What is MST? Where is MST Being Used?
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- Dominic Ball
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1 Multisystemic Therapy (MST) PJ Bruch Southwest Family Guidance Center Jane Prince-Smith David Bernstein The Center for Effective Interventions 1 What is MST? Community-based, family-driven treatment for antisocial/delinquent behavior in youth Focus is on Empowering caregivers (parents) to solve current and future problems MST client is the entire ecology of the youth - family, peers, school, neighborhood Highly structured clinical supervision and quality assurance processes 2 Where is MST Being Used? Over 34 states in the U.S. and 13 other countries Statewide infrastructures in Connecticut, Hawaii, New Mexico, North Carolina, Ohio and Louisiana International nationwide infrastructures in Norway and the Netherlands Additional international sites: Australia, Belgium, Canada, Chile, Denmark, England, Iceland, New Zealand, Northern Ireland, Scotland, Sweden and Switzerland 3 07/07 1
2 Families as the Solution MST focuses on families as the solution Families are full collaborators in treatment planning and delivery with a focus on family members as the long-term change agents Giving up on families, or labeling them as resistant or unmotivated is not an option MST has a strong track record of client engagement, retention, and satisfaction 4 MST Theory of Change Peers MST Improved Family Functioning School Community Reduced Antisocial Behavior and Improved Functioning 5 Social Ecological Model Family Members Community Provider Agency School Neighborhood Peers Extended Family Caregiver CHILD Siblings 6 07/07 2
3 MST Assumptions Children s behavior is strongly influenced by their families, friends and communities (and vice versa) Families and communities are central and essential partners and collaborators in MST treatment Caregivers/parents want the best for their children and want them to grow to become productive adults 7 MST Assumptions (Cont.) Families can live successfully without formal, mandated services Change can occur quickly Professional treatment providers should be accountable for achieving outcomes Science/research provides valuable guidance 8 How is MST Implemented? Intervention strategies: MST draws from research-based treatment techniques Behavior therapy Parent management training Cognitive behavior therapy Pragmatic family therapies - Structural Family Therapy - Strategic Family Therapy Pharmacological interventions (e.g., for ADHD) 9 07/07 3
4 How is MST Implemented? Single therapist working intensively with 4 to 6 families at a time Team of 2 to 4 therapists plus a supervisor 24 hr/ 7 day/ week team availability: on call system 3 to 5 months is the typical treatment time (4 months on average across cases) Work is done in the community, home, school, neighborhood: removes barriers to service access 10 How is MST Implemented? MST staff deliver all treatment typically no or few services are brokered/referred outside the MST team Never-ending focus on engagement and alignment with primary caregiver and other key stakeholders (e.g. probation, courts, children and family services, etc.) MST has strong track record of client retention and satisfaction with MST MST staff must be able to have a lead clinical role, ensuring services are individualized to strengths and needs of each youth/family 11 Keys to MST Engagement Treatment team responsible and accountable for engagement -- thus, therapists are taught to never give up on engaging a family Treatment is strength-focused Family members are viewed as full collaborators, with treatment goals set primarily by family members 12 07/07 4
5 Keys to MST Engagement (Continued) Services are individualized and comprehensive to meet multiple changing needs of youth and families Services are provided in the natural ecology, which decreases barriers to delivery Low caseloads provide time needed to establish treatment alliance Appointments are at times convenient for the family 13 How is MST Different? In general, MST differs from other treatments for antisocial behavior in these areas: Research: Proven long-term effectiveness through rigorous scientific evaluations Treatment theory: A clearly defined and empirically grounded treatment theory Implementation: A focus on provider accountability and adherence to the model Focus on long-term outcomes: Empowerment of caregivers to manage future difficulties 14 MST in New Mexico Guidance Ctr of Lea County La Frontera Hobbs Las Cruces, Alamogordo, Deming, Lordsburg, Silver City rkemp@gclcnm.org mickey.curtis@lafrontera.org Presbyterian Med Services Albuquerque, Santa Fe, Tsaos, Las Vegas, Rio Rancho, Belen, Los Lunas, Farmington julie_ingram@pmsnet.org Southwest Family Guidance Albuquerque, Santa Fe, Rio Rancho, Belen Los Lunas pjbruch.swfgc@gmail.com Turquoise Health & Wellness University of New Mexico Roswell, Clovis, Portales Albuquerque sbaltazar@thwnm.org japrince-smith@salud.unm.edu 15 07/07 5
6 MST with Problem Sexual Behavior Youth La Frontera Las Cruces, Deming Mickey Curtis Southwest Family Guidance Albuquerque. Rio Rancho, Santa Fe Renee Martinez Southwest Family Guidance Belen, Los Lunas Leandra Romero 16 Standard MST Referral Criteria (ages 12-17) Inclusionary Criteria Youth at risk for placement due to anti-social or delinquent behaviors, including substance abuse Youth involved with the juvenile justice system Youth who have committed sexual offenses in conjunction with other anti- social behavior Exclusionary Criteria Youth living independently Sex offending in the absence of other anti social behavior Autism Spectrum Disorder Actively homicidal, suicidal or psychotic Youths whose psychiatric problems are the primary reason leading to referral, or who have severe and serious psychiatric problems 17 Case Examples of MST with Special Populations With many youth being diagnosed with special issues beyond their delinquent acts, who is appropriate for MST and who is not? Some examples /07 6
7 19 What makes MST a good Substance Use Treatment? The value of treating adolescent substance use from a systemic perspective MST and Substance Abuse MST addresses risk and protective factors across the youth and family s ecology Serious clinical problems like youth criminal activity and substance abuse is mult-determined Youth cognative variables Family relationships Peer interactions School variables Family support networks Neighborhood context 07/07 7
8 MST and Substance Abuse Caregivers and Family are key to long term sustainable outcomes Continguency management that includes skill building for parents and care givers Continguency management for substance abusing parents Making Specific Clinical Recommendations re: Substance Abuse Treatment Specific assessment determines the need for substance use Looking at the continuum of Drug Use: Abstinence to Dependence The link between substance use and the high risk for negative life outcomes in adolescents (legal involvement, school failure, high conflict family interactions) MST Benefits Drawbacks Drug Court Benefits Drawbacks Intensive Out Patient Treatment (IOP) Benefits Drawbacks MST with Problem Sexual Behavior Youth La Frontera Las Cruces, Deming Mickey Curtis Southwest Family Guidance Albuquerque. Rio Rancho, Santa Fe Renee Martinez Southwest Family Guidance Belen, Los Lunas Leandra 24 07/07 8
9 Standard MST Referral Criteria (ages 12-17) Inclusionary Criteria Youth at risk for placement due to anti-social or delinquent behaviors, including substance abuse Youth involved with the juvenile justice system Youth who have committed sexual offenses in conjunction with other anti- social behavior Exclusionary Criteria Youth living independently Sex offending in the absence of other anti social behavior Autism Spectrum Disorder Actively homicidal, suicidal or psychotic Youths whose psychiatric problems are the primary reason leading to referral, or who have severe and serious psychiatric problems 25 Case Examples of MST with Special Populations With many youth being diagnosed with special issues beyond their delinquent acts, who is appropriate for MST and who is not? Some examples.. 26 Discussion Your experience with MST in New Mexico Questions/Concerns/Successes 27 07/07 9
10 Contact Information PJ Bruch, Southwest Family Guidance Center Jane Prince-Smith, University of New Mexico /07 10
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