Treating Serious Emotional and Behavioural Problems Using Multisystemic Therapy

Multisystemic therapy (MST) is a family‐ and community‐based treatment of serious emotional and behavioural problems presented by adolescents. The development of this model began in the late 1970s, and today MST is a leading evidence‐based treatment of serious antisocial behaviour in youths, with programs transported to more than 30 states in the United States and 12 nations, including Australia and New Zealand. This article rerviews the theoretical rationale that underlies MST and presents the central clinical features of the intervention model. In addition, the training and quality assurance protocols used to promote MST program fidelity and treatment adherence are described. Finally, findings from approximately 15 published randomised and two quasi‐experimental clinical trials with youths presenting serious clinical problems (e.g., violence, substance abuse, serious emotional disturbance, sexual offending, and chronic illness) are summarised.     

Effective components of interventions in juvenile justice facilities: How to take care of delinquent youths?

Therapeutic interventions support change in delinquent youths rather than rely on surveillance and deterrence. This article describes successful and concrete components for therapeutic interventions in juvenile justice facilities. The effectiveness of remedial measures to best address the sources of youths' delinquent behaviors and the performance of juvenile justice system are discussed first, and then two theoretical frameworks of rehabilitative models are described that are commonly used with delinquent youths. Finally, specific recommendations for enhancing treatment in juvenile justice facilities with regard to the content of interventions, social climate, and youth motivation to engage in treatment are described and explained in a way intended to help caregivers and practitioners, supervisors of juvenile justice facilities, and policy makers improve the daily life of youths placed in this kind of environment.     

An Evaluation of Mechanisms of Change in Multisystemic Therapy for Juvenile Justice‐Involved Youths A Decade Following Treatment

Although researchers have identified the more immediate mechanisms of change in family‐based treatments for juvenile justice‐involved youths, it is not known whether these same mechanisms continue to prevent criminal offending into adulthood. The present study evaluated whether caregiver‐directed improvements in family relations, youth prosocial peer relations, and youth academic performance during multisystemic therapy (MST) for serious and violent juvenile offenders had an impact on young adult involvement in criminal activity and sentencing 10.2 years following treatment. The results showed that improvements in family relations were associated with reduced odds of criminal outcomes a decade later for former MST participants. Furthermore, improvements in youth prosocial peer relations and academic performance were also related to lower odds of long‐term criminal activity. These results are consistent with the underlying theory of change in family‐based treatments and demonstrate that caregivers are critical to achieving and sustaining decreased antisocial behavior for youths with serious and violent criminal histories.     

Group therapy with sexually abused boys: Notes toward managing behavior

This article examines the gender-specific defense mechanisms of sexually abused boys as they emerge in group therapy, using Finkelhor's model of traumagenic dynamics. Concrete interventions address the acting out behavious that are typical for this population, connecting the acting out behaviors to the boys' common background of sexual abuse. Without these concrete interventions to address the unsafe, aggressive behaviours of sexually abused boys, their problems and experiences cannot be shared, nor can the group therapist address the issues outlined in a curriculum for group therapy for sexually abused children.     

School enrolment following multisystemic treatment: A register-based examination among youth with severe behavioural problems

This article addresses the ongoing debate about the effectiveness of multisystemic treatment (MST) by examining school enrolment at age 18 among youths who have received MST. The analyses are restricted to youths who engage in antisocial behaviour and/or substance abuse. We used propensity score matching to compare school enrolment between youths who had received MST and a control group who had not received MST. The analyses of population data showed a somewhat lower school enrolment in the MST group compared with youths receiving treatment as usual.     

Parent Management Training, Relationships with Agency Staff, and Child Mental Health: Urban Foster Parents' Perspectives

Many foster parents are ill prepared to meet the behavioral needs of children placed in their homes. Research suggests they lack training in evidence-based behavioral interventions and feel unsupported by child welfare professionals. Given the complex needs of foster children and increased rates of placement disruption for foster children with behavior problems, implementation of effective interventions is essential. However, little is known about foster parents' receptivity to these types of interventions. In this qualitative study, we examine urban foster parents' perceptions of the specific elements of parent management training (PMT), an evidence-based treatment for disruptive behaviors that teaches parents to improve desired behaviors and decrease oppositional behaviors by rewarding positive behaviors (positive reinforcement) and responding to negative behaviors with mild, consistent punishments such as timeout or a privilege removal. We present data from four focus groups (N = 38). While the questions focused on parent's perceptions of PMT, responses often related to parent interactions with agency staff. Four strong themes emerged from the data. First, foster parents discussed a need for more support and training in how to address children's behaviors, but also had concerns that some PMT discipline techniques would be ineffective based on their past experiences with foster children. Second, they described how staff communication skills and allegations of child abuse could affect parents' motivation to continue fostering. Third, they expressed a need for more detailed information about children's histories and visits with biological families as the lack of information contributed to difficulty in meeting foster children's needs. They suggested that joint training of foster parents and staff in the intervention could improve their ability to work together to support the child's positive behaviors. Finally, parents reported little involvement in child mental health services and doubted the effectiveness of the mental health services their foster children received.     

