An Evidence-based Treatment Model for Families and Children who have Experienced Child Maltreatment: Multisystemic Thera

1. An Evidence-based Treatment Model for Families and Children who have Experienced Child Maltreatment: Multisystemic Therapy HAWAI I INTERNATIONAL CONFERENCEON SOCIAL SCIENCESMay 2008Honolulu, Hawaii Kirstin Painter, Ph.D., LCSW Texas Woman’s University Maria Scannapieco, Ph.D. Center for Child Welfare University of Texas at Arlington HTTP://WWW2.UTA.EDU./SSW/CHILDWELF.HTM

2. Presentation Outline Overview of Problem Review of MST Review of Empirical Literature of MST Study Method Results Discussion and Conclusion

3. Children’s Mental Health: A Public Health Crisis Fragmented service delivery system A lag between discovery and practice Gaps of knowledge (New Freedom Commission, 2003)

4. Lack of Research For community-based treatment (Burns, Hoagwood, & Mrazek, 1999) For multi-problem youth and families (Evidence-based Services Committee Biennial Report, 2004) For interventions that combine treatments to address the multiple antecedents of mental health (Zaff, Calkins, Bridges, & Margie, 2002)

5. Consequences of Crisis Untreated youth end up in the child welfare or juvenile justice systems (Texas Institute for Policy Research, 2005) 36% of youth in the juvenile system due to inadequate or unavailable mental health services (Mental Health Association in Texas, 2005) 12,700 families relinquished custody of their children in 2003 (US. General Accounting Office)

6. Consequences of the Crisis Disrupted development Problems with school, peers, and family Problems follow youth into adulthood Children of color in poverty at higher risk of not receiving appropriate care (Gonzales, 2005)

7. Treatments for Youth with SED with multi-problem/abusing families Intensive Case Management Treatment foster care Home-based services

8. Multisystemic Therapy (MST) Stands out as a culturally competent, community-based, evidence-based treatment for treating certain populations in the juvenile justice system (Burns et al., 1999)

9. What is MST? Goal-oriented Community-based treatment Designed to serve multi-problem youth and families Developed at the Family Services Research Center at the Medical University of South Carolina Uses only treatment strategies supported by research Evidence-based

10. What is MST? MST Therapists available 24 hours a day, seven days a week Services provided in the home, school, neighborhood and community Small Caseloads  

11. What is MST? MST addresses in a social ecological manner the risk factors of from difficulties in the following areas: family relations and problems school performance peer relations neighborhood and community

12. What does MST do?   A social ecological functional assessment to understand “fit” of problem behavior Focuses interventions on areas sustaining problems TX provided in the home, school, community Emphasizes long-term change

13. MST Research Over 15 randomized, clinical trials with pre-test, post-test Studied across culturally diverse groups Studied across both males and females Studied across ages 10 y.o. to 17 y.o.

14. Study Populations in MST Research Juvenile Sex Offenders Violent and chronic Juvenile offenders Maltreating Families Youth presenting for psychiatric hospitalization

15. Control Group Treatment Usual community services Behavior parent training Individual counseling Inpatient psychiatric treatment

16. MST Research Findings Reduced recidivism of criminal offending Improved peer relations Improved school attendance and involvement Decreased behavior problems Improved family relations Decreased psychiatric symptoms Decreased substance abuse

17. Is MST Evidence-based? Some agree MST is a well validated, evidence-based program (Kazdin & Weisz, 1998) Some question its true efficacy (Littell, Popa, & Forsythe, 2005)

18. Purpose of Study To evaluate the use of MST and compare it to a parent skills training and case management model (usual services) with seriously emotionally disturbed youth involved in child welfare and community mental health

19. Research Hypotheses Emotionally disturbed youth ages 10 to 17 with who receive MST will experience more improved treatment outcomes and: 1a. Improved mental health symptoms 1b. Improved functioning 1c. Improved school functioning 1d. Improved family functioning 1e. Decreased risk of self harm 1f. Decreased severe and aggressive behavior

