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Family Preservation Using Multisystemic Therapy: An Effective Alternative to Incarcerating Serious Juvenile Offenders
Abstract
Multisystemic therapy (MST) delivered through a community mental health center was compared with usual services delivered by a Department of Youth Services in the treatment of 84 serious juvenile offenders and their multiproblem families. Offenders were assigned randomly to treatment conditions. Pretreatment and posttreatment assessment batteries evaluating family relations, peer relations, symptomatology, social competence, and self-reported delinquency were completed by the youth and a parent, and archival records were searched at 59 weeks postreferral to obtain data on rearrest and incarceration. In comparison with youths who received usual services, youths who received MST had fewer arrests and self-reported offenses and spent an average of 10 fewer weeks incarcerated. In addition, families in the MST condition reported increased family cohesion and decreased youth aggression in peer relations. The relative effectiveness of MST was neither moderated by demographic characteristics nor mediated by psychosocial variables.
... With regards to the setting of the interventions, five of them included family members exclusively (58,60,61,63,68). Five others combined family and individual sessions (k = 5), two used individual sessions only (56,66), two consisted of sessions ingroup formats (64,69), and one made use of all settings [group, individual, and family (59)]. ...
... Most of the studies relied on ED outcomes using self-report measures. In contrast, some studies used interviews with parent and adolescents (59,62) or derived ED directly from reports on delinquent activities and referrals (60,67). There was a strong tendency to use confirmatory factor analyses to create a critical measure of ED through different items from different instruments, besides criminal or justice referrals (58,61,66,68,69). ...
... With regards to outcome measures, the lack of a consensual criterion for assessing externalising behaviours was demonstrated. Namely, several studies (58,60,65,66,68) used various items from different self-report instruments to statistically develop an adjusted and reliable CFA to represent externalising behaviours. Others used objective, and hypothetically more robust measures of externalising behaviours such as interviews for testing antisocial behaviours (59,62), criminal activities and incarcerations (60), and the number of criminal referrals and days locked up (67). ...
Background
Externalising behaviours are becoming a remarkably prevalent problem during adolescence, often precipitating both externalising and internalising disorders in later adulthood. Psychological treatments aim to increase the social functioning of adolescents in order for them to live a more balanced life and prevent these negative trajectories. However, little is known of the intervening variables and mediators involved in these treatments' change mechanisms. We conducted a systematic review, exploring the available evidence on mediators of psychological treatments for externalising behaviours and symptoms amongst adolescents (10 to 19 years old).
Methods
A systematic search was performed on Medline and PsycINFO databases, which identified studies from inception to February 23, 2020. Eligible studies included randomised controlled trials that enrolled adolescents with externalising symptoms and behaviours as, at least, one of the primary outcomes. A group of 20 reviewers from the COST-Action TREATme (CA16102) were divided into 10 pairs. Each pair independently screened studies for inclusion, extracted information from the included studies, and assessed the methodological quality of the included studies and the requirements for mediators, following Kazdin's criteria. Risk of bias of RCTs was assessed by the Mixed Methods Appraisal Tool. Extracted data from the included studies were reported using a narrative synthesis.
Results
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), after removing duplicates, 3,660 articles were screened. Disagreements were resolved by consensus. In a second stage, 965 full-text articles were assessed for eligibility. A total of 14 studies fulfilled all inclusion criteria. The majority were related to systemic psychological treatment approaches. Two types of mediators were identified as potentially being involved in the mechanisms of change for better social improvements of adolescents: to increase healthier parent–adolescent relationships and parental discipline. However, there were significant and non-significant results amongst the same mediators, which led to discussing the results tentatively.
Conclusions
Family variables were found to be the largest group of investigated mediators, followed by relational, behavioural, and emotional variables. No cognitive or treatment-specific mediators were identified. Both adequate behavioural control of adolescents' peer behaviour and a better positive balance in their relationships with their parents seemed to buffer the effects of externalising behaviours in adolescents. Several methodological limitations concerning mediation testing design, outcome measures, and mediator selection have been identified.
Ethics and Dissemination
Ethical approval was not required. PROSPERO registration number: CRD42021231835.
... There are a number of examples of a revitalization of interest in a family intervention focus for juvenile justice policy and practice (Sweet, 1991;Wood, 1990;Wright & Wright, 1994). New family intervention programs include a variety of parent training and family behavior modification approaches (Patterson and Stouthamer-Loeber, 1984), family preservation (Henggeler, Melton & Smith, 1992), "home builders" (Forsythe, 1992), and a variety of crisis intervention and family treatment or "family systems" programs (McGaha and Fournier, 1987). In addition, more specialized family intervention units are now appearing in some juvenile courts, and there has been a renewed interest in the family court model as an administrative structure for integrating casework with delinquents, child welfare, child support and other functions (Rubin and Flango, 1992). ...
... National juvenile justice policy statements are beginning to cite family intervention as a renewed priority (e.g., Sweet, 1991;Wilson and Howell, 1993), and more training workshops for probation and parole professionals are being devoted to family services topics. Finally, delinquency researchers and theorists have become more interested in the family-albeit from new perspectives such as the role of abuse, family systems analysis, and differential oppression (Widom, 1992;Henggeler, Melton and Smith, 1992;Regoli and Hewitt, 1994;Van Voorhis et al., 1988). But while some of these studies-especially program evaluations of parental training and systems approaches-seem to have gained the attention of policymakers (e.g., Wilson and Howell, 1993;Wright & Wright, 1994), thus far, implementation of family intervention in the juvenile justice context does not appear to be research-based or theoretically grounded (c.f., AuClaire & Schwartz, 1986). ...
... If the juvenile justice system can influence the beliefs of juveniles, diminishing the war zone mentality by decreasing perception of threat and legitimization of violence, then it can better decrease the likelihood of more juvenile violent crime. This section will detail one type of treatment, Multisystemic Therapy (MST) which has been one of the most effective treatments at decreasing violent juvenile reoffending in number of offenses and severity of offenses (Henggeler et al., 1992(Henggeler et al., , 2009Tate et al., 1995;Borduin et al., 1995;Schaeffer & Borduin, 2005). ...
... A promising area for future research would be to survey youth on their beliefs about violence, and their perception of threat in order to test directly if MST is effective because of a decrease in war zone mentality. Researchers attribute the treatment's success to its systematic approach, but they do not get more specific (Henggeler et al., 1992). Future studies may include surveys measuring agreement with statements such as: I am safe in my neighborhood, I need a weapon to be safe, "aggression is legitimate, aggression increases self-esteem, victims deserve aggression," or, I often relive violent memories (statements on aggression from Guerra & Slaby, 1990, p 271). ...
http://deepblue.lib.umich.edu/bitstream/2027.42/134379/1/zoeaya.pdf
... Multisystemic Therapy (MST) is an intensive family and community-based intervention emphasizing the interplay of risk factors within a youth's ecological context to be the driving components of adolescent antisocial behavior (Henggeler et al., 1992;Henggeler, Rowland, et al., 1999). Accordingly, the overarching aim of MST is to surround juvenile offenders (ages 11 ...
... to 17) with serious antisocial behaviors and their primary caregivers with a context that supports prosocial behavior by targeting involvement and effective caregiving practices, a prosocial peer network, and supportive school environment (Henggeler et al., 1992;Henggeler, Rowland, et al., 1999). MST employs a home-based model where master's level professionals are available 24 hr a day, 7 days a week through an on-call rotation, and deliver services where problems occur (i.e., homes, schools, and neighborhood) (Henggeler, Rowland, et al., 1999). ...
Behavior disorders are the leading cause of psychological problems affecting young children and adolescents. Behavioral parent training (BPT) programs have been developed to address child behavioral disturbances by supporting caregivers’ skills in shaping their children's behaviors. BPT interventions are packaged in a variety of ways but maintain important common elements. This article reviews the evidence of effectiveness across 19 programs with 1–72 published treatment trials. Across programs, BPT interventions evidence positive outcomes for children and caregivers across psychological, social, and biological outcomes. Program implementations range from local to international, underlining the ubiquitous nature of parenting and the positive effects of parental participation in BPT on child behavior.
