Program Description
Multisystemic Therapy (MST) is a science-based intensive family and community-based treatment model designed to address the externalizing behaviors (fighting, arguing/threatening, destroying property, using drugs and alcohol, disrespectful and disobedient conduct, running away, and truancy and curfew violations) of emotionally and behaviorally disturbed youth. MST has been identified by the National Institute of Health and the U.S. Surgeon General as an effective intervention for health-risking social behaviors of youth. MST provides 50 hours of direct family-based treatment over a three to five month period to improve the coping and behavioral health of children at risk of out-of-home placement and reduce the need to place them in hospitals, residential treatment centers or therapeutic foster care settings.

MST is provided using a home-based model of services delivery. This model helps to overcome barriers to service access, increases family retention in treatment, allows for the provision of intensive services (i.e., therapists have low caseloads) and enhances the maintenance of treatment gains. This service is conducted in the home setting where the problem occurs and aims at helping children change by improving the communication, cohesion and warmth among family members; increasing the youth and family’s perception of empowerment and ability to change or manage problems; strengthening parenting skills, including monitoring, emotional coaching, negotiating and problem-solving; developing social and emotional competencies of the youth; building positive youth connections to healthy peers and activities and facilitating positive commitments to school.

Target Population

This service is for youth age 12-17 identified by multiple child-serving systems (MH/MR, Child Welfare, Courts, JPO or Education) due to severe behavioral or emotional problems and are at risk for out-of-home placement.  They are frequently diagnosed with ADHD, ODD, Conduct Disorder, Adjustment Disorder or Substance Abuse.  MST accepts referrals for both reunification and preservation interventions.

Treatment Model

This service uses the Family Preservation Model, which includes the following characteristics:

• Services are provided to the family, although a variety of activities may be undertaken with or on behalf of individuals. 
• Services are targeted to families with children at risk of out-of-home placement to foster care, group homes, residential treatment or hospitals. 
• Services are time-limited (three to five months). 
• Services are flexibly scheduled to meet the family’s needs and are delivered in the home. 
• Services are tailored to the needs of family members. 
• Services are provided in the context of a family’s values, beliefs and culture. 
• Services are available 24 hours a day, seven days a week. 
• Workers have small case loads of between four and six families and may visit families many times a week. In many programs, families are seen between two and five hours per week. Hence, the term "intensive" is sometimes used to describe family preservation services.

Service Areas

MST offers services to families who reside in Dauphin County, Cumberland County, Perry County, Lebanon County, Montour County, Northumberland County, Snyder County, Union County and Elizabethtown.  MST works in close collaboration with, and accepts referrals from, juvenile probation, children and youth, MH/MR, schools, police and judges.  Referrals can also be accepted directly from families.

Outcomes 

The mission of MST is to keep children successfully in their homes without the need for any out-of-home placement. MST began serving families during October 2002 as part of a four-year grant from the Pennsylvania Commission on Crime and Delinquency. MST is currently funded through Medical Assistance and through county funding.

The most recent data available encompasses the past 4 years of the program (June 2002-June 2006).  In the past 4 years a total of 150 youth were served in the MST program. Data collected on these 150 youth indicates that:

• Youth accounted for 368 unique delinquent behaviors.
• Youth had 46 detentions and 157 previous arrests.
• Youth were involved in 218 prior treatments.
• 57% of youth had poor school performance at intake.
• 40% of youth had poor school attendance at intake.
• 39% of youth had substance use problems at intake.
• 61% of youth presented with family conflict.
• 43% of youth were female, 57% were male.
• 7% of youth were not enrolled in school, 1% were home schooled.

MST was successful in preserving 83.5% of youth in their home at time of case closure. Long-term outcomes indicate that 78.9% of youth were maintained in the community between 6-18 months post-termination.