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Intervention Summary

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Multisystemic Therapy for Youth With Problem Sexual Behaviors (MST-PSB)

Multisystemic Therapy for Youth With Problem Sexual Behaviors (MST-PSB) is a clinical adaptation of Multisystemic Therapy (MST) that is specifically targeted to adolescents who have committed sexual offenses and demonstrated other problem behaviors. MST-PSB is suitable for use with male and female youth, although the youth included in the studies reviewed for this summary were primarily male. The primary objectives of MST-PSB are to decrease problem sexual and other antisocial behaviors and out-of-home placements. Based in principle on an ecological model, the intervention is directed at youth and their families, with the collaboration of community-based resources such as case workers, probation/parole officers, and school professionals.

Services to youth include a functional assessment in the context of their families, school, community, and social networks and a subsequent treatment plan including individual therapeutic sessions. The specific treatments provided depend on the factors driving the youth's behavior but typically address deficits in overall family relations and the youth's cognitive processes, peer relations, and school performance. Parents participate in family therapy, gain skills to provide guidance to youth, and are encouraged to develop social support networks.

MST-PSB is delivered in the youth's natural environment (i.e., home, school, community) by master's-level therapists trained in a clinical area of the human service field. Each therapist provides approximately 5 to 7 months of intensive services to three to five families at a time. Many families require two to four sessions per week during the most active parts of treatment, with some families requiring a higher frequency of sessions based upon clinical need.

Descriptive Information

Areas of Interest Mental health treatment
Outcomes Review Date: December 2009
1: Problem sexual behavior
2: Incarceration and other out-of-home placement
3: Delinquent activities other than problem sexual behaviors
4: Mental health symptoms
5: Family and peer relations
6: Substance use
Outcome Categories Alcohol
Crime/delinquency
Drugs
Family/relationships
Mental health
Social functioning
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings Home
School
Other community settings
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History Clinical trials of MST-PSB were conducted in 1983-1987, 1990-1993, and 2004-2006, with the last trial being funded by the National Institute of Mental Health. MST-PSB has been implemented in 17 sites in Arizona, Colorado, Connecticut, Maine, Michigan, New Mexico, New York, Ohio, and Pennsylvania, serving more than 1,000 families. Outside of the United States, MST-PSB is being implemented in England and the Netherlands.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations Most of the written assessment materials have been translated into Spanish.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: December 2009

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Borduin, C. M., Schaeffer, C. M., & Heiblum, N. (2009). A randomized clinical trial of Multisystemic Therapy with juvenile sexual offenders: Effects on youth social ecology and criminal activity. Journal of Consulting and Clinical Psychology, 77(1), 26-37.  Pub Med icon

Study 2

Henggeler, S. W., Letourneau, E. J., Chapman, J. E., Borduin, C. M., Schewe, P. A., & McCart, M. R. (2009). Mediators of change for Multisystemic Therapy with juvenile sexual offenders. Journal of Consulting and Clinical Psychology, 77(3), 451-462.  Pub Med icon

Letourneau, E. J., Henggeler, S. W., Borduin, C. M., Schewe, P. A., McCart, M. R., Chapman, J. E., et al. (2009). Multisystemic Therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial. Journal of Family Psychology, 23(1), 89-102.  Pub Med icon

Supplementary Materials

Borduin, C. M., Henggeler, S. W., Blaske, D. M., & Stein, R. (1990). Multisystemic treatment of adolescent sexual offenders. International Journal of Offender Therapy and Comparative Criminology, 35, 105-114.

Outcomes

Outcome 1: Problem sexual behavior
Description of Measures Problem sexual behavior was measured using:

  • Recidivism data from court records. Youth criminal arrest data were obtained yearly from juvenile office records by research assistants who were blinded to condition assignment. Adult criminal arrest data were obtained from a database by a State police employee. Dates of all juvenile and adult arrests were recorded to ensure that arrest information was not duplicated. Only arrests resulting in adjudication were included.
  • Adolescent Sexual Behavior Inventory (ASBI). Two subscales of the ASBI were used to assess inappropriate adolescent sexual behaviors from both youth and caregiver perspectives. The 5-item youth version and 9-item parent/caregiver version of the deviant sexual interests subscale tap youth behaviors such as owning pornography, use of phone sex lines, and voyeurism. The 10-item youth version and 8-item parent/caregiver version of the sexual risk subscale assess overt sexual behaviors such as having unprotected sex, being sexually used by others, and pressuring others into having sex.
Key Findings Juvenile sexual offenders referred by the judicial court were randomly assigned to receive MST-PSB or usual community services, which consisted of outpatient group and individual treatment. Data from court records showed that fewer MST-PSB than comparison group youth were rearrested at least once for a sexual crime during the follow-up period, which averaged 8.9 years (8.3% vs. 45.8%, p < .001).

