Multisystemic Therapy (MST) Consultation

Principal Investigator: 
Eric Trupin, Ph.D.
Funding Source: 
Community Youth Services, Thurston County
Central Washington Comprehensive Mental Health, Yakima
Central Youth and Family Services, Seattle
Project Period: 
PBHJP Project Faculty and Staff: 
Project Contact: 
Project Summary: 

Multisystemic Therapy (MST) is an evidence-based program developed to treat delinquent youth by intervening in the various systems in which the youth is embedded (i.e., family, school, peer, community) to change factors that contribute to or maintain problem behaviors. MST is a practical and goal-oriented treatment that draws from social-ecological and family systems theories of behavior. In MST, a single therapist delivers services to 4 – 6 families. For the purposes of supervision, consultation, training, and monitoring, clinical staff are organized into teams of 2 – 4 therapists led by an MST Supervisor. The therapist meets with the youth or family at least weekly throughout most of the treatment and often multiple times per week, depending on need. Services occur in the family’s home or community at times that are convenient for the family. Staff members are expected to work on weekends and evenings, for the convenience of their clients, and therapists and/or their supervisors are on-call for families 24/7. On average, a youth receives MST for 3 to 5 months, and typically no longer than 6 months.
MST components include:

  • Assessment
  • Ongoing treatment planning
  • Family therapy
  • Parent counseling (related to empowering caregivers to parent effectively and addressing issues
  • that pose barriers to treatment goals)
  • Consultation to and collaboration with other systems such as school, juvenile probation, children and youth, and job supervisors
  • Referral for psychological assessment, psychiatric evaluation, and medication management if
  • Individual therapy may occur, but is not the primary mode of treatment since MST emphasizes working with the youth’s ecology

Target Population:
MST Services, in its MST Preferred Service Description/Medicaid/Funding Standard, suggests the following admission criteria for MST programs:

  • Ages of 12-17
  • Youth is a chronic or violent juvenile offender
  • Child is at risk for out-of-home placement or is transitioning back from an out-of-home
  • Externalizing behavior symptomatology… [Common diagnoses among MST-referred youth include Conduct Disorder, Oppositional Defiant Disorder, Attention-Deficit/Hyperactivity
  • Disorder, and Disruptive Behavior Disorder NOS, although the specific diagnosis is less important than the presence of significant acting out behaviors. Youth may have other mild to moderate comorbid psychiatric disorder(s).]
  • Ongoing multiple system involvement due to high risk behaviors and/or risk of failure in mainstream school settings due to behavioral problems
  • Less intensive treatment has been ineffective or is inappropriate

Youth accepted into MST are often involved in the juvenile justice or child welfare system due to their behaviors, have past or current criminal charges, and have previous treatment failures. A parent or caregiver must be willing to participate in the youth’s treatment.

Youth that are typically not appropriate for the service include those who:

  • have an autism spectrum disorder
  • present with a primary internalizing disorders and minimal acting out behaviors
  • exhibit substance abuse in the absence of other delinquent or antisocial behavior
  • are referred primarily due to sexual offending or due to sexual offending in the absence of other acting out behavior
  • are referred primarily due to suicidal, homicidal, or psychotic behaviors
  • are living independently or for whom a primary caregiver cannot be identified despite extensive efforts to do so
  • MST is designed to address “willful” behaviors; youth whose acting out is driven by serious mental illness (such as schizophrenia or a manic episode) are generally not appropriate for the service.
Public Health Relevance: 

Results Show:

  • long-term re-arrest rates reduced by 25-70 percent
  • out-of-home placements reduced by 47-64 percent
  • families functioning much better
  • decreased substance use
  • fewer mental-health problems for serious juvenile offenders

And MST’s positive results are long lasting 
A 14-year follow-up study by the Missouri Delinquency Project showed youths who received MST had:

  • up to 54 percent fewer re-arrests
  • up to 57 percent fewer days of incarceration
  • up to 68 percent fewer drug-related arrests
  • up to 43 percent fewer days on adult probation

A 22-year follow-up study by the Missouri Delinquency Project showed youths who received MST had:

  • up to 36 percent fewer felony arrests
  • up to 75 percent fewer violent felony arrests
  • up to 33 percent fewer days in adult confinement
  • up to 38 percent fewer issues with family instability (divorce, paternity, child support suits)

MST is committed to continuing its program evaluation and has a quality assurance program that  provides all MST programs around the world with tools to assess the adherence of therapists, supervisors and organizations to the MST model.