Multisystemic Therapy – Building Stronger Families
Multisystemic Therapy – Building Stronger Families (MST-BSF) is an adaptation of Multisystemic Therapy (MST) designed for families with youth ages 6–17 who come under the guidance of child protective services due to co-occurring parental substance use and physical abuse or neglect of a child. MST-BSF combines three program models: (1) MST, (2) MST for Child Abuse and Neglect, and (3) Reinforcement-Based Treatment for substance use disorders. MST-BSF uses the same service delivery characteristics and guiding principles as the core MST model. However, all family members who need treatment receive it, with a strong emphasis on adult interventions and child safety, including interventions for children who are not the subject of the maltreatment report. MST-BSF follows the MST for Child Abuse and Neglect model closely but adds Reinforcement-Based Treatment for all cases. As in MST for Child Abuse and Neglect, MST-BSF adds two key team members to the standard MST model: (1) a family resource specialist, who provides case management to help families meet basic safety needs and navigate the public assistance system to obtain services (e.g., housing) and (2) a part-time psychiatrist or advanced practice registered nurse.
MST-BSF begins with an intake process that includes a variety of assessments (including assessments for trauma, post-traumatic stress disorder, and substance abuse) to identify family needs and determine their treatment goals. A member of the MST-BSF team explains the purpose and implications of drug testing results to the parent and then conducts a baseline assessment of drug use. The MST-BSF team and family develop a safety plan to protect the child in the event of parental relapse. For parents with physical drug dependency, the team also recommends a 5–7-day stay in an inpatient detoxification facility.
Therapists then use information from the assessments to determine which interventions and services are appropriate for the family and youth. Family interventions may include cognitive behavioral therapy to address anger management issues, behavioral family therapy to address communication and problem-solving skills, or prolonged exposure therapy to address post-traumatic stress disorder. Youth interventions are based on their needs and may include school-based interventions and cognitive behavioral therapies for trauma, anger management, and substance abuse.
Parents receive individual counseling sessions (such as counseling for trauma or substance use) and undergo weekly drug and alcohol testing throughout treatment. They receive positive reinforcement, such as small voucher incentives for negative screens. Parents self-monitor by graphing the results of urine drug screens weekly. Stickers and encouraging words are written on graphs when results are negative. Therapists also encourage participation in activities that compete with time spent using drugs (e.g., Alcoholics Anonymous, drug-free recreation, jobs). The provider agency holds a weekly 2-hour relapse prevention group to provide social support and reinforcement of progress. When needed, parents participate in couples therapy and family therapy sessions with their children.
MST-BSF is rated as a supported practice because at least one study carried out in a usual care or practice setting achieved a rating of moderate or high on design and execution and demonstrated a sustained favorable effect of at least 6 months beyond the end of treatment on at least one target outcome.
Date Last Reviewed (Handbook Version 1.0): Apr 2023
Sources
The program or service description, target population, and program and service delivery and implementation information were informed by the following sources: the program or service manual, the program or service developer’s website, the California Evidence-Based Clearinghouse for Child Welfare, and the studies reviewed.
This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, download the Handbook of Standards and Procedures, Version 1.0
Target Population
MST-BSF is designed for families with youth ages 6–17 who come under the guidance of child protective services due to co-occurring parental substance use and physical abuse or neglect of a child.
Dosage
Program dosage varies based on youth and family needs. The treatment team is comprised of three therapists that provide a minimum of three treatment sessions per week and who share an on-call rotation to provide crisis-related services for all families 24 hours per day, 7 days per week. Teams conduct intake assessments over several days and deliver needed interventions and services over a period of 6–9 months. Families typically receive services for an average of 7 months. Therapists have maximum caseloads of four families.
Location/Delivery Setting
Recommended Locations/Delivery Settings
Teams deliver MST-BSF in-person in participants’ homes, in schools, in community settings, or in in-patient treatment settings in cases where the parent is receiving detoxification services.