In another study, youth who were charged with a sexual offense and referred by the county State's attorney were randomly assigned to receive MST-PSB or typical offender-specific treatment, which consisted of group treatment and referrals. Based on youth and parent/caregiver reports on the two ASBI subscales, MST-PSB youth had a significantly greater reduction in problem sexual behavior from pretreatment to 12 months postrecruitment than their counterparts in the comparison group (p < .05 for youth and parent/caregiver reports on the deviant sexual interests subscale and the youth report on the sexual risk subscale; p < .01 for the parent/caregiver report on the sexual risk subscale).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.8 (0.0-4.0 scale)
Outcome 2: Incarceration and other out-of-home placement
Description of Measures Incarceration and other out-of-home placement were assessed using:

  • Court records. Information about sentencing was obtained for each juvenile and adult offense. Juvenile incarceration was measured as the number of days that a youth was placed by the department of youth services in a residential facility. Adult incarceration was measured as the number of days that a participant was sentenced to serve in an adult correctional facility. Juvenile and adult incarceration data were combined to provide a composite index of confinement during follow-up.
  • Services Utilization Tracking form. Each month, caregivers indicated whether the youth resided outside the home since the last assessment and, if so, the nature of the out-of-home placement (e.g., detention, foster care, residential sexual offender treatment).
Key Findings Juvenile sexual offenders referred by the judicial court were randomly assigned to receive MST-PSB or usual community services, which consisted of outpatient group and individual treatment. Data from court records showed that MST-PSB youth spent 80% fewer days in detention facilities than did youth in the comparison group during the follow-up period, which averaged 8.9 years (p < .01).

In another study, youth who were charged with a sexual offense and referred by the county State's attorney were randomly assigned to receive MST-PSB or typical offender-specific treatment, which consisted of group treatment and referrals. In monthly assessments through 12 months postrecruitment, MST-PSB youth were less likely to be in an out-of-home placement during the past 30 days than their counterparts in the comparison group (p < .001). The effect size for this finding is very small (odds ratio = 1.07).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.8 (0.0-4.0 scale)
Outcome 3: Delinquent activities other than problem sexual behaviors
Description of Measures Delinquent activities other than problem sexual behaviors were assessed using the Self Report Delinquency Scale (SRD), a 40-item measure that records self-reported criminal activity during the past 90 days. It includes a summary measure of the number of person-related crimes (e.g., assault, armed robbery) and property-related crimes (e.g., vandalism, stealing a car) committed by the youth.
Key Findings Juvenile sexual offenders referred by the judicial court were randomly assigned to receive MST-PSB or usual community services, which consisted of outpatient group and individual treatment. From pre- to posttreatment, self-reported person- and property-related crimes decreased among youth receiving MST-PSB and increased among those in the comparison group (p < .001).

In another study, youth who were charged with a sexual offense and referred by the county State's attorney were randomly assigned to receive MST-PSB or typical offender-specific treatment, which consisted of group treatment and referrals. Youth receiving MST-PSB had a greater reduction in self-reported delinquent behaviors over time than did those in the comparison group (p < .001). From pretreatment to 12 months postrecruitment, the percentage of youth reporting delinquent behaviors decreased by 60% for the MST-PSB group (74.6% at pretreatment, 41.5% at 6 months, and 29.7% at 12 months) and by 18% for the comparison group (51.7%, 43.4%, and 42.3%, respectively).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.9 (0.0-4.0 scale)
Outcome 4: Mental health symptoms
Description of Measures Mental health symptoms were assessed using:

  • Global Severity Index of the Brief Symptom Inventory (BSI-GSI). This 53-item self-report instrument measures symptoms of emotional distress experienced in the past week by mothers, fathers (when present), and youth. Items are rated on a scale from 0 (not bothered by the symptom) to 4 (extremely bothered by the symptom).
  • Revised Behavior Problem Checklist (RBPC). Behavior problems in youth were assessed by mother and father reports on the 89-item RBPC. Item scores range from 0 (no problem) to 2 (severe problems). In two-parent families, the mother's and father's individual rating scores were averaged together.
  • Child Behavior Checklist (CBCL) and Youth Self-Report (YSR). Youth externalizing and internalizing symptoms were assessed with parent reports on the CBCL and with youth reports on the corresponding YSR. Caregivers and youth were asked to rate the extent to which each description was true of the youth during the past 6 months on a scale from 0 (not true) to 2 (very often or often true).
Key Findings Juvenile sexual offenders referred by the judicial court were randomly assigned to receive MST-PSB or usual community services, which consisted of outpatient group and individual treatment. From pre- to posttreatment, mothers, fathers, and youth who participated in MST-PSB had decreases in self-reported psychiatric symptoms as measured by the BSI-GSI, whereas those in the comparison group had increases in these symptoms (p < .001 for mothers and youth; p < .05 for fathers). In addition, RBPC data showed that parent-reported youth behavior problems decreased among the MST-PSB youth and increased among youth in the comparison group from pre- to posttreatment (p < .05).

