Article Figures & Data
Figures
- Figure 1.
Results of the systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline.
Tables
Principles Description Finding the fit An assessment is made to understand the “fit” between identified problems and how they manifest and make sense in the entire context of the family’s environment. Assessing the fit of youth and parent successes also helps guide the treatment process. Focusing on positives and strengths MST emphasize the positives they find and use strengths as levers for positive change. Focusing on family strengths has numerous advantages, such as building on strategies the family already use, instilling hope, identifying protective factors, decreasing frustration, and enhancing caregivers’ confidence. Increasing responsibility Interventions are designed to promote responsible behavior and decrease irresponsible actions by all family members. Present-focused, action-oriented, and well-defined Interventions deal with what’s happening now in the family’s life. Therapists look for action that can be taken immediately, targeting specific and well-defined problems. Family members are expected to work actively toward goals by focusing on present-oriented solutions, rather than gaining insight or focusing on the past. When the clear goals are met, the treatment can end. Targeting sequences Interventions target sequences of behavior within and between the various interacting systems (family, peers, teachers, home, school, and community) that sustain the identified problems. Developmentally appropriate Interventions are established appropriate to the youth’s age and developmental needs. Continuous effort Interventions require daily or weekly effort by family members so that the youth and family have frequent opportunities to demonstrate their commitment and practice skills. Advantages of intensive regular efforts to change include more rapid problem resolution, earlier identification of when interventions need fine-tuning, continuous evaluation of outcomes, more frequent corrective interventions, and more opportunities for family members to experience success. Evaluation and accountability Intervention effectiveness is evaluated continuously from multiple perspectives, with MST team members being held accountable for overcoming barriers to successful outcomes. MST does not label families as “resistant, not ready for change or unmotivated.” This approach avoids blaming the family and places the responsibility for positive treatment outcomes on the MST team. Generalization Interventions are designed to invest the caregivers with the ability to address the family’s needs after the intervention is over. The caregiver is viewed as the key to long-term success. Family members drive the change process in collaboration with the MST therapist. Study Details Sample Characteristics Treatment Characteristics No. Study Design Sample Size Mean Age (SD) (Yrs) % Male Race Distribution (White/Black/Hispanic) Sexual Offense Criterion (Mean) Comparison Arm Participant Distributions: Comparison/MST Treatment Setting Treatment Duration (Mean (SD)) Follow-up Outcome 1 Borduin et al. 1990 (USA)7 RCT 16 14 100% 62.5%/37.5% Sexual Offense (1.8) Individual therapy Comp = 8, MST = 8 Outpatient MST = 37h, IT = 45h 36 mos Sexual offenses - Recidivism rates: MST vs. IT: 12.5% vs. 75% (P < 0.04), Rearrest frequency: MST vs. IT: Mean = 0.12 vs. 1.62 (P < 0.027) 2 Letourneau et al. 2009 (USA)8 RCT 127 14.6 (1.7) 97.6% 44%/54%/31% Diverted or adjudicated for sexual offense Treatment as usual Comp = 60, MST = 67 Community based MST = 7.1 mos (2.8), TAU = 14.6 mos (11) (A), 8.2 mos (5.5) (B) 6, 12 mos MST youth had significantly greater reduction in problematic sexual behavior over time (on ASBI). 3 Borduin et al. 2009 (USA)9 RCT 48 14 (1.9) 95.8% 72.9%/27.1%/2.1% Arrests for sexual offense (1.6) Community service (CBT and IT) Comp = 24, MST = 24 Community based MST = 7 mos (2.8), CS = 6.9 mos (4.14) 8.9 yrs MST participants had 83% fewer arrests for sexual crimes and spent 80% fewer days in detention facilities. 4 Fonagy et al. 2015 (UK)10 RCT 40 13.4 90% 43%/43% Problematic sexual behaviors Treatment as usual Comp = 19, MST = 21 Community based MST = 6 mos (1) 8, 12, and 20 mos Both interventions suggested improvements in problematic sexual behavior (on ASBI and police record)a 5 Letourneau et al. 2013b (USA)11 RCT 124 14.7 (1.7) 100% 44%/54%/30% Diverted or adjudicated for sexual offense Treatment as usual Comp = 58, MST = 66 Community based MST = 7 mos (3), TAU = 12.5 mos (9.9) 18, 24 mos MST treatment effects were sustained during second year follow up for youth with problematic sexual behavior (on ASBI). 6 Borduin et al. 2021c (USA)12 RCT 48 14 (1.9) 95.8% 72.9%/27.1%/2.1% Arrests for sexual offense (1.6) Community service (CBT and IT) Comp = 24, MST = 24 Community based MST = 7.1 mos (2.8), CS = 6.9 mos (4.1) 24.9 yrs MST group: 13.13 times lower rates for sexual offense (P < 0.01) and 8.27 times fewer arrests for sexual offenses (P = 0.02) aStatistical analysis was not feasible given limited sample strength.
bExtension of Letourneau et al. 20098.
cExtension of Borduin et al. 20099.
Abbreviations: A, probation youth; ASBI, Adolescent Sexual Behavior Inventory; B, diverted youth; CBT, cognitive behavioral therapy; Comp, comparison; h, hours; IT, individual therapy; mos, months; MST, multisystemic therapy; TAU, treatment as usual; UK, United Kingdom; USA, United States of America; yrs, years.
