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Multisystemic Therapy for Child Non-Externalizing Psychological and Health Problems: A Preliminary Review

Abstract

Multisystemic therapy (MST) is effective for decreasing or preventing delinquency and other externalizing behaviors and increasing prosocial or adaptive behaviors. The purpose of this project was to review the literature examining the efficacy of MST for other child psychological and health problems reflecting non-externalizing behaviors, specifically difficulties related to child maltreatment, serious psychiatric illness [Serious psychiatric illness was defined throughout the current review paper as the “presence of symptoms of suicidal ideation, homicidal ideation, psychosis, or threat of harm to self or others due to mental illness severe enough to warrant psychiatric hospitalization based on the American Academy of Child and Adolescent Psychiatry (Level of care placement criteria for psychiatric illness. American Academy of Child and Adolescent Psychiatry, Washington, DC, 1996) level of care placement criteria for psychiatric illness” (Henggeler et al. in J Am Acad Child Psy 38:1331–1345, p. 1332, 1999b). Additionally, youth with “serious emotional disturbance (SED)” defined as internalizing and/or externalizing problems severe enough to qualify for mental health services in public school who were “currently in or at imminent risk of a costly out-of-home placement” (Rowland et al. in J Emot Behav Disord 13:13–23, pp. 13–14, 2005) were also included in the serious psychiatric illness category.], and health problems (i.e., obesity and treatment adherence for diabetes). PubMed, Web of Science, MEDLINE, and PsycINFO databases; Clinicaltrials.gov; DARE; Web of Knowledge; and Cochrane Central Register of Controlled Trials were searched; and MST developers were queried to ensure identification of all relevant articles. Of 242 studies identified, 18 met inclusion criteria for review. These were combined in a narrative synthesis and critiqued in the context of review questions. Study quality ratings were all above mean scores reported in prior reviews. Mixed support was found for the efficacy of MST versus other treatments. In many cases, treatment effects for MST or comparison groups were not sustained over time. MST was efficacious for youth with diverse backgrounds. No studies discussed efficacy of MST provided in different treatment settings. Four studies found MST more cost-effective than a comparison treatment, leading to fewer out-of-home placements for youth with serious psychiatric illness or lower treatment costs for youth with poorly controlled diabetes.

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Notes

  1. 1.

    Serious psychiatric illness was defined throughout the current review paper as the “presence of symptoms of suicidal ideation, homicidal ideation, psychosis, or threat of harm to self or others due to mental illness severe enough to warrant psychiatric hospitalization based on the American Academy of Child and Adolescent Psychiatry (1996) level of care placement criteria for psychiatric illness” (Henggeler et al. 1999b, p. 1332). Additionally, youth with “serious emotional disturbance (SED)” defined as internalizing and/or externalizing problems severe enough to qualify for mental health services in public school who were “currently in or at imminent risk of a costly out-of-home placement” (Rowland et al. 2005, pp. 13–14) were also included in the serious psychiatric illness category.

References

  1. American Academy of Child and Adolescent Psychiatry. (1996). Level of care placement criteria for psychiatric illness. Washington, DC: American Academy of Child and Adolescent Psychiatry.

    Google Scholar 

  2. Borduin, C. M. (2009). Multisystemic therapy for antisocial behavior in adolescents. Familiendynamik, 34, 236–245.

    Google Scholar 

  3. Borduin, C. M., Schaeffer, C. M., & Heiblum, N. (2009). A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: Effects on youth social ecology and criminal activity. Journal of Consulting and Clinical Psychology, 77, 26–37.

    PubMed  Article  Google Scholar 

  4. Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press.

    Google Scholar 

  5. Brown, T. L., Henggeler, S. W., Schoenwald, S. K., Brondino, M. J., & Pickrel, S. G. (1999). Multisystemic treatment of substance abusing and dependent juvenile delinquents: Effects on school attendance at post treatment and 6-month follow-up (Electronic version). Children’s Services: Social Policy, Research, and Practice, 2, 81–93.

    Google Scholar 

  6. Brunk, M., Henggeler, S. W., & Whelan, J. P. (1987). Comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect. Journal of Consulting and Clinical Psychology, 55, 171–178.

    PubMed  Article  Google Scholar 

  7. Curtis, N. M., Ronan, K. R., & Borduin, C. M. (2004). Multisystemic treatment: A meta-analysis of outcome studies. Journal of Family Psychology, 18, 411–419.

    PubMed  Article  Google Scholar 

  8. Curtis, N. M., Ronan, K. R., Heiblum, N., & Crellin, K. (2009). Dissemination and effectiveness of multisystemic treatment in New Zealand: A benchmarking study. Journal of Family Psychology, 23, 119–129.

    PubMed  Article  Google Scholar 

  9. Downs, S. H., & Black, N. (1998). The feasibility of creating a checklist for the assessments of the methodological quality both of randomised and non-randomised studies of health care interventions. Journal of Epidemiology and Community Health, 52, 377–384.

    PubMed  Article  Google Scholar 

  10. Ellis, D. A., Frey, M. A., Naar-King, S., Templin, T., Cunningham, P., & Cakan, N. (2005a). Use of multisystemic therapy to improve regimen adherence among adolescents with type I diabetes in chronic poor metabolic control: A randomized controlled trial. Diabetes Care, 28, 1604–1610.

    PubMed  Article  Google Scholar 

  11. Ellis, D. A., Frey, M. A., Naar-King, S., Templin, T., Cunningham, P., & Cakan, N. (2005b). The effects of multisystemic therapy on diabetes stress among adolescents with chronically poorly controlled type 1 diabetes: Findings from a randomized, controlled trial. Pediatrics, 116, e826–e832.