The Trauma Trifecta of Military Sexual Trauma: A Case Study Illustrating the Integration of Mind and Body in Clinical Work with Survivors of MST

Military sexual trauma (MST) has recently received much attention from the media in contemporary society. With the ever-increasing population of United States service members returning from the Iraq and Afghanistan wars, it is vital for any mental health practitioner to be aware of the epidemic that is sexual assault in the military, the unique trauma experiences of the MST survivor, and treatment implications incorporating multiple psychological theories. This article explores three factors, referred to as the trauma trifecta, in which the effects of MST are exacerbated: the loss of professional and personal identity, the regulatory functions of self harm behaviors, and the retraumatization that many service members endure as a result of the distinctive characteristics of the military culture and its service to veterans. A case study with clinical interventions will be utilized to demonstrate this concept of “the trauma trifecta” and the unique challenges in treating the PTSD symptoms that can result from MST in clinical therapy. Drawing from multiple theories in clinical treatment, this paper illustrates the strengths and limitations of cognitive-behavioral techniques, highlights the integration of feminist theory to illustrate the obstacles of power structures, and mind–body interventions, bridging the gap between talk therapy and body therapy. Through this unique integration of multiple therapies, the case study illustrates the veteran’s reengagement with her body and the reformulation of her identity post MST.     

Parents' and children's perceptions of family processes in inner-city families with delinquent youths: a qualitative investigation

This study explored youths' and parents' perceptions of family interaction processes as well as the broader social and cultural factors that influence family functioning in a multiethnic sample of inner-city families with delinquent youth. In-depth interviews were conducted with 61 male youths and 33 parents predominantly from minority families. Guided by an ecological framework, qualitative data analyses were employed to explore individual and contextual factors that were perceived either to foster or to impede individual and family functioning. Findings supported previous empirical research highlighting the importance of family interaction processes in the lives of delinquent youths. Analysis of parent and youth data revealed important relationships among the individual, family, and community domains. The emphases placed on these interrelationships, however, varied in distinct and notable ways for parents and youths. The implications of these divergent patterns for family-level interventions are addressed.     

Changing Directions in HIV Prevention: The Move Toward a Psychosocial Model

ABSTRACT

Although some HIV prevention programs have been successful in helping gay and bisexual men change their sexual behaviors, rates of HIV infection continue to increase. In an attempt to address this problem, social workers need to move beyond traditional HIV prevention approaches to a psychosocial model of HIV prevention. Based on the work of previous researchers, this approach assumes that a combination of individual, psychological, and social factors contribute to risky sex in gay and bisexual men. Because social workers are trained to view problems from a psychosocial framework, they are already in a position to develop programs incorporating the psychosocial model. This article examines the psychosocial model of HIV prevention and the various psychosocial factors that may contribute to high-risk sexual behavior and concludes with examples of prevention research that have already incorporated the model.     

Social networks and sexual risk factor differences between cisgender heterosexual and cisgender LGBQ homeless youths

ABSTRACT

Cisgender lesbian, gay, bisexual, and queer/questioning (LGBQ) homeless youths are more likely to engage in sexual risk behaviors relative to cisgender heterosexual homeless youths. Homeless youths (N = 1,046) were recruited and surveyed from three drop-in centers in Los Angeles, California. This study assessed differences in demographics, background experiences, and perceived social network norms in order to understand the disparities in rates of unprotected sex and concurrent sex between these two subgroups. Results indicate significant differences in engagement in risk factors as well as social network norms. Findings provide support for tailored sexual risk-reduction interventions that cater specifically to LGBQ homeless youths.     