... In the first evaluation of MST to train therapists from an existing community mental health center in the MST model, multisystemic family preservation was examined in the treatment of serious juvenile offenders (Henggeler et al. 1992). The family preservation model of service delivery was used because of its theoretical and clinical compatibility with MST. ...
... Using data from two aforementioned studies (Borduin et al., unpublished;Henggeler et al. 1992), Henggeler and colleagues (1991) evaluated the effects of MST on substance use and abuse in samples of serious juvenile offenders. Analyses of 4-year recidivism data from the Missouri Delinquency Project showed that offenders who participated in MST had significantly fewer arrests for substancerelated crimes than did youths who participated in individual counseling. ...
... Multisystemic Therapy® (MST) began testing its model designed for status and criminally offending youth in the late 1980s (Brunk, Henggeler, & Whelan, 1987;Henggeler, Melton, & Smith, 1992). After a decade of research suggesting that MST was generally applicable to children with problematic behaviors who were at risk for out-of-home placement (i.e., detention), the model developers hypothesized that it would be effective for children at risk for psychiatric hospitalization (Henggeler et al., 1999). ...
... Highlighting the dissimilarities of IHBTs targeting different populations, previous authors have noted that MST-Psychiatric did not much resemble its forbearers in cost-effectiveness (Littell, Campbell, Green, & Toews, 2005). While a traditional MST caseworker spent 33 h with a delinquent youth and family (Henggeler et al., 1992), MST-Psychiatric therapists logged an average of 92 h, with reduced caseloads of 3, rather than 5, clients (Henggeler et al., 2003). At this level of intensity, intervention expenditures were approximately equivalent to hospitalization (about $6000 per child Burns, Schoenwald, Burchard, Faw, & Santos, 2000). ...
Intensive home-based programs for youth with serious emotional disturbances operate in nearly every state and occupy a critical position in the continuum of care: the threshold between community retention and institutional placement. Despite their ubiquity and in contrast to research on home-based interventions for other populations, there is a relative dearth of empirical findings describing the efficacy of such interventions with youth with serious emotional disturbances and their families. The present paper offers a comprehensive review of experimental and quasi-experimental studies in this field. Taken together, the results of these studies suggest that intensive home-based interventions can effectively improve children's emotional and behavioral impairment, particularly from caregivers' perspectives. Involving state partners in large-scale, multi-outcome studies may further elucidate mechanisms of change and establish benchmarks that allow for more conclusive comparisons between treatment alternatives.
... Several evidence-based programs exist for treating highrisk youth, including the well-researched treatment model, multisystemic therapy (MST; Henggeler et al. 1992Henggeler et al. , 1997Henggeler et al. , 2009Borduin et al. 1995). The MST treatment framework posits that problem behaviors are associated with the interplay of individual, family, and community characteristics; thus, intervention must occur between multiple systems in order to create optimal behavioral and health outcomes for youth (for a review, see Henggeler 2011). ...
... Over the last 35 years, several studies conducted by MST program developers and independent, smaller-scale studies, have examined the efficacy and effectiveness of MST for reducing problem behaviors (e.g., Timmons-Mitchell et al. 2006;Henggeler et al. 1992Henggeler et al. , 1997Borduin et al. 1995). However, few studies have examined the effectiveness of MST when disseminated in large-scale, statewide systems (e.g., Lofholm et al. 2014;Dekovic et al. 2012;Glisson et al. 2010), or across long-term follow-up periods. ...
Multisystemic Therapy (MST) was developed to help youth with serious social, emotional, and behavioral problems. Research on the efficacy and effectiveness of MST has shown positive outcomes in different domains of development and functioning among various populations of youth. Nonetheless, even with a large body of literature investigating the treatment effects of MST, few studies have focused on the effectiveness of MST through large-scale dissemination efforts. Utilizing a large sample of youth involved in a statewide dissemination of MST (N = 740; 43% females; 14% Black; 29% Hispanic; 49% White; Mage = 14.9 years), propensity score matching was employed to account for baseline differences between the treatment (n = 577) and comparison (n = 163) groups. Treatment effects were examined based on three outcomes: out-of-home placement, adjudication, and placement in a juvenile training school over a six-year period. Significant group differences remained after adjusting for baseline differences, with youth who received MST experiencing better outcomes in offending rates than youth who did not have an opportunity to complete MST due to non-clinical or administrative reasons. Survival analyses revealed rates of all three outcomes were approximately 40% lower among the treatment group. Overall, this study adds to the body of literature supporting the long-term effectiveness of MST in reducing offending among high-risk youth. The findings underscore the potential benefits of taking evidence-based programs such as MST to scale to improve the well-being and functioning of high-risk youth. However, strategies to effectively deliver the program in mental health service settings, and to address the specific needs of high-risk youth are necessary.
... Based on a systematic review analysing the ef cacy of MST, all included studies showed clinically signi cant treatment effect post intervention (Tan & Fajardo, 2017). The improvement was signi cant in terms of reducing incarceration and delinquency Henggeler et al., 1992;Letourneau et al., 2009) and sexoffending behaviour Letourneau et al., 2009). Most importantly, two of three found MST to help in reducing antisocial behaviour including aggression and non-compliant (Ogden & Halliday-Boykins, 2004;Weiss et al., 2013). ...
Aggression within the family has been explored in multiple areas, but the most neglected area is young people’s aggression directed towards their parents. Recently, researchers and policy makers are giving more attention to this area of family aggression, in light of the increasing number of cases. However, similar to spousal violence, adolescents’ aggression towards the family still suffers from underreporting. In this chapter, we will give the definition of adolescent’s aggression towards the family. We will give an overview of the prevalence of aggression by young people within the home settings, especially on child violence directed towards parents, and outline the characteristics and risk factors of this type of aggression. We also use case examples to illustrate this phenomenon. This chapter also includes a brief guideline for conducting assessment, formulation and suggestions for interventions. The challenges for professionals working in this family violence area will also be presented and explained, with the hope that it can be used as a guideline for parents, family and practitioners working with the affected families.KeywordsChild to parent aggressionRisk factorsProtective factorsIntervention for parent-direction aggression
... Multisystemic Therapy (MST) is an evidence-based treatment implemented in many PMHC settings which is based on ecological theories of behavior in which therapists work with the multiple systems a youth interacts with (school, community, family) and has been shown to be effective for youth with antisocial behaviors, conduct-related problems, and substance abuse (Henggeler, 2011;Timmons-Mitchell et al., 2006). In fact, MST was developed in the context of juvenile justice systems, and with juvenile offenders and their families, which often serve clients like those seen in PMHC (e.g., clients with externalizing concerns, co-and multi-morbid psychiatric disorders, from historically underserved communities; Henggeler et al., 1992). Furthermore, MST's emphasis on balancing individualization (e.g., specific goal setting) and treatment fidelity makes it ideal for examining TFD. ...
Purpose
Treatment focus diffusion (TFD), dividing focus across multiple concerns during treatment, is common in public mental health care and differs from the more narrowly focused empirically supported treatments for youth reported in the literature. The present study examined whether and to what extent TFD is associated with youth functional improvement over the course of therapy. Method: This study utilized multi-level modeling techniques to analyze 12 consecutive years of standardized routine clinical service data from youth receiving treatment in one of two intensive in-home service settings: (a) Multisystemic Therapy (MST; n = 776 youths, 99 therapists), an implemented evidence-based treatment based on ecological theories of behavior in which therapists work with the multiple systems a youth interacts with (school, community, family), and (b) a standards-based service (n = 1854 youth, 413 therapists). Both service settings operate in the context of a publicly funded mental health care system which serves youth and families who are typically from underserved and low-income backgrounds. Majority of youth in this sample identified as multi-ethnic and male, and they, on average, were approximately 13 years old with three co-occurring diagnoses. Results: A significant TFD by service format interaction on youth functional improvement (alone and in the overall model) and follow up simple effects indicated that higher TFD was associated with significantly poorer outcomes in MST. The parameter estimate for TFD on functional improvement in the standards-based service format was in the same direction, but not statistically significant. Conclusion: Our findings suggest that maintaining a narrower treatment focus might be beneficial to clients, particularly in implemented evidence-based treatments. Likewise, TFD could be a helpful case monitoring tool for clinicians, supervisors, and systems leaders when reviewing intensive-in-home cases.