Location/Delivery Settings Observed in the Research
- Home
- Provider Agency
Education, Certifications and Training
MST-BSF teams consist of three therapists who are part of licensed MST teams and organizations. MST-BSF therapists deliver the program with support from a supervisor, a family resource specialist, and a part-time psychiatrist or advanced practice registered nurse. Therapists typically have master’s degrees in social work, psychology, counseling, or marriage and family therapy. Supervisors typically have a master’s or doctoral degree in social work, psychology, counseling, or marriage and family therapy.
Therapists, supervisors, and other MST-BSF clinical team members must first complete 13 days of training. This includes a 5-day training in the MST model provided by Ph.D. and master’s level mental-health specialists. The training includes teaching, role-playing, and other exercises designed to develop skills used in the treatment process and to provide opportunities to practice using MST assessment strategies. The training also aims to familiarize team members with the theory underlying the MST model, the causes of serious behavior problems that MST can address, the strategies MST teams use to build collaborative relationships with stakeholder agencies in the community, and the team member’s role in continuous quality improvement. Team members also participate in 2 days of training in MST for Child Abuse and Neglect and 2 days of training in Reinforcement-based Treatment. Following initial training, clinical team members participate in 2 days of training on adult treatment for trauma and 2 days of training on child treatment for trauma. All clinical team members also participate in on-the-job learning, including 1.5 hours of weekly group supervision, individual supervision as needed, and 1.5 hours of weekly consultation with an MST-BSF expert.
Program or Service Documentation
Book/Manual/Available documentation used for review
MST-BSF is implemented with the following three resources:
Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., & Rowland, M. D. (2009). Multisystemic Therapy for antisocial behavior in children and adolescents (2nd ed.). The Guilford Press.
Swenson, C. C., Penman, J. E., Henggeler, S. W., & Rowland, M. D. (2011). Multisystemic Therapy for Child Abuse and Neglect, revised edition. Medical University of South Carolina Family Services Research Center, National Institute of Mental Health, Connecticut Department of Children and Families, and MST Services.
Tuten, L. M., Jones, H. E., Schaeffer, C. M., & Stitzer, M. L. (2012). Reinforcement-Based Treatment for substance use disorders: A comprehensive behavioral approach. American Psychological Association.
Available languages
MST-BSF materials are available in English.
Other supporting materials
For More Information
Website: http://www.mstservices.com/
Phone: (843) 856-8226
Email: info@mstservices.com
Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.
| Results of Search and Review | Number of Studies Identified and Reviewed for Multisystemic Therapy – Building Stronger Families |
|---|---|
| Identified in Search | 2 |
| Eligible for Review | 2 |
| Rated High | 0 |
| Rated Moderate | 1 |
| Rated Low | 1 |
| Reviewed Only for Risk of Harm | 0 |
| Outcome | Effect Size
 and Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
|---|---|---|---|---|
| Child safety: Child welfare administrative reports |
0.81
29 |
1 (6) | 43 |
Favorable:
4 No Effect: 2 Unfavorable: 0 |
| Child permanency: Out-of-home placement |
0.68
25 |
1 (3) | 43 |
Favorable:
1 No Effect: 2 Unfavorable: 0 |
Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes for some outcomes were not able to be calculated by the Prevention Services Clearinghouse.
