Multisystemic Therapy (MST) for adolescents involved in the justice system
Multisystemic Therapy (MST) is an intensive, family- and community-based intervention for adolescents who have committed serious offenses in which two to four therapists meet youth and their families weekly at home or at 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 peers1, 2. Adaptations of MST have been applied to child health and psychiatric problems, youth substance abuse, problem sexual behavior, and child abuse and neglect3.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced recidivism
Reduced incarceration
Reduced foster care use
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced delinquent behavior
Reduced substance abuse
Improved family functioning
Improved mental health
Reduced suicide
Improved health outcomes
Reduced sexual violence
What does the research say about effectiveness?
There is strong evidence that Multisystemic Therapy (MST) reduces the likelihood of recidivism and incarceration for adolescents who have committed serious offenses more than treatment as usual4, 5, 6, 7, 8, 9. MST can also reduce delinquent or antisocial behavior and alcohol and drug use among youth who have offended6, 7, 9, 10, 11. MST also reduces out-of-home placements in foster care4, 6, 7, 10, 12.
MST can improve participating youths’ functioning at school, work, and home6, 7, 10, and increase positive peer relationships6, 7. MST may also improve family functioning and reduce self-reported delinquency4, 7, 9, 10. MST can decrease delinquent behavior, sexual behavior problems, incarceration, and residential treatment for youth charged with sexual offenses13, 14.
MST may reduce arrest and incarceration, and increase probation completion among Hispanic youth that have offenses8. MST appears to be effective for youth involved with gangs15. A small study suggests that MST may be effective for youth with autism spectrum disorder (ASD) who display disruptive behaviors16. A 25-year follow-up evaluation of MST for those with problematic sexual behaviors found fewer offenses, days of incarceration, and family-related civil suits among MST participants, compared to youth that received usual community services17. Arrest rates and days of incarceration are also lower for siblings and caregivers of MST participants 20 years after treatment18, 19.
Reductions in delinquency are greater for youth that committed serious offenses than for non-justice-involved youth with conduct disorder2, 5, 6, 13. Effects are also stronger when the program is implemented with high treatment fidelity20. A Hawaii-based study indicates that MST that focuses on a limited number of concerns may be associated with better therapeutic outcomes, compared to MST that addresses multiple co-occurring concerns, such as multiple diagnoses, life stressors, disruptive life events, and barriers to the therapeutic process, at the same time21, 22.
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 children23, 24. A Netherlands-based adaptation of MST for youth with intellectual disabilities can improve parenting skills, family relationships, and lead to sustained positive behavior changes25. MST for youth with mental illnesses may reduce poor behavior, suicide attempts, and out-of-home placements, and improve family functioning24. Adaptations of MST have also been linked to better metabolic control and reduced hospital admissions for youth with poorly controlled diabetes, weight loss for youth that are overweight24, and reduced viral load for youth taking HIV retroviral medications26.
Researchers suggest that MST for youth who have offended is cost-effective compared to treatment as usual27, 28. A Washington-based analysis estimates that MST cost $9,486 per adolescent in 2022, with an average benefit of $3.01 for every dollar invested29.
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.
It is unclear what impact Multisystemic Therapy (MST) may have on disparities among youth involved in the justice system. Disparities exist within the justice system and in both access to mental health services and the quality of mental health care available13. Adolescents from racially minoritized groups experience higher rates of mental health conditions, yet they are less likely to use mental health services30. Additionally, while total youth incarceration rates have declined over the past ten years, youth of color are significantly more likely to be incarcerated than white youth31.
Experts recommend adapting MST to reflect the client’s cultural background32, 33 and suggest that effective therapists may have relevant cultural knowledge in order to adapt MST for clients34.
What is the relevant historical background?
Youth of color have been disproportionately overrepresented throughout the history of the juvenile justice system in the U.S. and racially disparate practices and treatment for youth in the system persist to this day. These disparities can be attributed to the nation’s history of racial segregation and discrimination, the false belief that youth of color are culturally inclined to delinquency, and the systemic and racialized policies and practices within the juvenile justice system. Examples of these policies and practices include discriminatory policing in communities of color along with differential treatment of youth of color throughout the juvenile court process, where decision makers lack appropriate assessment tools, training, program options for youth, and cultural competence35. Black, Native, and Hispanic youth have and continue to be arrested and involved in the juvenile justice system at disproportionate rates, compared to white youth36.
The Juvenile Justice and Delinquency Prevention Act, which was reauthorized in 2018, provides federal standards for the care and custody of youth and families involved in the juvenile justice system37. One of its four requirements helps states assess and eliminate racial and ethnic disparities within the juvenile justice system37.
Equity Considerations
- In your community, which youth involved in the justice system have access to Multisystemic Therapy (MST) services? Who cannot access MST services?
- How can correctional officers, MST providers, educators, family members, peer mentors, and others work together to support youth involved in the justice system that are receiving MST?
- What other societal and community-level factors impact youth involved in the justice system within your community? For example, do they experience poverty, racial profiling, discrimination, or barriers to accessing support services?
Implementation Examples
Thirty-four states have licensed Multisystemic Therapy (MST) providers. Some states, for example Maine, Nebraska, and New Mexico, fund MST programs through Medicaid state plans3.
Implementation Resources
‡ Resources with a focus on equity.
MST - Multisystemic Therapy (MST). Breaking the cycle of criminal behavior by keeping teens at home, in school and out of trouble.