... "The Incredible Years Parent, Teacher, and Child" training series which targets children who display early indications of conduct problems have also been shown to reduce the chances of violent offending later in adolescence (Piquero et al., 2008). To reduce the SVC delinquency in youths whom this behavior has already manifested, a tertiary prevention program known as multisystemic therapy (MST) was implemented and found as a strong tool in the reduction and cessation of SVC delinquency (Borduin et al., 1995;Curtis et al., 2004;Henggeler et al., 1992). This intervention was individualized and highly flexible, addresses intrapersonal (cognitive) and systemic factors (family, peer, school) factors that were known to be related to adolescent antisocial behavior (Borduin et al., 1995). ...
Aggression and violent behavior are widespread in the world and cause serious threats to public safety. Violent criminal recidivism rates remain very high among certain groups of offenders. In India, the quantum of total violent crimes is continuously increasing from 2009 to 2019. Adverse childhood experiences can affect the development of a child in many ways, leading to highly maladaptive behaviors, such as serious, violent, and chronic (SVC) delinquency. This study was done as a case-control method among recidivist violent offenders and controls to examine the effects of adverse childhood experiences (ACEs) on violent criminality. The questionnaire included the World Health Organization Adverse Childhood Experiences International Questionnaire (ACE- IQ) and standardized measures of Health Risk Behaviors (HRBs). Thirteen categories of adverse childhood experiences of the recidivist violent offenders and controls were measured. Bivariate analysis showed that there was a significant relation (p < 0.001) between ACEs and violent criminality in cases (M = 72.14, SD = 6.80, N = 35) and controls (M = 44.91, SD = 5.39, N = 32). The largest correlation was found between collective violence and household violence (r = 0.813). Bivariate correlation analyses were highly significant between total ACE score and criminality (r (35) = 0.927, p < 0.001). The results reveal that household violence, community violence and collective violence experienced by recidivist violent offenders were nearly double the rate of the control group. Findings emphasize the need for evaluations of ACEs in recidivist offenders for better rehabilitation strategies and also the necessity for preventive efforts at all levels.
Supplementary information:
The online version contains supplementary material available at 10.1007/s40653-021-00434-1.
... Research to identify feasible and acceptable substance use interventions to implement and sustain within juvenile justice settings to prevent or decrease substance use is emerging (Knight et al., 2016), but in tremendous need given the shortage of such services (Funk et al., 2020). Efficacious substance use interventions for JIY include family, are intensive, and typically address secondary or tertiary prevention of substance use (e.g., Multisystemic Therapy; Henggeler et al., 1992); these are not typically feasible for implementation within busy, often overburdened and under-resourced juvenile justice settings, yet research on brief substance use prevention interventions for JIY is lacking. Individual level, modifiable factors that can be incorporated into brief interventions and feasibly delivered within juvenile justice settings to prevent and/or reduce youth substance use must be identified (Dauria et al., 2018). ...
Background
Justice-involved youth use cannabis at higher rates than their same-aged peers increasing likelihood of adverse behavioral health consequences and continued legal involvement. This study examined individual level predictors of early onset use cannabis use (<13 years of age) and cannabis use initiation in the 12 months following first court contact.
Methods
Participants were 391 first-time justice-involved youth (56.9% male; Mage = 14.6 years; 32.1% White, 11.1% Black, 14.7% Other/Multi-racial, 42.2% Latinx) and an involved caregiver (87.2% female; Mage = 41.0 years). Baseline assessments captured individual level factors; cannabis use was assessed every four months post-baseline for 12 months. Primary analyses involved multivariable modified Poisson regressions and survival analysis.
Results
In multivariable models, youth who reported lifetime cannabis use (n = 188, 48.1%) were older, reported alcohol use and positive cannabis use expectancies. Greater self-control and self-concept were associated with lower likelihood of lifetime cannabis use. Youth who initiated cannabis during the 12-month follow-up (n = 30, 14.8%) tended to be older, White/non-Latinx, and to report more psychiatric symptoms (posttraumatic stress, externalizing, internalizing, and affect dysregulation), delinquent behavior, lower levels of self-control, poorer self-concept, greater drug use intentions and positive cannabis expectancies. In the multivariable survival analysis, affect dysregulation, internalizing symptoms, and more positive cannabis expectancies remained independently and positively associated with cannabis initiation.
Conclusions
There is a critical and unique window of opportunity to prevent cannabis use initiation among first-time justice-involved youth. Research is needed to determine whether brief interventions that aim to modify expectancies about cannabis use reduce rates of cannabis initiation in this underserved population.
... Whilst the majority of tertiary prevention strategies are provided in prison settings, as demonstrated in IM these can also be provided in the community. Multi-Systemic Therapy (MST; Henggeler et al., 1992) is a home-based intervention for adolescents, aged 12-17 years, that have engaged in offending behavior (Mertens et al., 2017). According to MST, deviant behavior is a product of the proximal systems (i.e., family, peer groups, school and community) that the young person belongs to. ...
Tackling street gangs has recently been highlighted as a priority for public health. In this paper, the four components of a public health approach were reviewed: (1) surveillance, (2) identifying risk and protective factors, (3) developing and evaluating interventions at primary prevention, secondary prevention and tertiary intervention stages, and; (4) implementation of evidence-based programs. Findings regarding the effectiveness of prevention and intervention programs for street gang members were mixed, with unclear goals/objectives, limited theoretical foundation and a lack of consistency in program implementation impeding effectiveness at reducing street gang involvement. This paper proposes that the Good Lives Model (GLM), a strengths-based framework for offender rehabilitation, provides an innovative approach to street gang intervention. Utilizing approach-goals, the GLM assumes that improving an individual's internal skills and external opportunities will reduce the need to become involved in street gangs. Wrapping the GLM framework around current evidence-based interventions (e.g., Functional Family Therapy) increases client engagement and motivation to change, which is notably poor amongst those at-risk of, or involved in, street
... MST is delivered at homes in order to reduce the barriers that families may face when receiving treatment services. The average length of treatment is 4 months and focuses on empowering parents and improving strengths and support systems (Henggeler et al., 1992). MST has been implemented in community-based mental health settings and among diverse populations (Borduin et al., 1995;Brunk et al., 1987;Henggeler et al., 1995Henggeler et al., , 1996. ...
Research has demonstrated a relationship between childhood trauma, violence, and justice involvement. As juvenile justice systems have become more attune to the needs of traumatized youth, a number of trauma-informed treatment programs have been developed to mitigate the effects of trauma. Evaluations of trauma-informed treatment demonstrate their effectiveness in reducing trauma-related symptoms. Further, prior research has found that trauma-informed treatment can reduce behavioral infractions and institutional violence. While there is indirect evidence that trauma-informed treatment reduces juvenile violence and recidivism, no research to date has assessed trauma-informed treatment on behavioral outcomes outside of residential facilities. This systematic review provides an overview of the use trauma-informed treatment in juvenile justice settings and provides recommendations for practice and future research.
... Russell Crane (2008) Familientherapeutisch-strategische Aspekte Provokant-paradoxe Interventionen entwickelte auch Jay Haley (1980Haley ( , 1981 (Henggeler et al. 1998). Verschiedene randomisierte klinische Studien konnten ihre Effektivität in der Behandlung hochproblematischer Stichproben nachweisen, darunter delinquente Jugendliche (Borduin et al. 1995(Borduin et al. , 2003Henggeler et al. 1992), Drogenabhängige (Henggeler et al. 2002) und akute Psychotiker . Das Behandlungskonzept der multisystemischen Therapie ist sozio-ökologisch und familientherapeutisch fundiert. ...
