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Multisystemic Therapy (MST) for youth with serious emotional disturbance (SED)

Children's Mental Health: Serious Emotional Disturbance
  Literature review updated July 2018.
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Multisystemic Therapy (MST) is an intensive family- and community-based treatment, which combines aspects of cognitive, behavioral, and family therapies. The purpose of MST is to reduce juvenile delinquency and youth substance use and empower parents to manage future difficult behavior. Children with serious emotional disturbance are most often referred to MST by child welfare agencies, juvenile courts, and schools. MST therapists provide individualized treatment in a child’s home, school, or community for an average of five months. These therapist-led sessions aim to modify the youth’s environment to support lasting behavioral changes through goal-setting, weekly treatment tasks, and progress monitoring. MST is often conducted with court-involved youth as a requirement of their adjudication; however, the studies included in this analysis primarily focused on children with serious emotional disturbance either without or prior to adjudication.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured No. of effect sizes Treatment N Adjusted effect size(ES) and standard error(SE) Unadjusted effect size (random effects model)
ES SE Age ES p-value
Alcohol use in high school 14 1 79 -0.103 0.160 14 -0.103 0.522
Alcohol use before end of middle school 14 1 57 -0.151 0.188 14 -0.289 0.126
Attention-deficit/hyperactivity disorder symptoms 14 1 290 -0.098 0.085 14 -0.098 0.249
Cannabis use before end of middle school 14 1 57 0.023 0.188 14 0.045 0.812
Crime 14 6 1189 -0.058 0.064 14 -0.094 0.338
Disruptive behavior disorder symptoms 14 7 733 -0.229 0.054 14 -0.248 0.001
Hospitalization (psychiatric) 14 2 136 0.137 0.168 14 0.137 0.414
Illicit drug use in high school 14 1 79 0.128 0.160 14 0.128 0.425
Internalizing symptoms 14 4 212 -0.113 0.133 14 -0.130 0.352
Major depressive disorder 14 1 78 -0.017 0.160 14 -0.033 0.835
Out-of-home placement 14 5 1027 -0.240 0.081 14 -0.462 0.001
School attendance 14 1 79 -0.364 0.220 14 -0.364 0.098
Suicidal ideation 14 1 78 -0.016 0.160 14 -0.031 0.887
Suicide attempts 14 1 78 -0.153 0.160 14 -0.294 0.278

Citations Used in the Meta-Analysis

Asscher, J.J., Deković, M., Manders, W.A., Laan, P.H., & Prins, P.J.M. (2013). A randomized controlled trial of the effectiveness of multisystemic therapy in the Netherlands: post-treatment changes and moderator effects. Journal of Experimental Criminology, 9, 169-187

Asscher, J.J., Dekovic, M., Manders, W., van der Laan, P.H., Prins, P.J.M., & van Arum, S. (2014). Sustainability of the effects of Multisystemic Therapy for juvenile delinquents in The Netherlands: Effects on delinquency and recidivism. Journal of Experimental Criminology, 10, 227-243.

Glisson, C., Schoenwald, S. K., Hemmelgarn, A., Green, P., Dukes, D., Armstrong, K. S., & Chapman, J. E. (2010). Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. Journal of Consulting and Clinical Psychology, 78(4), 537-550.

Fonagy, P., Butler, S., Cottrell, D., Scott, S., Pilling, S., Eisler, I., Fuggle, P., ... Goodyer, I.M. (2018). Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): A pragmatic, randomised controlled, superiority trial. The Lancet. Psychiatry, 5(2), 119-133.

Henggeler, S. W., Rowland, M. D., Randall, J., Ward, D. M., Pickrel, S. G., Cunningham, P. B., . . . Santos, A. B. (1999). Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: Clinical outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 38(11), 1331-1339.

Huey, S.J., Jr., Henggeler, S., Rowland, M., Halliday-Boykins, C.A., Cunningham, P.B., Pickrel, S., & Edwards, J. (2004). Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies. Journal of the American Academy of Child and Adolescent Psychiatry, 43(2), 183-190.

Lofholm, C.A., Olsson, T., Sundell, K., Hansson, K. (2009) Multisystemic therapy with conduct-disordered young people: Stability of treatment outcomes two years after intake. Evidence and Policy, 5(4), 373-397

Ogden, T., & Halliday-Boykins, C. A. (2004). Multisystemic treatment of antisocial adolescents in Norway: Replication of clinical outcomes outside of the US. Child and Adolescent Mental Health, 9(2), 77-83.

Rowland, M. D., Halliday-Boykins, C. A., Henggeler, S. W., Cunningham, P. B., Lee, T. G., Kruesi, M. J. P., & Shapiro, S. B. (2005). A randomized trial of multisystemic therapy with Hawaii's Felix Class youths. Journal of Emotional and Behavioral Disorders, 13(1), 13- 23.

Schoenwald, S.K., Ward, D.M., Henggeler, S.W., & Rowland, M.D. (2000). Multisystemic therapy versus hospitalization for crisis stabilization of youth: Placement outcomes 4 months post referral. Mental Health Services Research, 2(1), 3-12.

Sundell, K., Hansson, K., Lofholm, C. A., Olsson, T., Gustle, L. H., & Kadesjo, C. (2008). The transportability of multisystemic therapy to Sweden: Short-term results from a randomized trial of conduct-disordered youths. Journal of Family Psychology, 22(4), 550-560.

Vidal, S., Steeger, C.M., Caron, C., Lasher, L., & Connell, C.M. (2017). Placement and delinquency outcomes among system-involved youth referred to Multisystemic Therapy: A propensity score matching analysis. Administration and Policy in Mental Health, 44(6), 853-866.

Weiss, B., Han, S., Harris, V., Castron, T., Ngo, V. K., & Caron, A. (n.d.). An independent evaluation of the MST treatment program. Unpublished manuscript emailed to M. Miller by S. Henggeler on May 4, 2010.