20. Methods Secondary data analysis Pretest-post-test Quasi-experimental design

21. Study Participants Youth with a severe emotional disturbance Ages 10 to 17 Involved in child welfare and community mental health systems

22. Independent Variable Multisystemic Therapy (treatment group) Case Management and Barkley’s Parenting Skills Training Curriculum (Comparison Group)

23. Dependent Variables The Ohio Youth Problem Severity Scale (Ogles, Lunnen, Gillespie and Trout, 1996) The Ohio Youth Functioning Scale (Ogles et al., 1996) Family Resources Scale Severe Disruptive or Aggressive Behavior Scale School Behavior Scale Risk of Self Harm Scale Severe and Aggressive Behavior Scale Components of the CA-TRAG(TDMHMR, 2003)

24. Overarching Hypothesis Emotionally disturbed youth ages 10 to 17 who receive MST will experience more improved treatment outcomes than youth receiving usual services Linear combination of all dependent variables

25. Data Collection Report from MHMRTC data system: Type of service Diagnoses Age Gender Ethnicity Pre-post-test scores of measurement instruments

26. From the report 87 youth who qualified for this study received MST 30 African American (16 male, 14 female) 9 Hispanic (5 male, 4 female) 47 Caucasian (20 male, 27 female) 1 other 863 youth who qualified for the study received usual services Stratified random sample Matching based on gender and ethnicity

27. Data Analysis Factorial MANCOVA Covariates: Intake Ohio Functioning Scale Intake Ohio Problem Severity Scale Intake School Behavior Scale Intake Family Resources Scale Intake Risk of Self Harm Scale Intake Severe and Aggressive Behavior Scale Psychotropic medications Independent Variables: Treatment type Gender Ethnicity Age Range Paired-Samples t tests

28. Clinical Significance 11 point change on the Problem Severity Scale 8 point change on the Functioning Scale

29. Study Findings and Discussion

30. Overarching Research Hypothesis Emotionally disturbed youth who receive multisystemic therapy will experience more improved treatment outcomes than those receiving usual community services The overarching research hypothesis was supported (Lambda(10,154) = .851, p = .005, partial ?2 = .149)

31. Hypothesis 1a Emotionally disturbed who receive multisystemic therapy will experience more improved mental health symptoms than those receiving usual community services Hypothesis 1a was supported

32. Statistical and Clinical Comparison of Mental Health Symptoms

33. Hypothesis 1b Emotionally disturbed youth who receive multisystemic therapy will experience more improved functioning than those receiving usual community services Hypothesis 1b was not supported

34. Statistical and Clinical Comparison of Functioning

35. Hypotheses 1c,d,e, & f Emotionally disturbed youth ages 10 to 17 with an externalizing disorder who receive MST will experience more improved: 1c. Improved school functioning 1d. Family functioning 1e. Decreased risk of self harm 1f. Decreased severe and aggressive behavior than youth who receive usual services Hypotheses 1c,d,e, & f were not supported

36. Between Groups Comparison of School Behavior

37. Between Groups Comparison of Family Resources

38. Between Group Comparison of Risk of Self Harm

39. Between Group Comparison of Severe and Aggressive Behavior

40. Comparison based on Age, Gender, Ethnicity Multivariate analysis indicated that no differences existed based on: Gender (Lambda(6,139) = .969, p > .05) Ethnicity (Lambda(6,139) = .975, p > .05) Age range (Lambda(6,139) = .922, p > .05)

41. Limitations of the Study Quasi-experimental design Secondary data analysis Completers versus non-completers Lack of a control group receiving no services

42. Strengths of the Study Community-based Compares 2 credible treatments Compared treatment outcomes based on age range, ethnicity, and gender Not conducted by a MST founder

43. Implications for Research Compare MST to other home and community-based treatments with empirical support Increase the knowledge base of effective community based interventions for youth and their multi-problem families Increase research conducted in the natural environment of youth with serious emotional impairments

44. Conclusions While findings of this study were mixed across individual areas of the youth’s social ecology in that both treatments were found to be effective, the overall finding was that MST improved things across the combined areas in the ecology.