Die Wahl des passenden Settings ist mehr als die halbe Miete, wenn es darum geht, Straftäter nicht allein zur Änderung ihrer inneren Haltung, sondern ihres Handelns anzuregen. Vor dem Hintergrund schwerer Gewalt- und Sexualstraftaten setzt die Notwendigkeit zur Veränderung aber nicht nur den Täter unter Druck, seine Kommunikationsformen und -strukturen künftig gewaltfrei zu gestalten.
Auch der Therapeut ist einer erhöhten Erfolgserwartung ausgesetzt. Umso dringlicher stellt sich die Frage, mit welchen Beteiligten die Therapie wirkungsvoll stattfinden kann. Wie können Angehörige des realen Lebensumfeldes in intramurale und ambulante Behandlungssettings einbezogen werden? Welche Voraussetzungen sollten dafür erfüllt sein? An der Hochschule für Technik, Wirtschaft und Kultur in Leipzig wird gegenwärtig in Kooperation mit dem Sächsischen Justizministerium die Konzeption für die Aufbaustufe des Leipziger Selbstkontrolltrainings (Klemm 2003, 2005, 2006 a) entwickelt, die auf spezifische Besonderheiten der therapeutischen Übergangsbegleitung von der
intramuralen Behandlung in die ambulante Nachsorge ausgerichtet ist. Eine bedeutsame Rolle spielt dabei die symbolische und reale Einbeziehung von Angehörigen. Erste evaluatorische Ergebnisse zur Familienkonstellation von Straftätern werden vorgestellt.
... One example of such an approach is multisystemic therapy (MST). Originally designed to treat chronic offending, violent or substance using youth (Borduin et al., 1995;Henggeler, Melton, & Smith, 1992), MST is based on an ecological systems theory of change in which intervention is not restricted to individual behaviour but is adapted and contextualised within the surrounding social environment. That is, intensive support is provided not only to the young person, but also to their families and schools in order to equip those surrounding the individual with the skills and resources needed for supporting behaviour change. ...
People who commit sexual offences are a heterogeneous group, with research suggesting that children and young people commit a large proportion of all sex offences, especially those committed against other children. This systematic review provides a synthesis of literature concerning the characteristics of children and adolescents who exhibit harmful sexual behaviour. There is a particular focus in this review on studies that examine the characteristics of children and young people exhibiting these behaviours within institutional and organisational settings or which take a situational and/or developmental approach to understanding sexually abusive behaviour. Using a developmental and life-course criminology lens, this review explores implications from the literature for the prevention and response to child sexual abuse, with a particular focus on institutional contexts where the perpetrators are children and adolescents.
... Multisystemic therapy (MST) is a multi-faceted, intensive family-based intervention for young people typically aged between 11 and 17 years old with severe psychosocial and behavioural problems (Henggeler, Melton and Smith, 1992). The premise of MST corresponds with a socioecological framework (Bronfenbrenner, 1979) to address an array of interconnected systems surrounding a young person, including their family, school, peers and wider community (Randall et al., 2001), with a view to supporting positive outcomes for the young person, such as improved family relationships, increased responsibility and desistance from crime (Paradisopoulos, Pote, Fox and Kaur, 2015). ...
Research on the application of multisystemic therapy (MST) has focused on the experiences of caregivers, families and the young people with behavioural conduct difficulties for whom MST has been established as an effective intervention. Perspectives of MST therapists are lacking, yet hold relevance for MST model adherence and services. Using a social constructivist grounded theory approach, eight MST therapists in the United Kingdom took part in a semi‐structured interview designed to explore the requirements of the role. Data revealed four categories: two of explicit roles that included establishing rapport, engaging with families, defining the drivers to a young person’s behaviour, and doing ‘whatever it takes’ to overcome challenges; while underpinning these were two categories of implicit roles related to coping with the organisational environment and interpersonal skill demands of the role. This study widens the understanding of both individual and organisational factors/climate and its impact on therapist performance in MST practice.
Practitioner points
- Supervisors need to monitor therapists’ workloads, organisational climate and the emotional impact of their role, applying a greater duty of care in an ethos of doing ‘whatever it takes’
- Maintaining engagement is a distinct and essential phase of MST. Non‐engagement can be overcome by therapists who adapt their interpersonal style to meet individual needs
- Collaboration with external agencies (e.g. schools) supports cross‐agency working in line with MST principles
... Funding for research on MST rose from $5 million (US dollars) in 1995 to approximately $18 million in 2000 to $35 million in 2003 (Henggeler 2003). At least 15 randomised controlled trials (RCTs) have been conducted to assess the impacts of MST, of which the results of eight are published (Borduin 1990, Borduin 1995, Henggeler 1992, Henggeler 1999a, Henggeler 1999b, Leschied 2002). Approximately 30 further RCTS are underway (MST Services 2003). ...
... Contributing to research on the impact of JDCs on recidivism in youth, several investigations have been conducted to determine the financial benefits of JDCs. Aos, Miller, and Drake (2006) conducted a systematic review of the JDC field and determined that a number of treatment approaches resulted in financial benefits (as measured by total benefits minus costs), including programs such as Multidimensional Treatment Foster Care (Fisher & Chamberlain, 2000) Henggeler, Melton, & Smith, 1992), and Aggression Replacement Training (Glick & Goldstien, 1987). More recently, Drake (2012) calculated the average cost of JDCs and found a substantial benefit to cost ratio. ...
... Multisystemic therapy (MST) has decades of research supporting use in youth and families at high risk of justice involvement and as an alternative to incarceration for those who have already made contact. 46 MST is a family and community-based intervention through which the youth and family unit receive therapeutic interventions and social supports in their immediate communities. 47 When held to the standard of the original model, MST has shown efficacy in reducing recidivism at a cost saving to the system at large. ...
Justice-involved youth are at exceedingly high risk of trauma exposure, multisystem involvement, and mental health distress, including depression. Justice-involved youth carry with them both a high symptom burden and a high cost to society. Both could be reduced through evidence-based prevention and treatment strategies. Effective treatment of mental disorders may reduce future justice involvement, whereas lack of treatment increases likelihood of justice involvement into adulthood. Multiple effective programs exist to improve the lives of justice-involved youth and subsequently decrease the cost to society of detaining and adjudicating these youth within the juvenile justice system.
... Borduin, Henggeler, Blaske, and Stein (1990), in the fi rst controlled study of adolescent sexual offenders to appear in the literature, showed that MST reduced three-year recidivism for both sexual offenses and criminal offenses when compared with individual outpatient counseling. Preliminary fi ndings from two studies ( Borduin et al., 1995;Henggeler, Melton, & Smith, 1992;Henggeler, Melton, Smith, Schoenwald, & Hanley, 1993) showed that MST reduced drug use and abuse in samples of serious juvenile offenders ( Henggeler et al., 1991). A long-term targeted outcome is that the youth's behavior can be managed in the least restrictive school setting and no longer presents problems that overwhelm the school's resources. ...
A multitiered approach to school improvement and safety
... To date, MST has undergone 20 RCTs in multiple countries. Within the US, these studies consistently suggest significant reductions in reoffending and reoffending behaviour ( Borduin et al,1990;Borduinet al.,1995;Henggeler, et al 2002: Henggeler, et al,1996Henggeler, et al.,1992;Henggeler, et al,1998.) and a recent UK study has shown similar results (Butler, et al, 2011) MST has also been found to successfully reduce out-of-home placements, improve family functioning, and substantially decreased mental health problems (including substance misusesee Henggeler and Schaeffer, 2010). ...
This report describes the evidence of interventions suitable for families with children who are at risk of going into care.
... To address complex family problems, multisystemic therapy has been found to be an effective intervention with juvenile offenders and their families. Along with improved individual outcomes such as fewer arrests and decreased aggression, multisystemic therapy has also helped increase family cohesion (Henggeler, Melton, & Smith, 1992). A meta-analysis of interventions using multisystemic therapy with antisocial youth further found the treatment to decrease family stress while improving school attendance (Curtis, Ronan, & Bourduin, 2004). ...