Footnotes
* Journal subscription may be required for access.
1 Henggeler 2016 - Henggeler SW, Schaeffer CM. Multisystemic therapy: Clinical overview, outcomes, and implementation research. Family Process. 2016;55(3):514-528.
2 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.
3 MST - Multisystemic Therapy (MST). Breaking the cycle of criminal behavior by keeping teens at home, in school and out of trouble.
4 Campbell-Littell 2021 - Littell, J. H., Pigott, T. D., Nilsen, K. H., Green, S. J., & Montgomery, O. L. K. (2021). Multisystemic Therapy® for social, emotional, and behavioural problems in youth age 10 to 17: An updated systematic review and meta‐analysis. Campbell Systematic Reviews, 17(4), e1158.
5 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.
6 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.
7 van der Stouwe 2014 - van der Stouwe T, Asscher JJ, Stams GJJM, Dekovic M, van der Laan PH. The effectiveness of multisystemic therapy (MST): A meta-analysis. Clinical Psychology Review. 2014;34(6):468-481.
8 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: RAND Corporation; 2014.
9 Blueprints - Center for the Study and Prevention of Violence (CSPV). Blueprints for healthy youth development.
10 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.
11 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.
12 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.
13 Satodiya 2024 - Satodiya, R., Bied, A., Shah, K., Parikh, T., & Ash, P. (2024). A systematic review of multisystemic therapy in adolescent sex offenders. The Journal of the American Academy of Psychiatry and the Law, 52(1), 51–60.
14 CEBC - California Evidence-Based Clearinghouse for Child Welfare (CEBC). Information and resources for child welfare professionals: List of programs.
15 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.
16 Wagner 2019 - Wagner, D. V., Borduin, C. M., Mazurek, M. O., Kanne, S. M., & Dopp, A. R. (2019). Multisystemic therapy for disruptive behavior problems in youths with autism spectrum disorder: Results from a small randomized clinical trial. Evidence-Based Practice in Child and Adolescent Mental Health, 4(1), 42–54.
17 Borduin 2021 - Borduin, C. M., Quetsch, L. B., Johnides, B. D., & Dopp, A. R. (2021). Long-term effects of multisystemic therapy for problem sexual behaviors: A 24.9-year follow-up to a randomized clinical trial. Journal of Consulting and Clinical Psychology, 89(5), 393–405.
18 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.
19 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.
20 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.
21 Holmes 2022 - Holmes, K. L., & Mueller, C. W. (2022). Treatment focus diffusion predicts poorer clinical progress in children’s public mental health care. Journal of Behavioral and Cognitive Therapy, 32(2), 99–110.
22 Holmes 2023a - Holmes, K. L., & Mueller, C. W. (2023). Treatment focus diffusion is associated with long-term outcomes in youth public mental health care. Journal of Child and Family Studies, 32(12), 3742–3754.
23 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.
24 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.
25 Blankestein 2019 - Blankestein, A., Van Der Rijken, R., Eeren, H. V., Lange, A., Scholte, R., Moonen, X., De Vuyst, K., Leunissen, J., & Didden, R. (2019). Evaluating the effects of multisystemic therapy for adolescents with intellectual disabilities and antisocial or delinquent behaviour and their parents. Journal of Applied Research in Intellectual Disabilities, 32(3), 575–590.
26 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):507-514.
27 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.
28 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.
29 WSIPP-MST 2023 - Washington State Institute for Public Policy (WSIPP). (December 2023). Multisystemic therapy (MST) for court-involved/post-release youth.
30 Hoffman 2022 - Hoffmann, J. A., Alegría, M., Alvarez, K., Anosike, A., Shah, P. P., Simon, K. M., & Lee, L. K. (2022). Disparities in pediatric mental and behavioral health conditions. Pediatrics, 150(4), e2022058227.
31 Sentencing Project 2023 - The Sentencing Project. (2023, December 12). Racial disparities in youth incarceration stagnate. Retrieved December 12, 2024.
32 Sayegh 2019 - Sayegh, C. S., Hall-Clark, B. N., McDaniel, D. D., Halliday-Boykins, C. A., Cunningham, P. B., & Huey, S. J. (2019). A preliminary investigation of ethnic differences in resistance in multisystemic therapy. Journal of Clinical Child & Adolescent Psychology, 48(sup1), S13–S23.
33 Brown 2024 - Brown, S. & Rojas Perez, O.F. (2024). Juvenile justice-based interdisciplinary collective care: An innovative approach. Community Mental Health, 60, 1042-1054.
34 Bunting 2021 - Bunting, A., Fox, S., Adhyaru, J., & Holland, A. (2021). Considerations for minority ethnic young people in multisystemic therapy. Clinical Child Psychology and Psychiatry, 26(1), 268–282.
35 NCTSN-Lacey 2013 - Lacey C. Racial disparities and the juvenile justice system: A legacy of trauma. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress (NCTSN); 2013.
36 OJJDP-R/ED 2022 - Development Services Group, Inc. (2022). Racial and ethnic disparity (R/ED) in juvenile justice processing. Washington, D.C.: Office of Juvenile Justice and Delinquency Prevention (OJJDP).
37 CJJ-JJDPA - Coalition for Juvenile Justice (CJJ). Juvenile Justice and Delinquency Prevention Act (JJDPA).
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