Multisystemic Treatment of Juvenile Sexual Offenders

Abstract

Multisystemic therapy (MST)is an ecologically-based treatment model that has proven effective with violent and chronic juvenile offenders and that holds promise with juvenile sexual offenders. This article describes the empirical underpinnings, theoretical foundation, and clinical features of MST and provides a brief review of MST outcome studies with juvenile sexual offenders. The theoretical foundation and clinical features of MST draw upon empirical findings regarding the multidetermined nature of serious antisocial behavior as well as upon social-ecological models of behavior in which the youth and family's school, work, peers, and neighborhood are viewed as interconnected systems with dynamic and reciprocal influences on the behavior of family members. In two randomized trials with juvenile sexual offenders, MST has had positive effects on key social-ecological factors (e.g., family affective relations, peer relations, school performance) associated with sexual offending and has demonstrated long-term reductions in criminal activity and incarceration. The success of MST can be attributed primarily to (a) the match between MST intervention foci and empirically identified correlates/causes of sexual offending in youths and (b) the flexible use of well-validated intervention strategies in the natural environment.     

Risk Factors for Homelessness Among Lesbian, Gay, and Bisexual Youths: A Developmental Milestone Approach

Lesbian, gay, and bisexual (LGB) youths are over-represented in the homeless population. To examine why some LGB youths become homeless, this report compares homeless and non-homeless LGB youths. Of the 156 LGB youths, 48% reported ever being homeless (i.e., running away or being evicted from home). Results indicate that sexual orientation awareness and the initiation of sexual behavior occurred earlier in homeless than in non-homeless LGB youths and predated the first homeless episode. Substance use was more frequent and first occurred at an earlier age in homeless as compared to non-homeless LGB youths; however, substance use occurred subsequent to first homelessness. Childhood sexual abuse was associated with homelessness; and, early sexual orientation development was related to homelessness among youths without a history of sexual abuse. Findings suggest that interventions should help youths cope with their unfolding sexual orientation and work to prevent or address the consequences of sexual abuse.     

Multidimensional Family Therapy: A Science‐Based Treatment System

MDFT is a family‐based intervention for adolescent substance abuse and associated mental health and behavioural problems (Liddle, 2010). Integrative in several ways, MDFT uses an ecological or contextual conceptual framework to understand the developmental tasks of teens and their families. Research‐derived knowledge about risk and protective factors, and proximal causes, correlates and contributors to adolescent drug and related problems inform clinical thinking and interventions with every case. A multisystems approach, MDFT assesses and intervenes in four areas: (1) the adolescent as an individual and a member of a family and peer network; (2) the parent(s), both as individual adults and in his or her role as mother; father or caregiver; (3) the family environment and family relationships, as manifested in day‐to‐day family transactional patterns; and (4) extrafamilial sources of influence such as peers, school and juvenile justice. Interventions are made within and coordinated across domains. Progress in one area or with one person has implications for and use in others. Individual meetings with parent(s) and teen set the stage for family sessions, and family meetings may offer content and new outcomes that need to be brought to extrafamily meetings with juvenile justice or school personnel. MDFT was developed and tested as a treatment system rather than a one‐size‐fits‐all approach. A treatment system offers different versions of a clinical model that vary according to factors such as clinical sample characteristics (older versus younger adolescents, juvenile justice involved versus no involvement in juvenile justice systems), and treatment parameters (type of clinical setting and treatment dose).     

Why Wait ‘til Marriage? The Determinants of Premarital Sex among Adolescents in a Country in Sub-Saharan Africa: Botswana

The purpose of the study was to describe the premarital sexual behaviors of Botswana adolescents and examine the factors associated with premarital sex intentions. An anonymous self-reported questionnaire was administered to 1,054 pupils ages 10 to 18 years in school and out of school. The findings indicate that the theory of planned behavior provides a model for developing interventions to reduce the risk behavior in regard to HIV/AIDS through premarital sex. The findings in the study indicate factors that influence adolescent intentions to engage in premarital sexual intercourse and the need to address these when designing effective interventions.     

Reconciling Reality With Fantasy: Exploration of the Sociocultural Factors Influencing HIV Transmission Among Black Young Men Who Have Sex With Men (BYMSM) Within the House Ball Community: A Chicago Study

Studies involving the House Ball Community (HBC) have found high rates of HIV prevalence and undiagnosed HIV infection, as well as unique social and sexual network-related HIV risk and protective behaviors (Murrill et al., 2008; Sanchez, Finlayson, Murrill, Guilin, & Dean, 2010). Efforts to understand culturally appropriate and effective methods of HIV prevention services within the relatively understudied HBC are scarce (Phillips, Peterson, Binson, Hidalgo, & Magnus, 2011). This qualitative study, utilizing a diffusion of innovation theoretical framework, aimed to explore social norms regarding HIV and accessibility of HIV prevention services within the HBC. Thirty-seven participants (16 community leaders and 21 youths) engaged in focus group discussions. Participants discussed the perceptions of HIV and stigmatization within the HBC, general and HBC-specific risk factors for HIV transmission, as well as HIV prevention needs and strategies for culturally appropriate HIV interventions. Findings from this qualitative study highlight both the vulnerability of the HBC to HIV transmission and the corresponding support for HIV prevention interventions.     

