, , Zajac 2015, ).

MST can decrease delinquent behavior, sexual behavior problems, incarceration, and residential treatment for youth charged with sexual offenses (Letourneau 2009, Letourneau 2013b, CEBC). MST may also reduce arrest and incarceration, and increase probation completion among Hispanic youth offenders (RAND-Fain 2014). MST appears to be effective for gang-involved youth (). A 21-year follow-up evaluation of MST indicates low recidivism and less frequent offenses among MST participants than individual therapy participants (). Arrest rates and days of incarceration are also lower for siblings and caregivers of MST participants 20 years after treatment (, ).

Reductions in delinquency are greater for serious juvenile offenders than non-justice-involved youth with conduct disorder (Tan 2017, , McCart 2016). Effects are also stronger when the program is implemented with high treatment fidelity ().

A version of MST for families of abused and neglected children has been shown to improve children’s and caregivers’ mental health and reduce the likelihood that caregivers will neglect or assault their children (Swenson 2010, ). MST for mentally ill or disturbed youth may reduce poor behavior, suicide attempts, and out-of-home placement, and improve family functioning (). Adaptations of MST have also been linked to better metabolic control and reduced hospital admissions for youth with poorly controlled diabetes, weight loss in overweight youth (), and reduced viral load for youth HIV taking retroviral medication ().

Researchers suggest that MST for juvenile offenders is cost-effective compared to treatment as usual (Goorden 2016, ). A Washington-based analysis estimates that MST cost $7,830 per juvenile offender in 2012, with an average benefit of $1.62 for every dollar invested (WSIPP-Benefit cost).

Impact on Disparities

No impact on disparities likely

Implementation Examples

Thirty-four states have licensed MST providers. Some states, for example Maine, Nebraska, and New Mexico, fund MST programs through Medicaid state plans (MST).

Implementation Resources

MST - Multisystemic Therapy (MST). Breaking the cycle of criminal behavior by keeping teens at home, in school and out of trouble.

Citations - Evidence

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Blueprints - Center for the Study and Prevention of Violence (CSPV). Blueprints for healthy youth development.

SAMHSA-NREPP - SAMHSA's National Registry of Evidence-based Programs and Practices (NREPP).

CEBC - California Evidence-Based Clearinghouse for Child Welfare (CEBC). Information and resources for child welfare professionals: List of programs.

Sawyer 2011* - Sawyer AM, Borduin CM. 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. 2011;79(5):643-52.

Baldwin 2012* - Baldwin SA, Christian S, Berkeljon A, Shadish WR, Bean R. The effects of family therapies for adolescent delinquency and substance abuse: A meta-analysis. Journal of Marital & Family Therapy. 2012;38(1):281-304.

Letourneau 2009 - Letourneau EJ, Henggeler SW, Borduin CM, et al. Multisystemic therapy for juvenile sexual offenders: 1-Year results from a randomized effectiveness trial. Journal of Family Psychology. 2009;23(1):89-102.

Swenson 2010 - Swenson CC, Schaeffer CM, Henggeler SW, Faldowski R, Mayhew AM. Multisystemic therapy for child abuse and neglect: A randomized effectiveness trial. Journal of Family Psychology. 2010;24(4):497-507.

Letourneau 2013* - Letourneau EJ, Ellis DA, Naar-King S, et al. Multisystemic therapy for poorly adherent youth with HIV: Results from a pilot randomized controlled trial. AIDS Care. 2013;25(4):507–14.

Pane 2013* - Pane HT, White RS, Nadorff MR, Grills-Taquechel A, Stanley MA. Multisystemic therapy for child non-externalizing psychological and health problems: A preliminary review. Clinical Child and Family Psychology Review. 2013;16(1):81–99.

van der Stouwe 2014* - van der Stouwe T, Asscher JJ, Stams GJJM, Dekovi? M, van der Laan PH. The effectiveness of Multisystemic Therapy (MST): A meta-analysis. Clinical Psychology Review. 2014;34(6):468–481.

Zajac 2015 - Zajac K, Randall J, Swenson CC. Multisystemic therapy for externalizing youth. Child and Adolescent Psychiatric Clinics of North America. 2015;24(3):601–616.

Letourneau 2013b - Letourneau EJ, Henggeler SW, McCart MR, et al. Two-year follow-up of a randomized effectiveness trial evaluating MST for juveniles who sexually offend. Journal of Family Psychology. 2013;27(6):978–985.

RAND-Fain 2014 - Fain T, Greathouse SM, Turner S, Weinberg HD. Is multisystemic therapy (MST) effective for Hispanic youth? An evaluation of outcomes for juvenile offenders in Los Angeles County. Santa Monica, CA: RAND Corporation; 2014.

Wagner 2014* - Wagner DV, Borduin CM, Sawyer AM, Dopp AR. Long-term prevention of criminality in siblings of serious and violent juvenile offenders: A 25-year follow-up to a randomized clinical trial of multisystemic therapy. Journal of Consulting and Clinical Psychology. 2014;82(3):492–499.

WSIPP-Benefit cost - Washington State Institute for Public Policy (WSIPP). Benefit-cost results.

McCart 2016 - McCart MR, Sheidow AJ. Evidence-based psychosocial treatments for adolescents with disruptive behavior. Journal of Clinical Child & Adolescent Psychology. 2016;45(5):529-563.

Tan 2017 - Tan JX, Fajardo MLR. Efficacy of multisystemic therapy in youths aged 10–17 with severe antisocial behaviour and emotional disorders: Systematic review. London Journal of Primary Care. 2017;9(6):95-103.

Markham 2018* - Markham A. A review following systemic principles of multisystemic therapy for antisocial behavior in adolescents aged 10-17 years. Adolescent Research Review. 2018;3(1):67-93.

Vidal 2017* - Vidal S, Steeger CM, Caron C, Lasher L, Connell CM. Placement and delinquency outcomes among system-involved youth referred to multisystemic therapy: A propensity score matching analysis. Administration and Policy in Mental Health and Mental Health Services Research. 2017;44(6):853-866.

Boxer 2017* - Boxer P, Docherty M, Ostermann M, Kubik J, Veysey B. Effectiveness of multisystemic therapy for gang-involved youth offenders: One year follow-up analysis of recidivism outcomes. Children and Youth Services Review. 2017;73:107-112.

Goense 2016* - Goense PB, Assink M, Stams GJ, Boendermaker L, Hoeve M. Making “what works” work: A meta-analytic study of the effect of treatment integrity on outcomes of evidence-based interventions for juveniles with antisocial behavior. Aggression and Violent Behavior. 2016;31:106-115.

Goorden 2016 - Goorden M, Schawo SJ, Bouwmans-Frijters CAM, et al. The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: A systematic review. BMC Psychiatry. 2016;16:237.

Dopp 2018* - Dopp AR, Coen AS, Smith AB, et al. Economic impact of the statewide implementation of an evidence-based treatment: Multisystemic therapy in New Mexico. Behavior Therapy. 2018.

Johnides 2017* - Johnides BD, Borduin CM, Wagner DV, Dopp AR. Effects of multisystemic therapy on caregivers of serious juvenile offenders: A 20-year follow-up to a randomized clinical trial. Journal of Consulting and Clinical Psychology. 2017;85(4):323-334.

Citations - Implementation Examples

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MST - Multisystemic Therapy (MST). Breaking the cycle of criminal behavior by keeping teens at home, in school and out of trouble.

Date Last Updated

Mar 8, 2018