A randomized controlled trial of the effectiveness of multisystemic therapy in the Netherlands: post-treatment changes and moderator effects

Abstract

Objective In the present randomized controlled trial, the effectiveness of multisystemic therapy (MST) in The Netherlands was examined. Moderator tests were conducted for ethnicity, age and gender. Methods The sample consisted of N0256 adolescents, referred because of conduct problems, and randomized to MST or treatment as usual (TAU). Assessments (questionnaires and observational ratings) took place before and immediately after the treatment. Results MST was more effective than TAU in decreasing externalizing behavior, ODD, CD and property offences, but not for violence. Findings were mixed for adolescents' and parental cognitions: the MST group, compared to TAU, showed an improvement in parental sense of competence, and a decrease in adolescents' hostility, but no change in self-esteem and an increase in personal failure. MST was effective for positive dimensions of parenting and associations with prosocial peers, but not for relationships with deviant peers. MST was equally effective for adolescents of different ages and with different ethnicities. However, MST showed larger (and more positive) effects for adolescent cognitions for boys than for girls.

Risks, Outcomes, and Evidence-Based Interventions for Girls in the US Juvenile Justice System

“…There have been documented reductions in criminal offending by both sexes. Sex-specific treatment effects were not found nor reported across any of these studies, and girls did no better or worse than boys did on outcomes in any single study, with the exception of Asscher et al (2013) who reported larger effects for boys than girls on hostility outcomes following MST. Does this prove that these three EBPs are generally equally effective for males and for females?…”

“…The results of these trials indicate that the interventions are associated with improved outcomes across a host of domains, and in particular, that they lead to reductions in delinquency and recidivism. In each study, the intervention was effective for the sample as a whole, and with a single exception (Asscher et al, 2013), no differences were identified with respect to outcomes based on sex. However, girls were underrepresented in these trials relative to the population base rates for JJ-involved youths, except for TFCO, in which the trials included only girls.…”

“…In addition, many of the original trials were conducted by the developers of the intervention. Although there have been numerous recent independent RCTs led by individuals not associated with the intervention development (e.g., Asscher et al, 2013; Westermark, Hansson, & Olsson, 2010), additional independent trials would make valuable contributions to the conclusions that can be drawn from the evidence. What is clear is that further research is need that targets this vulnerable growing population of girls and young women who are at high risk for a plethora of negative outcomes.…”

Multisystemic Therapy for Externalizing Youth

“…7, 8, 9, 10 Therefore, caregiver monitoring, supervision, family cohesion and support, and provision of consistent rules and consequences are frequent targets of MST. When addressing these factors, MST therapists must be prepared to overcome barriers such as parental mental health problems, substance abuse, and poor parenting skills, all of which may be included in the ongoing conceptualization of problem behaviors.…”

Placement and Delinquency Outcomes Among System-Involved Youth Referred to Multisystemic Therapy: A Propensity Score Matching Analysis

“…The treatment effects of MST have also been linked to improved behavioral health symptoms 18 months after treatment among youth with antisocial and behavioral problems compared to youth who received wraparound services (Stambaugh et al 2007) or treatment-as-usual (Glisson et al 2010). The positive effects of MST in addressing problem behaviors among high-risk populations of offending youth have led to program adaptations for other at-risk populations of youth and families, including those with substance abuse problems (Henggeler et al 1999, 2006), serious conduct problems (Asscher et al 2013; Weiss et al 2013), serious emotional disturbance (Stambaugh et al 2007; Rowland et al 2005), and youth and families involved in the child protective services (MST-Child Abuse and Neglect or MST-CAN; Swenson et al 2010). The benefits of MST to reduce problem behaviors among high-risk youth and families have been corroborated by two meta-analytic studies, which suggest small to moderate treatment effect sizes on internalizing and externalizing symptoms among youth who participated in MST (van der Stouwe et al 2014; Curtis et al 2004; for a rebuttal, see; Littell et al 2005).…”