Multisystemic Therapy (MST) for juvenile offenders

Evidence Rating  
Evidence rating: Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Health Factors  
Date last updated

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 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

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

  • Reduced foster care use

  • Improved health outcomes

What does the research say about effectiveness?

There is strong evidence that Multisystemic Therapy (MST) reduces the likelihood of recidivism and incarceration for serious juvenile offenders more than treatment as usual4, 5, 6, 7, 8. MST can also reduce delinquent or antisocial behavior and alcohol and drug use among juvenile offenders5, 6, 8, 9, 10.

MST can improve participating youths’ functioning at school, work, and home5, 6, 9, and increase positive peer relationships5, 6. MST may also improve family functioning6, 8, 9 and reduce out-of-home placement5, 6, 9, 11.

MST can decrease delinquent behavior, sexual behavior problems, incarceration, and residential treatment for youth charged with sexual offenses12, 13, 14. MST may also reduce arrest and incarceration, and increase probation completion among Hispanic youth offenders7. MST appears to be effective for gang-involved youth15. A 21-year follow-up evaluation of MST indicates low recidivism and less frequent offenses among MST participants than individual therapy participants16. Arrest rates and days of incarceration are also lower for siblings and caregivers of MST participants 20 years after treatment17, 18.

Reductions in delinquency are greater for serious juvenile offenders than non-justice-involved youth with conduct disorder2, 4, 5. Effects are also stronger when the program is implemented with high treatment fidelity19.

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 children20, 21. MST for mentally ill or disturbed youth may reduce poor behavior, suicide attempts, and out-of-home placement, and improve family functioning21. 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 youth21, and reduced viral load for youth HIV taking retroviral medication22.

Researchers suggest that MST for juvenile offenders is cost-effective compared to treatment as usual23, 24. 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 invested25.

How could this strategy impact health disparities? This strategy is rated 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 plans3.

Implementation Resources

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


* 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 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.

5 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.

6 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.

7 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.

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

9 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.

10 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.

11 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.

12 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.

13 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.

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 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.

17 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.

18 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.

19 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.

20 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.

21 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.

22 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.

23 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.

24 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.

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