Youth incarcerated in juvenile detention facilities in Western Pennsylvania completed questionnaires related to family history, educational attainment, and psychological traits. Linear regression models were conducted to examine the influence of family and individual trait factors on youth’s aspirations to attend college. Nearly 90% of youth aspired to attend college. Findings from regression analyses indicate that maternal education, neglect, and youth irresponsibility were significantly associated with aspirations. In particular, juveniles with a mother who completed some college or more had 3.37 times greater odds of aspiring to attend college compared to juveniles with a mother who had a high school diploma or less (OR = 3.37, 95% confidence interval [CI] = [1.02, 11.11]). Additionally, juveniles experiencing greater neglect (OR = 0.42, 95% CI [0.18, 0.94]) and reporting higher irresponsibility (OR = 0.84, 95% CI [0.72, 0.99]) were less likely to have college aspirations. Practitioners should capitalize upon aspirations to attend college and help youth establish concrete plans for turning their aspirations into reality.
... Multisystemic therapy (MST) is an intervention developed in the United States (US) in the 1990s by psychologist Scott Henggeler and colleagues (e.g., Henggeler et al. 1992), with a focus on 12-to 17-year-old violent juvenile offenders. It is an intensive family-based intervention based on a systemic approach: the therapist meets the child in the family home or in other familiar surroundings and is available on call 24 h a day, 7 days a week. ...
This chapter provides new evidence on the effects of multisystemic therapy (MST), which is a social intervention for youth with conduct disorder problems. New data are provided on young people receiving MST in the years 2007–2011. Register data enable the construction of a comparison group of youth who are receiving alternative social treatments but who have similar parental characteristics and a similar life-cycle profile of previous social interventions and health-care use. It is found that MST participants are more likely than similar youth in alternative interventions to take primary school exams, and fewer MST participants with previous convictions are placed outside their homes. However, MST participants have lower upper secondary education completion rates and lower employment rates, are more dependent upon welfare income, and are more often convicted of crimes.
... This approach is represented by the Fast Track program, which has demonstrated modest but meaningful efficacy in decreasing aggression and increasing prosocial behavior, in part by teaching social skills and conflict resolution (Bierman et al., 2010). On the other hand, intensive interventions efforts that involve significant environmental changes (e.g., daily in-home consultations with an interventionist), such as Multisystemic Therapy, have shown to be successful in reducing arrest rates and aggression in peer relationships (Henggeler, Melton, & Smith, 1992). Thus, while few interventions have purported to directly target personality as the dependent variable in a treatment outcome study, researchers have made strides in reducing aggression by directing efforts at 1) mechanisms by which antagonistic tendencies lead to aggressive behavior and 2) the environmental contingencies that contribute to aggression. ...
... Family and parenting interventions are typically premised on the assumption that if family relationships are appropriately mobilized, they can be a potent therapeutic agent for reducing unwanted behaviors and preventing relapse (Woolfenden, Williams, & Peat, 2001). The numerous family and parenting interventions for delinquency range from parent-training programs to multisystemic therapy (MST) (or multidimensional family therapy; MDFT) (Bank et al., 1991;Borduin et al., 1995;Chamberlian & Reid, 1998;Emshoff, 1983;Henggeler, Melton, & Smith, 1992;Henggeler, Melton, Brondino, Scherer, & Hanley, 1997;Quinn & van Dyke, 2004;Schaeffer & Bordiun, 2005;Scherer, 1994). Schaeffer and Borduin (2005) conducted a long-term follow-up (approximately 14 years later, when participants were on average 28.8 years of age) of (Borduin et al., 1995). ...
The news of teenagers and even younger children committing ever more serious and violent crimes continues to shock and baffle. The escalating psychological and social toll of youth crime is being paid by all – from victims to offenders to parents and siblings to teachers and to the community as a whole. Adolescent Reputations and Risk looks beyond traditional theories to examine, from a solid empirical basis, the motivation and values that make some young people choose antisocial over positive behavior, resulting in potent new insights and possible solutions to this ongoing problem.
Synthesizing 15 years of research with delinquent youth, this volume describes the volatile dynamic of child and adolescent social worlds, emphasizing reputation enhancement and goal-setting as bases underlying deviant behavior. In innovative and accessible terms, Adolescent Reputations and Risk:
• Addresses delinquency throughout the course of childhood and adolescence.
• Offers the first detailed explanation of delinquency by integrating goal-setting and reputation enhancement theories.
• Provides evidence analyzing deviant trends in goal-setting and reputation enhancement terms among primary and high school students.
• Answers key questions on topics such as impulsivity, drug and inhalant use, early-childhood psychopathy, links between ADHD and aggression, and the psychology of loners.
• Includes current data on interventions for at-risk youth, including family and school methods, cognitive-behavioral therapy, wilderness and boot camp programs, and interactive multimedia strategies.
This volume is an essential resource for clinical child, school, and counseling psychologists; social workers; and allied education and community mental health professionals and practitioners.
... MST is efficacious for youths with severe antisocial behaviour including sexual offenders, as it targets the determinants of antisocial behaviour and perpetuating factors of sexual behaviour [9,10] in the natural environment with youths and families [7]. The reliability of the positive results is supported by multiple methods of measurement and by data collected in the long-term (59 weeks post-referral) [26]. 5 articles [7,9,10,13,16] with juvenile offenders found the association of treatment adherence to outcomes. ...
Background
Antisocial behaviour and conduct disorders are the most common behavioural and mental health problems in children and young people globally. An efficacious intervention is needed to manage these antisocial behaviours that have costly consequences. Multisystemic Therapy (MST), an intensive home-based intervention for youths with psychosocial and behavioural problems, is recommended under National Institute for Health and Clinical Excellence guidelines for conduct disorder. However, reviews on the efficacy of MST are mixed.
Aim
To review randomised controlled trials (RCTs) reporting efficacy of MST among youths presenting with antisocial behaviour and emotional disorder respectively.
Method
A systematic map term to subject heading search was conducted in PsycINFO, Embase, and Ovid Medline databases for articles up to November 2015. RCTs comparing MST vs.treatment as usual (TAU) in youths presenting with antisocial behaviour and emotional disorder were included.
Results
12 RCTs (n = 1425) reported efficacy of MST vs. TAU in youths presenting with antisocial behaviour and emotional disorder. Clinically significant treatment effects of MST showed a reduction of antisocial behaviour which includes delinquency. MST, vs. psychiatric hospitalisation, was associated with a reduction of suicidal attempts in youths presenting with psychiatric emergencies. 4 studies showed that MST was less costly than TAU in the short term, with further analysis required for long-term cost-effectiveness.
Conclusion
MST is an efficacious intervention for severe antisocial behaviours in reduction of delinquency and should be included in clinical practices. MST was shown to have a positive effect on emotional disorder but further research is needed to evaluate the efficacy of MST with emotional disorder. Further analysis is required to assess the services utilized for long-term cost effectiveness.
... See Tables 3, 4, 5 and 6. Table 3 Included studies in the systematic review undertaken by Littell et al. (2005) Henggeler et al. (1999) has been not been included in this table as multisystemic therapy was offered as an alternative to the hospitalization of adolescents in psychiatric crisis Author(s) Title Borduin et al. (1990) Multisystemic treatment of adolescent sexual offenders Borduin et al. (1995) Multisystemic treatment of serious juvenile offenders: long-term prevention of criminality and violence Henggeler et al. (1992) Family preservation using multisystemic therapy: an effective alternative to incarcerating serious juvenile offenders Henggeler et al. (1997) Multisystemic therapy with violent and chronic juvenile offenders and their families: The role of treatment fidelity in successful dissemination Henggeler et al. (1999) Multisystemic treatment of substance-abusing and -dependent delinquents: outcomes, treatment fidelity, and transportability Leschied and Cunningham (2002) Seeking effective interventions for young offenders: Interim results of a 4-year randomized study of multisystemic therapy in Ontario Ogden and Halliday-Boykins (2004) Multisystemic treatment of antisocial adolescents in Norway: replication of clinical outcomes outside of the US ...