In another study, youth who were charged with a sexual offense and referred by the county State's attorney were randomly assigned to receive MST-PSB or typical offender-specific treatment, which consisted of group treatment and referrals. MST-PSB youth had a significantly greater reduction in self-reported externalizing symptoms on the YSR across time (from pretreatment to 6 and 12 months postrecruitment) relative to youth from the comparison group (p < .05). There were no significant differences between groups on the remaining variables (i.e., caregiver-reported externalizing symptoms and caregiver- and youth-reported internalizing symptoms).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.9 (0.0-4.0 scale)
Outcome 5: Family and peer relations
Description of Measures Family and peer relations were assessed using:

  • Family Adaptability and Cohesion Evaluation Scales II (FACES-II). Mother, father (when present), and youth perceptions of family relations were reported using the 30-item FACES-II, which assesses the constructs of cohesion and adaptability. The items are rated on a scale from 1 (almost never) to 5 (almost always). Because parent and youth ratings were highly correlated, they were averaged together to form composites.
  • Missouri Peer Relations Inventory (MPRI). Parent, youth, and teacher perceptions of the youth's peer relations were evaluated with the 13-item MPRI. The MPRI measures three dimensions of peer relations: emotional bonding, aggression, and social maturity. Item scores range from 1 (rarely) to 5 (often). Given high intercorrelations between parent and teacher ratings on these dimensions, their scores were averaged together to form composites. Youth ratings had low correlations with parent and teacher ratings and therefore were evaluated separately.
Key Findings Juvenile sexual offenders referred by the judicial court were randomly assigned to receive MST-PSB or usual community services, which consisted of outpatient group and individual treatment. Results of this study showed that:

  • From pre- to posttreatment, self-reported cohesion and adaptability increased significantly among families receiving MST-PSB and decreased among those in the comparison condition (p values < .001).
  • Based on reports by both youth and their parents and teachers, emotional bonding and social maturity increased from pre- to posttreatment among youth in the MST-PSB condition and decreased among youth in the comparison condition (p < .008 for emotional bonding as reported by youth, emotional bonding as reported by parents and teachers, and social maturity as reported by youth; p < .001 for social maturity as reported by parents and teachers). Parent and teacher reports also indicated that aggression toward peers decreased among youth receiving MST-PSB and increased among youth in the comparison condition (p < .008), but youth reports on aggression did not show a difference between groups.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.6 (0.0-4.0 scale)
Outcome 6: Substance use
Description of Measures Substance use was assessed using a subscale of the Personal Experience Inventory (PEI). This subscale consists of two self-report items measuring the frequency of adolescent alcohol and marijuana use during the past 90 days.
Key Findings Youth who were charged with a sexual offense and referred by the county State's attorney were randomly assigned to receive MST-PSB or typical offender-specific treatment, which consisted of group treatment and referrals. Youth receiving MST-PSB had a significant reduction in self-reported substance use over time relative to those in the comparison group (p < .01). From pretreatment to 12 months postrecruitment, the percentage of youth reporting substance use decreased by 52% for the MST-PSB group (35.8% at pretreatment, 24.6% at 6 months, and 17.2% at 12 months) and increased by 65% for the comparison group (23.3%, 32.8%, and 38.5%, respectively).
Studies Measuring Outcome Study 2
Study Designs Experimental
Quality of Research Rating 3.9 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent) 96% Male
4% Female
71.4% White
26.5% Black or African American
2.1% Hispanic or Latino
Study 2 13-17 (Adolescent) 97.6% Male
2.4% Female
41.2% Black or African American
33.6% White
23.7% Hispanic or Latino
1.5% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Problem sexual behavior 3.5 3.5 4.0 4.0 3.5 4.0 3.8
2: Incarceration and other out-of-home placement 4.0 3.5 4.0 4.0 3.5 4.0 3.8
3: Delinquent activities other than problem sexual behaviors 4.0 4.0 4.0 4.0 3.5 4.0 3.9
4: Mental health symptoms 4.0 4.0 4.0 4.0 3.5 4.0 3.9
5: Family and peer relations 3.5 3.5 3.5 4.0 3.0 4.0 3.6
6: Substance use 4.0 4.0 4.0 4.0 3.5 4.0 3.9