| Outcome | Effect Size
and Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
Months after treatment when outcome measured
|
|---|---|---|---|---|---|
| Child safety: Child welfare administrative reports |
0.81
29 |
1 (6) | 43 |
Favorable:
4 No Effect: 2 Unfavorable: 0 |
- |
| Study 14760 - MST-BSF vs. Comprehensive Community Treatment (Schaeffer, 2013) | |||||
| Substantiated Maltreatment Report for Mother (Any Child) |
0.96
*
33 |
- | 43 | - | 12 |
| Substantiated Maltreatment Reports for Mother (Number, Any Child) |
Favorable
*
not calculated |
- | 43 | - | 12 |
| Alleged Maltreatment Reports for Mother (Number, Any Child) |
Favorable
*
not calculated |
- | 43 | - | 12 |
| Substantiated Maltreatment Report for Any Caregiver |
0.67
24 |
- | 43 | - | 12 |
| Substantiated Maltreatment Reports for Any Caregiver (Number) |
Favorable
*
not calculated |
- | 43 | - | 12 |
| Alleged Maltreatment Reports for Any Caregiver (Number) |
Null
not calculated |
- | 43 | - | 12 |
| Child permanency: Out-of-home placement |
0.68
25 |
1 (3) | 43 |
Favorable:
1 No Effect: 2 Unfavorable: 0 |
- |
| Study 14760 - MST-BSF vs. Comprehensive Community Treatment (Schaeffer, 2013) | |||||
| Out-of-Home Placement |
0.68
25 |
- | 43 | - | 12 |
| Out-of-Home Placements (Number) |
Null
not calculated |
- | 43 | - | 12 |
| Out-of-Home Placements (Number of Days) |
Favorable
*
not calculated |
- | 43 | - | 12 |
*p <.05
Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Version 1.0, Section 5.10.4 and may not align with effect sizes reported in individual publications. The Prevention Services Clearinghouse uses information reported in study documents and, when necessary, information provided by authors in response to author queries to assign study ratings and calculate effect sizes and statistical significance (see Section 7.3.2 in the Handbook of Standards and Procedures, Version 1.0). As a result, the effect sizes and statistical significance reported in the table may not align with the estimates as they are reported in study documents. Effect sizes for some outcomes were not able to be calculated by the Prevention Services Clearinghouse.
Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.
Full citations for the studies shown in the table are available in the "Studies Reviewed" section.
The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.
The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.
For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.
| Characteristics of the Participants in the Studies with Moderate or High Ratings | ||||||
|---|---|---|---|---|---|---|
|
Study Location
|
Study Year
|
Age or Grade-level
|
Race, Ethnicity, Nationality
|
Gender
|
Populations of Interest*
|
Household Socioeconomic Status
|
| Study 14760 - MST-BSF vs. Comprehensive Community Treatment | ||||||
| Characteristics of the Children and Youth | ||||||
| New Britain, CT, USA | 2005 | Mean age: 12 years; Age range: 6-17 years |
65% White, Non-Hispanic 14% Hispanic 14% Biracial 4.7% Black, Non-Hispanic 2.3% Other |
44% Female | -- | -- |
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| New Britain, CT, USA | 2005 | Average age: 39 years |
79% White, Non-Hispanic 16% Hispanic 4.7% Black, Non-Hispanic |
-- | 100% Maltreatment incident within past 180 days (71% Physical neglect, 21% Emotional abuse, 7% Physical abuse); 100% Parental substance abuse confirmed or suspected by DCF; 91% Mother had a prior maltreatment report; 16% Child previously placed out of the home | -- |
“--” indicates information not reported in the study.
* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.
Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.
Studies Rated Moderate
Study 14760Schaeffer, C. M., Swenson, C. C., Tuerk, E. H., & Henggeler, S. W. (2013). Comprehensive treatment for co-occurring child maltreatment and parental substance abuse: Outcomes from a 24-month pilot study of the MST-Building Stronger Families program. Child Abuse & Neglect, 37(8), 596–607. https://doi.org/10.1016/j.chiabu.2013.04.004
This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)Studies Rated Low
Study 14761Schaeffer, C. M., Swenson, C. C., & Powell, J. S. (2021). Multisystemic Therapy - Building Stronger Families (MST-BSF): Substance misuse, child neglect, and parenting outcomes from an 18-month randomized effectiveness trial. Child Abuse & Neglect, 122, Article 105379. https://doi.org/10.1016/j.chiabu.2021.105379
This study received a low rating because it did not meet design confound standards.