One intervention that has shown promise in reducing serious adolescent antisocial behavior is Multisystemic Therapy. This approach is ecologically driven and considers those social systems within which adolescents are embedded. The aims of this systematic review were firstly to investigate whether Multisystemic Therapy for adolescents aged 10–17 years reduces antisocial behavior and out-of-home placement and, secondly whether improvements in other domains, such as, substance use, adolescent emotional and behavioral difficulties, family functioning, peer relations and school are observed. An initial scoping exercise undertaken to explore the available literature found a systematic review undertaken over 10 years ago. Since then, Multisystemic Therapy has been the subject of a number of randomized control trials across the world. Subsequently an updated review following systematic principles was undertaken utilizing inclusion criteria and quality control measures. This resulted in 11 studies, published from 2006 to 2014 conducted in and outside of America, assessed in quality as ranging from weak to strong. Results indicated that the outcomes for Multisystemic Therapy continue to be mixed across studies. Comparisons between studies were challenging and the review highlighted the need for increased consistency in reporting about “usual services,” deeper consideration about cultural differences in the international transportation of Multisystemic Therapy, adequate sample sizes and improved documenting of aftercare services.
... Briefly, MST is an intensive, family-and community-based treatment designed to address youth antisocial behavior comprehensively by targeting the interaction between youth and their existing environmental systems (Henggeler, Melton, & Smith, 1992;Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2009). FFT is a short-term treatment c27.indd 460 7/13/2017 10:53:52 AM program designed for families of youth with externalizing behavior problems at risk for institutionalization (Alexander & Parsons, 1973). ...
This chapter provides an overview of the evidence-based psychosocial treatment and prevention programs for children with, or at risk for, oppositional defiant disorder (ODD) and conduct disorder (CD). It focuses on treatment and prevention strategies for children in middle childhood and early adolescence, spanning approximately ages 9-13. The chapter also describes universal prevention programs, followed by indicated prevention and treatment programs for youth with identified disruptive behavior and impulse-control problems. Universal prevention programs can be classified into Promoting Alternate THinking Strategies (PATHS), Botvin LifeSkills Training program, Second Step program, Seattle Social Development Project, Positive Action, PAX Good Behavior Game (GBG), and other promising approaches. Multimodal preventive intervention can be classified into Fast Track, Coping Power, Incredible Years (IY), Problem-Solving Skills Training (PSST) plus Parent Management Training (PMT), Treatment Foster Care Oregon, Achievement Mentoring, and Multisystemic Therapy (MST) and Functional Family Therapy (FFT).
... This approach is represented by the Fast Track program, which has demonstrated modest but meaningful efficacy in decreasing aggression and increasing prosocial behavior, in part by teaching social skills and conflict resolution (Bierman et al., 2010). On the other hand, intensive interventions efforts that involve significant environmental changes (e.g., daily in-home consultations with an interventionist), such as Multisystemic Therapy, have shown to be successful in reducing arrest rates and aggression in peer relationships (Henggeler, Melton, & Smith, 1992). Thus, while few interventions have purported to directly target personality as the dependent variable in a treatment outcome study, researchers have made strides in reducing aggression by directing efforts at 1) mechanisms by which antagonistic tendencies lead to aggressive behavior and 2) the environmental contingencies that contribute to aggression. ...
... Dalam konteks pemulihan, kemahiran ini adalah merupakan antara salah satu faktor yang penting dalam memastikan keberkesanan pelaksanaan sesebuah program pemulihan (Gornik, 2002;Gendreau, Goggin & Smith, 1999;Hollin, Epps & Kendrick, 1995). Menurut Henggeler et al., (1992), faktor kemahiran ini mempunyai kaitan langsung dengan pengurangan jenayah berulang dalam kalangan penjenayah. Ini adalah kerana pelaksana program yang mahir mampu memberi impak positif terhadap perubahan tingkah laku negatif kanak-kanak. ...
ABSTRAK Program pemulihan untuk pesalah kanak-kanak merupakan satu perkhidmatan pemulihan akhlak yang disediakan untuk kanak-kanak yang telah melakukan kesalahan atau jenayah. Program ini perlulah dilaksanakan dengan berkesan agar pesalah kanak-kanak ini tidak lagi mengulangi kesalahan atau jenayah kelak. Oleh itu, artikel ini membincang tentang faktor-faktor pelaksanaan program pemulihan akhlak kanak-kanak yang berkesan. Antara faktor-faktor dibincangkan dalam artikel ini adalah kemudahan fizikal, kemahiran pelaksana program, sikap pelaksana program, proses pengajaran, sokongan pentadbir serta penilaian program. Metodologi kajian ini adalah berasaskan analisis kandungan iaitu melalui pembacaan artikel-artikel dan buku-buku yang berkaitan pelaksanaan program pemulihan akhlak yang berkesan. Perbincangan ini bermanfaat dari sudut kerja sosial dan kepenjaraan khususnya dalam bidang pemulihan akhlak yang melibatkan pesalah kanak-kanak. Ianya satu perbincangan yang penting dalam praktis kerja sosial yang mana dapat membantu pelaksana-pelaksana program dan pekerja-pekerja sosial bagi meningkatkan mutu perkhidmatan pemulihan akhlak di Malaysia. Kata kunci: Kerja sosial, faktor-faktor perlaksanaan program, program pemulihan akhlak, pesalah kanak-kanak. ABSTRACT Moral rehabilitation programmes are provided for child offenders who have committed an offence or crime. Such programmes should be implemented effectively, so that, these child offenders will not repeat the offences or crimes in the future. Therefore, this article discussed factors involved in implementing effective moral rehabilitation programmes for child offenders, including the provision for physical facilities, competency of programmes executive, attitudes of programmes executive, teaching process, administrative support and programme evaluation. The methodology of the study was based on content analysis, namely, reading of articles and books related to the implementation of effective moral rehabilitation programmes. This discussion was particularly useful, from the perspective of social work specifically, for the moral rehabilitation aspect involving child offenders, as it could assist
Young children with disruptive behavior problems are often seen as the embodiment of their problematic behavior. For the past 30 years, the Child Development Institute, Canada, has offered Stop Now And Plan (SNAP®), an evidence‐based program that challenges this misconception. SNAP leverages the potential to address behavior problems in the middle years, an often forgotten yet critical development stage. In developing SNAP, we have looked beyond children's problematic behavior to focus on promoting their potential and supporting parents to nurture their children's social–emotional development. In this chapter, we describe the development of SNAP within the context of historical and emerging research in the field, and how SNAP is scaling nationally to offer increased support to children and families across Canada.
Multisystemic Therapy (MST) is a family‐based treatment that has demonstrated significant effects on the serious and violent criminal activity of juvenile offenders. MST was developed to address major limitations of existing mental health services for juvenile offenders by (1) addressing key social–ecological factors associated with serious youth antisocial behavior and (2) delivering services in home and other community (e.g., school) settings. This chapter describes how MST interventions address violent and aggressive behaviors of serious juvenile offenders. Specifically, we provide a discussion of the empirical, theoretical, and clinical foundations of MST; a review of findings from clinical trials that demonstrate the clinical and economic benefits of MST; and a description of ongoing efforts to disseminate MST into community settings.
Research into developmental aspects of antisocial behaviour and psychopathy has made strong progress in recent decades. The findings most notably informed by growing evidence regarding callous-unemotional (CU) traits suggest that the neurodevelopmental abnormalities associated with psychopathy emerge early in life, and are shaped by genetics, biology, and environmental factors. In line with this, initial trials of intervention programs for antisocial youth with CU traits have begun to show the potential for family-based interventions to reduce antisocial behaviour as well as CU traits when delivered early in life. Importantly, this research also suggests family interventions may need to be adapted to meet the unique needs of high CU youth. This chapter reviews current best approaches to adapting family interventions for antisocial youth with CU traits. We further argue that it is timely to examine the integration of current theories of antisocial behaviour with emerging scientific frameworks for personalizing clinical intervention. Three core issues are discussed in accordance with scientific frameworks for personalizing interventions relevant to adapting family interventions for high CU youth: (i) research supporting family interventions as an evidence supported treatment for antisocial behaviour as the primary problem (ii) research supporting family-based interventions as the best model of intervention for antisocial youth with CU traits, and (iii) putative treatment strategies that may be integrated or adapted for family interventions such that programs are tailored to the unique developmental aspects of antisocial behaviour among high CU youth. An evaluation of promising best-treatment approach(es) is discussed as well as future directions for research.KeywordsAntisocial behaviourCallous-unemotional traitsPsychopathyFamily interventionsParentingPersonalizing interventions
Background
Multisystemic Therapy® (MST®) is an intensive, home‐based intervention for families of youth with social, emotional, and behavioural problems. MST therapists engage family members in identifying and changing individual, family, and environmental factors thought to contribute to problem behaviour. Intervention may include efforts to improve communication, parenting skills, peer relations, school performance, and social networks. MST is widely considered to be a well‐established, evidence‐based programme.
