Multisystemic Therapy for Child Non-Externalizing Psychological and Health Problems: A Preliminary Review

Abstract

Multisystemic therapy (MST) is effective for decreasing or preventing delinquency and other externalizing behaviors and increasing prosocial or adaptive behaviors. The purpose of this project was to review the literature examining the efficacy of MST for other child psychological and health problems reflecting non-externalizing behaviors, specifically difficulties related to child maltreatment, serious psychiatric illness [Serious psychiatric illness was defined throughout the current review paper as the “presence of symptoms of suicidal ideation, homicidal ideation, psychosis, or threat of harm to self or others due to mental illness severe enough to warrant psychiatric hospitalization based on the American Academy of Child and Adolescent Psychiatry (Level of care placement criteria for psychiatric illness. American Academy of Child and Adolescent Psychiatry, Washington, DC, 1996) level of care placement criteria for psychiatric illness” (Henggeler et al. in J Am Acad Child Psy 38:1331–1345, p. 1332, 1999b). Additionally, youth with “serious emotional disturbance (SED)” defined as internalizing and/or externalizing problems severe enough to qualify for mental health services in public school who were “currently in or at imminent risk of a costly out-of-home placement” (Rowland et al. in J Emot Behav Disord 13:13–23, pp. 13–14, 2005) were also included in the serious psychiatric illness category.], and health problems (i.e., obesity and treatment adherence for diabetes). PubMed, Web of Science, MEDLINE, and PsycINFO databases; Clinicaltrials.gov; DARE; Web of Knowledge; and Cochrane Central Register of Controlled Trials were searched; and MST developers were queried to ensure identification of all relevant articles. Of 242 studies identified, 18 met inclusion criteria for review. These were combined in a narrative synthesis and critiqued in the context of review questions. Study quality ratings were all above mean scores reported in prior reviews. Mixed support was found for the efficacy of MST versus other treatments. In many cases, treatment effects for MST or comparison groups were not sustained over time. MST was efficacious for youth with diverse backgrounds. No studies discussed efficacy of MST provided in different treatment settings. Four studies found MST more cost-effective than a comparison treatment, leading to fewer out-of-home placements for youth with serious psychiatric illness or lower treatment costs for youth with poorly controlled diabetes.

Disclosure of Financial Conflicts of Interests in Interventions to Improve Child Psychosocial Health: A Cross-Sectional Study

“…[ 25 ] Various trials suggest that Multisystemic Therapy is effective for decreasing delinquency and other externalizing behaviors including substance use, and in reducing the likelihood of out-of-home placement. [ 26 ] In the past 15 years MST has been increasingly disseminated internationally. MST is currently available in 34 US states, 15 countries worldwide, with 23,000 young people treated each year.…”

Integration of Expressive Techniques in Multisystemic Therapy With At-Risk Adolescents: A Retrospective Case Analysis

“…The social ecology systems consist of micro-, meso-, exo-, and macrosystems (Bronfenbrenner, 1979) at which MST has defined as individual, family, community, school, and peers (Henggeler & Shaeffer, 2016). The treatment engages in a multicultural approach through utilization of the community system as a representative of the overarching culture (Pane, White, Nadorff, Grills-Taquechel, & Stanley, 2013) in addition to the other proximal systems the behavior is functioning (Henggeler & Shaeffer, 2016).…”

“…MST holds a breadth of literature around its effectiveness of interventions (Henggeler & Sheidow, 2011); however, there are limitations to be considered among outcome research. These limitations include inconsistent results during follow-up studies, lack of independently conducted research, and limited research of noncourt-ordered adolescents (Painter, 2010; Pane, White, Nadorff, Grills-Taquechel, & Stanley, 2013). Rowland and colleagues (2005) identified a significant reduction in internalizing behaviors and fewer days in out-of-home placement as well as an increase in social support for caretakers among adolescents with severe emotional disturbances.…”

“…Rowland and colleagues (2005) identified a significant reduction in internalizing behaviors and fewer days in out-of-home placement as well as an increase in social support for caretakers among adolescents with severe emotional disturbances. However, since Rowland et al, researchers have primarily focused on the cost-effectiveness of MST and have not continued with adolescents with internalized behaviors (Pane et al, 2013).…”

Social skills and psychopathic traits in maltreated adolescents

“…: drug-abusing parents) by specific interventions, such as multidisciplinary family treatment drug court [50], parent-child interaction therapy [51,52], family behaviour therapy [53] and personal and family support [54]. Only few specifically designed interventions for neglected children are described in the literature [55] and multisystemic therapy may be a tool for the treatment of both victims and their families [56]. Future prospective studies should also investigate neuroimaging and possible genetic underpinnings, as well as specific effective strategies focusing on empathy, self-control and social confidence training for this vulnerable population, which may result in a lower propensity to antisocial personality traits.…”