Interdisciplinary team discussion on work environment issues related to low back disability: a multiple case study

From both a social and cost-benefit perspective, disability prevention and associated management strategies for assisting employees with back pain are only successful if they address critical return-to-work (RTW) determining factors present in the workplace, including ergonomic factors. Despite our current knowledge of the importance of an integrated team approach targeting these factors, questions remain regarding the conceptual framework adopted by contemporary rehabilitation teams as it relates to work-oriented interventions to accommodate employees back to work. The purpose of this study was to explore and describe the work environment issues discussed by an interdisciplinary team engaged in the work rehabilitation process of low back disability cases. A qualitative content analysis was conducted for 10 sample cases that underwent a rehabilitation program in Quebec (Canada). Drawing on the results of these analyses, a framework representing a synopsis of practitioners' involvement in the person-environment dynamic is presented and discussed. This study makes a unique contribution to the understanding of the 'real-life' content of an interdisciplinary activity in disability management, thus, helping rehabilitation practitioners to build knowledge on the practical application of a cross-disciplinary framework to address work environment issues during the RTW process of those patients sick-listed due to back pain.     

Therapists Working in New and Old Ways: An Integrative Ecological Framework for Non‐Familial Intergenerational Relationships

Non‐familial intergenerational (NFIG) relationships can complement conventional therapeutic interventions. We discuss the intergenerational gap and structural changes families have experienced over the last several decades. We advocate for an integrative framework combining non‐familial intergenerational opportunities with conventional therapeutic interventions. Finally, we address logistical and ethical dimensions of the integrative framework and participants' fitness, motivation, potential, and needs within non‐familial intergenerational programs/partnerships.     

A comparison of drug involvement between runaways and school youths

Problems related to homeless/runaway youths have received increased attention in recent years. Homeless/runaway youths manifest many problems in addition to being absent from home and without supervision of a parent or guardian. The purpose of the study was to determine drug use and abuse patterns of homeless/runaway youths and to compare those patterns, along with attitudes toward selected illicit behaviors, with similar data collected from adolescents in school. Data were collected from persons (n = 253) in homeless/runaway shelters in the southeast United States. Comparisons made with data from other studies of runaways and of youths in school indicate that drug use and abuse is two-three times more prevalent for runaways than with the school youths. Runaways' attitudes toward selected illicit behaviors are more tolerant than those of school youths. Intervention programs for runaway/homeless youths should reflect an understanding of the complexity of the psycho-social and behavioral history of the clients which is much different than that of those who are in school.     

Translating family-focused prevention science into public health impact

Underage drinking is a pervasive problem in the United States, with serious consequences for youth, families, communities, and society as a whole. Family-focused preventive interventions for children and adolescents have shown potential for reducing underage drinking and other problem behaviors. Research findings indicate that clear advances have been made, in terms of both the number of evidence-based interventions available, and in the quality of the methods used to evaluate them. To fully reap the benefits of such preventive interventions and achieve public health impact, the findings of family-focused preventive intervention science must be translated into real-world, community practices. This type of translation can be enhanced through four sets of translational impact factors-effectiveness of interventions, extensiveness of their population coverage, efficiency of interventions, and engagement of eligible populations, with sustained quality intervention implementation. Findings from studies conducted by researchers at the Partnerships in Prevention Science Institute and other empirical work highlight the importance of these factors. A model for community- university partnerships has been developed that potentially can facilitate the dissemination and public health impact of universal interventions to prevent underage drinking and other problem behaviors. This model fits well within a comprehensive strategic framework for promoting effective prevention.     

Development of a Culturally Specific Career Exploration Group for Urban Chinese Immigrant Youth

A rapid increase in the number of Chinese immigrants and the specific challenges faced by low‐income Chinese immigrant youth attending urban schools warrant culturally sensitive school‐based interventions and services. However, research and services are limited for this population because of cultural biases in traditional career theories and the “model minority” myth suggesting that Asian students are excelling. The authors developed and implemented a culturally specific career exploration group for low‐income Chinese immigrant youth to address their career concerns with respect to multiple social and cultural factors and to provide social support. Implications for future program development and research are provided.