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 to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on 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. See Estimating Program Effects Using Effect Sizes for additional information on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change 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. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured	Treatment age	Primary or secondary participant	No. of effect sizes	Treatment N	Effect sizes (ES) and standard errors (SE)			Unadjusted effect size (random effects model)
					ES	SE	Age	ES	p-value
School attendance Number or percentage of school days present in a given enrollment period.	14	Primary	1	79	-0.364	0.220	14	-0.364	0.098
Alcohol use before end of middle school Any use of alcohol by the end of middle school, typically by age 13.	14	Primary	1	57	-0.151	0.188	14	-0.289	0.126
Cannabis use before end of middle school Any use of cannabis by the end of middle school, typically by age 13.	14	Primary	1	57	0.023	0.188	14	0.045	0.812
Alcohol use before end of high school Any use of alcohol by the end of high school, typically between ages 14 and 18.	14	Primary	1	79	-0.103	0.160	14	-0.103	0.522
Attention-deficit/hyperactivity disorder symptoms Clinical diagnosis of attention-deficit/hyperactivity disorder (ADHD) or symptoms measured on a validated scale.	14	Primary	1	290	-0.098	0.085	14	-0.098	0.249
Major depressive disorder Clinical diagnosis of major depression or symptoms measured on a validated scale.	14	Primary	1	78	-0.017	0.160	14	-0.033	0.835
Disruptive behavior disorder symptoms Clinical diagnosis of a disruptive behavior disorder (e.g., conduct disorder, oppositional defiant disorder) or symptoms measured on a validated scale.	14	Primary	7	733	-0.229	0.054	14	-0.248	0.001
Internalizing symptoms Symptoms of internalizing behavior (e.g., sadness, anxiety, or withdrawal) measured on a validated scale.	14	Primary	4	212	-0.113	0.133	14	-0.130	0.352
Hospitalization (psychiatric) Admission to a psychiatric ward or hospital.	14	Primary	2	136	0.137	0.168	14	0.137	0.414
Suicide attempts An attempt to die by suicide resulting in survival.	14	Primary	1	78	-0.153	0.160	14	-0.294	0.278
Suicidal ideation Thinking about and/or planning death by suicide.	14	Primary	1	78	-0.016	0.160	14	-0.031	0.887
Out-of-home placement The removal of a child from parental care, most often to foster care.	14	Primary	5	1027	-0.240	0.081	14	-0.462	0.001
Illicit drug use before end of high school Any use of illicit drugs by the end of high school, typically between ages 14 to 18. When possible, we exclude cannabis/marijuana use disorder from this outcome.	14	Primary	1	79	0.128	0.160	14	0.128	0.425
Crime Any criminal conviction according to court records, sometimes measured through charges, arrests, incarceration, or self-report.	14	Primary	6	1189	-0.058	0.064	14	-0.094	0.338
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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.

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