Study Strengths

Most of the instruments used in the studies have well-researched psychometric properties. Numerous studies have used these measures and have supported their reliability and validity, and some of the measures are considered the gold standard in the field (i.e., CBCL, BSI-GSI). Methods undertaken to ensure intervention fidelity were comprehensive and included a standardized treatment manual, a standard measure of therapist adherence, and weekly supervision and consultation sessions by an MST supervisor. The studies had high retention rates. Researchers used randomization to treatment condition, and tests showed no baseline differences between the intervention and comparison groups in demographic characteristics or criminal histories. Appropriate analyses were used in both studies.

Study Weaknesses

The ASBI and MPRI have low and moderate reliability, respectively, and the ASBI additionally has only face validity and lacks other psychometric information. There was a potential confound in one study in that court records were limited to the State in which the intervention took place; although all study participants lived in that State throughout the follow-up period, they may have committed crimes outside the State that were not reflected in the records reviewed.

Readiness for Dissemination
Review Date: December 2009

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Borduin, C. M., Letourneau, E. J., Henggeler, S. W., & Swenson, C. C. (n.d.). Treatment manual for multisystemic therapy with problem sexual behavior youths and their families. Columbia, MO: Author.

Borduin, C., & Munschy, R. (n.d.). Supplemental training: Multisystemic Therapy with problem sexual behavior youths and their families.

Henggeler, S. W., & Schoenwald, S. K. (1998). Multisystemic Therapy supervisory manual: Promoting quality assurance at the clinical level. Charleston, SC: Author.

Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents. New York: Guilford Press.

MST Services. (2003). Making the paperwork work for you: A step-by-step guide to completing the documentation used in MST supervision and consultation. Mt. Pleasant, SC: Author.

MST Services. (2004). Multisystemic Therapy: An introductory training [training handouts]. Mt. Pleasant, SC: Author.

MST Services. (2004). Multisystemic Therapy (MST) overview [PowerPoint slides]. Mt. Pleasant, SC: Author.

MST Services. (n.d.). Multisystemic Therapy [DVD]. Mt. Pleasant, SC: Author.

Multisystemic Therapy Readiness for Dissemination

Program Web sites, http://mstpsb.com, http://www.mstservices.com, and http://www.mstinstitute.org/

Schoenwald, S. K. (1998). Multisystemic Therapy consultation manual. Charleston, SC: Author.

Strother, K. B., Swenson, M. E., & Schoenwald, S. K. (2007). Multisystemic Therapy organizational manual. Mt. Pleasant, SC: MST Services.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
4.0 4.0 4.0 4.0

Dissemination Strengths

Well-developed and comprehensive implementation materials guide and support clinicians and supervisors as well as the administrative and organizational dimensions of program implementation. Manuals include specific strategies for engaging and working with families of youth with problem sexual behavior. The developer completes an indepth telephone interview with potential MST-PSB implementers to ensure that the program will address the needs of the population served and that the organization has the resources and capacities to deliver the intervention with fidelity. A robust and comprehensive training is offered for clinicians and supervisors. Furthermore, the developer has well-organized follow-up coaching and booster sessions to support implementation. Highly developed quality assurance methodologies are provided to ensure high-fidelity implementation, and assistance is available to help measure site-specific outcomes.

Dissemination Weaknesses

No weaknesses were identified by reviewers.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Implementation materials and licensing fees $4,000 per site and $2,500 per team Yes
Start-up support, site assessment, and all system consultation (includes 2-day, on-site orientation training) $11,000 plus travel expenses Yes
Ongoing support (includes quarterly on-site booster training) $38,000 per year plus travel expenses Yes
Quality assurance data collection support $10,800 per team No

Additional Information

The total cost of implementation is driven primarily by staff salaries, which vary geographically. An MST-PSB team typically consists of a full-time master's-level clinical supervisor, four full-time master's-level therapists, and a part-time administrative assistant. For a typical MST-PSB program implementation with 1 team serving 36 families per year, the total cost for the first year is $460,400, or $12,788 per participant. This estimate accounts for start-up and ongoing support, licensing, quality assurance activities, staff compensation, and travel expenses.

Contact Information

To learn more about implementation, contact:
Richard J. Munschy, Psy.D.
(860) 348-1938
Munschy@mstpsb.com

To learn more about research, contact:
Charles M. Borduin, Ph.D.
(573) 882-4578
borduinc@missouri.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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