What is Multisystemic Treatment?
Multisystemic treatment, or MST, is a comprehensive treatment model for adolescents with behavioral and emotional issues. An MST approach to adolescent treatment acknowledges the complex world in which our children’s behaviors are learned and constantly reinforced. MST acknowledges that your daughter’s world is comprised of numerous systems-family, school, friends, treatment team, etc.-all of which are connected and each of which can either support or impede her healing. In clinical language, that means we’re all part of a network of interdependent systems that must be coordinated for healing to occur; in simpler language, it means that we’re all in this together.
MST was created in the 1970s to address high rates of recidivism and relapse among teens suffering from oppositional-defiant disorder (ODD), drug and alcohol abuse, and other destructive behaviors. The lack of long-term success in addressing these issues along with the advent of systems theory led clinicians to explore a multisystemic model. This meant that clinicians accounted for and, where practical, engaged a variety of social systems-family, peer groups, school staff, etc.-in the treatment process. Both risk factors and protective factors are identified for each social system so that they can be accounted for in the treatment process. Though complex by nature, MST has been shown to work. Outcome studies over the past several decades show that MST is a highly effective approach for:
- decreasing relapse and recidivism,
- reducing rates of out-of-home placements,
- improving family functioning,
- decreasing behavior and mental health problems.
MST research has identified specific risk factors for each type of system the young person is involved in-family, extended family, school, peers, home community, residential care community, etc. Each system also has a set of identified protective factors that can mitigate those risk factors. At school, for instance, associating with negative peers is identified as a risk factor that can be mitigated by teaching the young person to identify and connect with positive peers. As the young person’s risk factors and protective factors are identified in all of the systems in which she participates, a treatment plan can then be constructed. An MST treatment plan is strengths-based and focuses on building up existing protective factors across all systems and creating new ones where possible.
Not every program is equipped to implement an effective MST program. If you are considering an MST oriented program for your child, be sure the program is:
Individualized: MST requires an understanding of the complexities of the adolescent and all of her social groups. Because every person is different and lives in a unique social universe, MST is a highly individualized model of treatment. Look for a program that that tailors treatment to the individual adolescent and that re-evaluates the treatment plan regularly.
Team Oriented: Because a residential treatment program using MST is individualized rather than one-size-fits-all, it requires a higher staff to student ratio than a program using, for instance, a behavioral approach to treatment. Since students and the various systems they participate in must be constantly monitored, understood, and engaged in real time, an MST oriented treatment team benefits from lots of eyes and ears and robust communication. The more coordinated and healthy the treatment team is, the better able they are to effectively address the needs of other systems such as the family, the peer group, etc.
Strengths Based: Even though pathology and risk factors are critical information for an MST treatment plan, MST is focused on developing strengths. Rather than fixing the problem by focusing on it, MST fixes the problem by focusing on building or tapping compensatory, protective strengths in the young person and all of the systems that she interacts with. By capitalizing on strengths that already exist, progress is more efficient and enduring.
Relational: Even though MST is clinically sophisticated and deals with the complexity of multiple social systems, it is at core a highly relational approach to treatment. Therapists and therapeutic teams utilizing MST must maintain high-quality relationships with each other, their clients, and their client’s families and communities. Without this high quality of relationship, an MST program is unlikely to succeed. Look for a warm, accessible, relationally oriented staff when you visit an MST program.
Family Focused: As the most influential and enduring system a young person participates in, the family should factor large in any MST treatment program. Look for a strong family therapy and parent education component in an MST program, preferably one that utilizes a family-systems approach. MST programs should strive to empower parents so that their influence on their daughter and on other systems is powerful and positive.
Evidence Based: MST is a highly pragmatic, clinically sophisticated model that is backed by solid research. As such, programs using MST have access to well-documented best practices and applied methodologies. It is a central tenet of MST to constantly monitor and publish outcomes so that the MST treatment community can continue to evolve its practices. A program using MST should be able to describe the research its practices are based on and should be able to provide you with outcome data on their own students. They should have evidence of a low relapse and recidivism rate compared to other programs working with a similar population.
MST programs can effectively harness the power of an adolescent’s social affiliations to redirect behaviors in a positive direction. To ensure that a program is effectively utilizing MST approaches, it’s important to actually visit and confirm that it employs the critical features of MST. A good MST program can powerfully and permanently help young people with longstanding behavioral issues heal and succeed.