Objectives
We assessed (1) impacts of MST on out‐of‐home placements, crime and delinquency, and other behavioural and psychosocial outcomes for youth and families; (2) consistency of effects across studies; and (3) potential moderators of effects including study location, evaluator independence, and risks of bias.
Search Methods
Searches were performed in 2003, 2010, and March to April 2020. We searched PsycINFO, MEDLINE, ERIC, NCJRS Abstracts, ProQuest and WorldCAT dissertations and theses, and 10 other databases, along with government and professional websites. Reference lists of included articles and research reviews were examined. Between April and August 2020 we contacted 22 experts in search of missing data on 16 MST trials.
Selection Criteria
Eligible studies included youth (ages 10 to 17) with social, emotional, and/or behavioural problems who were randomly assigned to licensed MST programmes or other conditions. There were no restrictions on publication status, language, or geographic location.
Data Collection and Analysis
Two reviewers independently screened 1802 titles and abstracts, read all available study reports, assessed study eligibility, and extracted data onto structured electronic forms. We assessed risks of bias (ROB) using modified versions of the Cochrane ROB tool and What Works Clearinghouse standards.
Where possible, we used random effects models with inverse variance weights to pool results across studies. We used odds ratios for dichotomous outcomes and standardised mean differences for continuous outcomes. We used Hedges g to adjust for small sample sizes. We assessed the heterogeneity of effects with χ² and I ². Pairwise meta‐analyses are displayed in forest plots, with studies arranged in subgroups by location (USA or other country) and investigator independence. We provide separate forest plots for conceptually distinct outcomes and endpoints. We assessed differences between subgroups of studies with χ ² tests.
We generated robust variance estimates, using correlated effects (CE) models with small sample corrections to synthesise all available outcome measures within each of nine outcome domains. Exploratory CE analyses assessed potential moderators of effects within these domains.
We used GRADE guidelines to assess the certainty of evidence on seven primary outcomes at one year after referral.
Main Results
Twenty‐three studies met our eligibility criteria; these studies included a total of 3987 participating families. Between 1983 and 2020, 13 trials were conducted in the USA by MST program developers and 10 studies were conducted by independent teams (three in the USA, three in the UK, and one each in Canada, the Netherlands, Norway, and Sweden).
These studies examined outcomes of MST for juvenile offenders, sex offenders, offenders with substance abuse problems, youth with conduct or behaviour problems, those with serious mental health problems, autism spectrum disorder, and cases of child maltreatment. We synthesised data from all eligible trials to test the claim that MST is effective across clinical problems and populations.
Most trials compared MST to treatment as usual (TAU). In the USA, TAU consisted of relatively little contact and few services for youth and families, compared with more robust public health and social services available to youth in other high‐income countries. One USA study provided “enhanced TAU” to families in the control group, and two USA studies compared MST to individual therapy for youth.
The quality of available evidence for MST is mixed. We identified high risks of bias due to: inadequate randomisation procedures (in 9% of studies); lack of comparability between groups at baseline (65%); systematic omission of cases (43%); attrition (39%); confounding factors (e.g., between‐group differences in race, gender, and attention; 43%); selective reporting of outcomes (52%); and conflicts of interest (61%). Most trials (96%) have high risks of bias on at least one indicator.
GRADE ratings of the quality of evidence are low or moderate for seven primary outcomes, with high‐quality evidence from non‐USA studies on out‐of‐home placement.
Effects of MST are not consistent across studies, outcomes, or endpoints. At one year post randomisation, available evidence shows that MST reduced out‐of‐home placements in the USA (OR 0.52, 95% confidence interval [CI] 0.32 to 0.84; P < .01), but not in other countries (OR 1.14, CI 0.84 to 1.55; P = .40). There is no overall evidence of effects on other primary outcomes at one year. When we included all available outcomes in CE models, we found that MST reduced placements and arrests in the USA, but not in other countries. At 2.5 years, MST increased arrest rates in non‐USA countries (OR 1.27, CI 1.01 to 1.60; P = .04) and increased substance use by youth in the UK and Sweden (SMD 0.13, CI −0.00 to 0.27; P = .05). CE models show that MST reducesd self‐reported delinquency and improved parent and family outcomes, but there is no overall evidence of effects on youth symptoms, substance abuse, peer relations, or school outcomes. Prediction intervals indicate that future studies are likely to find positive or negative effects of MST on all outcomes.
Potential moderators are confounded: USA studies led by MST developers had higher risks of bias, and USA control groups received fewer services and had worse outcomes than those in independent trials conducted in other high‐income countries. The USA/non‐USA contrast appears to be more closely related to effect sizes than than investigator independence or risks of bias.
Authors' Conclusions
The quality of evidence for MST is mixed and effects are inconsistent across studies. Reductions in out‐of‐home placements and arrest/conviction were observed in the USA, but not in other high‐income countries. Studies that compared MST to more active treatments showed fewer benefits, and there is evidence that MST may have had some negative effects on youth outside of the USA. Based on moderate to low quality evidence, MST may reduce self‐reported delinquency and improve parent and family outcomes, but there is no overall evidence of effects on youth symptoms, substance abuse, peer relations, or school outcomes.
Denne kunnskapsoversikten oppsummerer forskningskunnskap om virksomme eller lovende modeller for behandling av rusproblemer hos ungdom. Med behandlingsmodell mener vi en intervensjon med et klart definert innhold. Generelt vil modeller for rusbehandling rette seg mot et definert rusproblem, enten problemet er begynnende eller veletablert. Behandlingsmodeller kan variere både i omfang, innhold, lengde, intensitet og teoretisk tilnærming, og iverksettes som
en del av familie- og nærmiljøbasert behandling eller behandling i institusjon. Det er glidende overganger mellom forebygging og behandling på rusfeltet, og behandlingstiltak rettet mot ungdom kan derfor også ha en forebyggende effekt. Denne kunnskapsoversikten vil primært fokusere på rusbehandlende tiltak knyttet til et definert rusproblem der målsettingen er redusert bruk av rusmidler. I tillegg er det et formål med kunnskapsoversikten å gi noen anbefalinger om
videre arbeid med å utvikle rusbehandling. Rapporten er basert på kunnskapsoppsummeringer og systematiske oversikter som vurderer
virkningen av tiltak mot alkohol- og narkotikamisbruk hos ungdom i alderen 12-26 år, med vektlegging av tiltak for ungdom under 20 år.
En la actualidad continúa existiendouna controversia con respecto ala forma de concebir las cárceles en torno a su función, dado queen un inicio estos espacios tenían una connotación distinta centrada principalmente en la detención de los delincuentes para que llegado el momento se les aplicara el castigo correspondiente, tiempo después con la fundamentación humanista y racionalista del siglo XIX y las implicaciones morales del castigo físico, incluyendo la pena de muerte, la cárcel pasa de ser un momento de la pena a ser el momento “en si”, es decir, pasa de ser un espacio de detención a uno de sanción. En nuestros días la cárcel ha sido estudiada desde distintos puntos de vista y se le ha dado un propósito diferente deacuerdo ala óptica con la que se ha observado, por tanto, no representa lo mismo para los estudiosos del derecho, que para los sociólogos, psicólogos, antropólogos o en general para la sociedad, a si, es concebida de diversas maneras en función del fin de la prisión. Sinembargo, la cárcel tiene una forma específica por la cual se puede entender;desde el punto de vista institucional, y las funciones que el Estado le ha otorgado como elemento fundamental del sistema penal. Sin duda las condicioneseconómicas, políticas ysociales de cada momento históricohan impregnado a la cárcel de peculiaridades relacionadas con su contexto no solo local o regional sino también mundial. Hoy en díadentro de un contexto globalizado y globalizador los estados han hecho de los espacios de reclusión la retribución punitiva por excelencia en donde la delincuencia pagará el costo de su comportamiento con la privación de su libertad, pero no solo eso, si no también los espacios de reclusión tendrán como encomienda el orientar las acciones delos desviados de la ley al “buen camino”, es decir,readaptarlosy con ello evitar que en un futuro reincidan en sus acciones antijurídicas.
The common occurrence of trauma-related mental illnesses in transitional age youth (TAY) deserves special focus both in terms of context and treatment options. This chapter will discuss the prevalence and consequences of trauma in TAY, which can range from brief acute reactions to chronic disabling conditions. Considerations for psychotherapeutic and pharmacological interventions for this age group will be discussed. Treatments generally involve psychotherapy, and there are a number of evidence-based ones to choose from, though most originated for use with adolescents or adults. Further research is needed to determine adaptability for TAY. Pharmacologic options can support patients through symptom targeting and remission, particularly in combination with psychotherapy. Finally, special considerations and challenges in trauma intervention with this age group will be discussed.
Contemporary young adults differ from those of previous generations in their heavy engagement with screen media, including increasingly sophisticated video gaming and social media. This change in lifestyle has significant implications for their mental health and its treatment, for good and ill. Young adults typically prioritize screen media habits, thus displacing risky behavior such as recreational drug and alcohol use, sexual intercourse, and violence. Yet this also displaces healthy habits including adequate sleep, reading books, and in-person socializing. Some young adults develop an impairing but treatable behavioral addiction to gaming and other screen media, although names and definitions regarding the phenomenon vary greatly. Digital media behaviors interact with depression, anxiety, ADHD, and autism spectrum disorders in distinct manners which must be assessed and addressed in treatment. Psychiatrists should incorporate aspects of digital media habits and experiences into their assessments and formulations of young adult patients, adapting practice to the highly digitized lives of this generation.
The aims of the present study were to identify empirically supported psychosocial intervention programs for young people with conduct problems and to evaluate the underpinnings, techniques and outcomes of these treatments. We analyzed reviews and meta-analyses published between 1982 and 2016 concerning psychosocial intervention programs for children aged 3 to 12 years with conduct problems. Parent training should be considered the first-line approach to dealing with young children, whereas cognitive-behavioral approaches have a greater effect on older youths. Family interventions have shown greater efficacy in older youths, whereas multi-component and multimodal treatment approaches have yielded moderate effects in both childhood and adolescence.
Some limitations were found, especially regarding the evaluation of effects. To date, no single program has emerged as the best. However, it emerges that the choice of intervention should be age-specific and should take into account developmental differences in cognitive, behavioral, affective and communicative abilities.
Denne kunnskapsoversikten oppsummerer forskningskunnskap om virksomme eller lovende modeller for behandling av rusproblemer hos ungdom. Med behandlingsmodell mener vi en intervensjon med et klart definert innhold. Generelt vil modeller for rusbehandling rette seg mot et definert rusproblem, enten problemet er begynnende eller veletablert. Behandlingsmodeller kan variere både i omfang, innhold, lengde, intensitet og teoretisk tilnærming, og iverksettes som en del av familie- og nærmiljøbasert behandling eller behandling i institusjon. Det er glidende overganger mellom forebygging og behandling på rusfeltet, og behandlingstiltak rettet motungdom kan derfor også ha en forebyggende effekt. Kunnskapsoversikten fokuserer primært på rusbehandlende tiltak knyttet til et definert rusproblem der målsettingen er redusert bruk av rusmidler. I tillegg gir kunnskapsoversikten anbefalinger med hensyn til videreutvikling av rusbehandling.
Esse texto enfoca um recorte da pesquisa-ação "Grupo Multifamiliar de Adolescentes Ofensores Sexuais". São escassos, em nosso contexto, os estudos sobre a temática do adolescente ofensor sexual. Foram feitas entre-vistas iniciais com o adolescente e sua família para avaliar a dinâmica familiar e as condições da agressão sexual perpetrada. Nesse texto, privilegiamos o conhecimento de como o adolescente se percebe, como é percebido por sua família e sua relação com a escola. Participaram do estudo sete (7) adolescentes e suas mães. Os resultados evidenciam contradições entre como a mãe vê o adolescente e como ele se vê. Essas contradições se estendem para a expectativa de ambos em relação a uma ocupação do adolescente e também ao meio social. O contexto do adolescente ofensor sexual necessita ser conhecido visando à implementação de intervenções familiares e individuais.
Purpose
Systemic family interventions have shown to be effective in adolescents with substance use disorder and delinquent behavior. The interventions target interactions between the adolescent and involved systems (i.e. youth, family, peers, neighbors, school, work, and society). Next to effectiveness considerations, economic aspects have gained attention. However, conventional generic quality of life measures used in health economic evaluations may not be able to capture the broad effects of systemic interventions. This study aims to identify existing outcome measures, which capture the broad effects of systemic family interventions, and allow use in a health economic framework.
Methods
We based our systematic review on clinical studies in the field. Our goal was to identify effectiveness studies of psychosocial interventions for adolescents with substance use disorder and delinquent behavior and to distill the instruments used in these studies to measure effects. Searched databases were PubMed, Education Resource Information Center (ERIC), Cochrane and Psychnet (PsycBOOKSc, PsycCRITIQUES, print). Identified instruments were ranked according to the number of systems covered (comprehensiveness). In addition, their use for health economic analyses was evaluated according to suitability characteristics such as brevity, accessibility, psychometric properties, etc.
Results
One thousand three hundred seventy-eight articles were found and screened for eligibility. Eighty articles were selected, 8 instruments were identified covering 5 or more systems.
Conclusions
The systematic review identified instruments from the clinical field suitable to evaluate systemic family interventions in a health economic framework. None of them had preference-weights available. Hence, a next step could be to attach preference-weights to one of the identified instruments to allow health economic evaluations of systemic family interventions.
The present study aims at presenting some institutional aspects in the implementation of the socio-educative measure of internment. As from a qualitative approach, participant observation was made at the Center for Integration of Adolescents at Planaltina with three youngsters between 17 and 19 years old, during the activities of the art workshop. The results were analised by the constructive-interpretative content analysis. The observation of the researched institution allowed us to conclude that in spite of the advancements, we still face a penal-police State as far as the public policies for adolescents in conflict wih the law are concerned, specially those who are under the socio-educative measure of internment. In spite of the implementation ot the SINASE, the biggest challenge remains, i.e. to guarantee total protection for children and adolescents in social and personal risk and for adolescents in conflict with the law, and to implement the project for society that the Children and Adolescent By-Law calls for.
This dissertation critically reviews prior labeling theory research concerning juvenile delinquency and adult criminality, and presents a structural equation model utilizing the National Longitudinal Study of Adolescent Health (Add Health). The labeling perspective is outlined as it was originally presented, and the theoretical elaborations that have taken place since are highlighted. Distinctions are made between formally applied criminal justice labels and the informal labels that are applied by significant others and parents. An interactionist labeling model that incorporates respondents’ levels of self-control is presented to explain formal labeling, levels of juvenile delinquency, and future criminality among a nationally representative sample of American adolescents: three waves of Add Health. The findings show that formal labeling was the strongest significant predictor of subsequent criminal involvement and that it mediated the effect of prior delinquency on subsequent criminal involvement.
This research involves an International and New Zealand focussed literature review, including expert
interviews, of initiatives/interventions used to address youth driving offending. The research also aims
to provide agencies with useful, practical, evidence-based options on which to design pilot programmes
as potentially more effective alternatives to current approaches. The project has a Government
Reference Group. Because alternative interventions are used in conjunction with traditional sanctions
(demerit points, fines) these traditional sanctions are also discussed. Information on the Graduated
Driver Licence System (GDLS) and the Criminal Justice System in New Zealand, regarding youth traffic
offenders is also included.
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