    PubMed  Article  Google Scholar 

  12. Ellis, D. A., Janisse, H., Naar-King, S., Kolmodin, K., Jen, K.-L. C., Cunningham, P., et al. (2010). The effects of multisystemic therapy on family support for weight loss among obese African̄-American adolescents: Findings from a randomized controlled trial. Journal of Developmental and Behavioral Pediatrics, 31, 461–468.

    PubMed  Google Scholar 

  13. Ellis, D. A., Naar-King, S., Chen, X., Moltz, K., Cunningham, P. B., & Idalski-Carcone, A. (2012). Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: Findings from a randomized controlled trial. Annals of Behavioral Medicine, 44, 207–215.

    PubMed  Article  Google Scholar 

  14. Ellis, D. A., Naar-King, S., Frey, M., Templin, T., Rowland, M., & Cakan, N. (2005c). Multisystemic treatment of poorly controlled type 1 diabetes: Effects on medical resource utilization. Journal of Pediatric Psychology, 30, 656–666.

    PubMed  Article  Google Scholar 

  15. Ellis, D. A., Naar-King, S., Frey, M., Templin, T., Rowland, M., & Greger, N. (2004). Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in poor metabolic control: A pilot investigation. Journal of Clinical Psychology in Medical Settings, 11, 315–324.

    Article  Google Scholar 

  16. Ellis, D., Naar-King, S., Templin, T., Frey, M., Cunningham, P., Shiedow, A., et al. (2008). Multisystemic therapy for adolescents with poorly controlled type 1 diabetes: Reduced diabetic ketoacidosis admissions and related costs over 24 months. Diabetes Care, 31, 1746–1747.

    PubMed  Article  Google Scholar 

  17. Ellis, D. A., Templin, T., Naar-King, S., Frey, M. A., Cunningham, P. B., Podolski, C.-L., et al. (2007). Multisystemic therapy for adolescents with poorly controlled type 1 diabetes: Stability of treatment effects in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 75, 168–174.

    PubMed  Article  Google Scholar 

  18. Fleiss, J. L. (1981). Statistical methods for rates and proportions (2nd ed.). New York: Wiley.

    Google Scholar 

  19. Henggeler, S. W. (1999). Multisystemic therapy: An overview of clinical procedures, outcomes, and policy implication. Child Psychology & Psychiatry Review, 4, 4–9.

    Article  Google Scholar 

  20. Henggeler, S. W. (2011). Efficacy studies to large-scale transport: The development and validation of multisystemic therapy programs. Annual Review of Clinical Psychology, 7, 351–381.

    PubMed  Article  Google Scholar 

  21. Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders (Electronic version). Journal of Consulting and Clinical Psychology, 60, 953–961.

    PubMed  Article  Google Scholar 

  22. Henggeler, S. W., Pickrel, S. G., & Brondino, M. J. (1999a). Multisystemic treatment of substance abusing and dependent delinquents: Outcomes, treatment fidelity, and transportability. Mental Health Services Research, 1, 171–184.

    PubMed  Article  Google Scholar 

  23. Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C., Sheidow, A. J., Ward, D. M., Randall, J., et al. (2003). One-year follow-up of multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 543–551.

    PubMed  Article  Google Scholar 

  24. Henggeler, S. W., Rowland, M. D., Randall, J., Ward, D. M., Pickrel, S. G., Cunningham, P., et al. (1999). Home-based multsystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: Clinical outcomes (Electronic version). Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1331–1345.

    PubMed  Article  Google Scholar 

  25. Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic therapy for antisocial behavior in children and adolescents (2nd ed.). New York: The Guilford Press.

    Google Scholar 

  26. Huey, S. J., Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C. A., Cunningham, P. B., Pickrel, S. G., et al. (2004). Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 183–190.

    PubMed  Article  Google Scholar 

  27. Kendall, P., & Hedtke, K. (2006). Cognitive-behavior therapy for anxious children: therapist manual (3rd ed.). Ardmore: Workbook Publishing.

    Google Scholar 

  28. Khan, K. S., Ter Reit, G., Glanville, J., Sowden, A. J., & Kleijnen, J. (2000). Undertaking systematic reviews of research on effectiveness. CRD’s guidance for carrying out or commissioning reviews. York, England: University of York, NHS Centre for Reviews and Dissemination.

  29. Klietz, S. J., Borduin, C. M., & Schaeffer, C. M. (2010). Cost-benefit analysis of multisystemic therapy with serious and violent juvenile offenders. Journal of Family Psychology, 24, 657–666.

    PubMed  Article  Google Scholar 

  30. Lynch, F. L., & Clarke, G. N. (2006). Estimating the economic burden of depression in children and adolescents. American Journal of Preventive Medicine, 31, 143–151.

    Article  Google Scholar 

  31. McPherson, S., Cairns, P., Carlyle, J., Shapiro, D. A., Richardson, P., & Taylor, D. (2005). The effectiveness of psychological treatments for treatment-resistant depression: A systemic review. Acta Psychiatrica Scandinavica, 111, 331–340.

    PubMed  Article  Google Scholar 

  32. Moher, D., Jadad, A. R., Nichol, G., Penman, M., Tugwell, P., & Walsh, S. (1995). Assessing the quality of randomised controlled trials: An annotated bibliography of checklists. Controlled Clinical Trials, 16, 62–73.

    PubMed  Article  Google Scholar 

  33. Multisystemic therapy: An overview. (2007). Retrieved from MST services website. http://www.mstservices.com/index.php/resources/mst-library.

  34. Naar-King, S., Ellis, D. A., Idalski, A., Frey, M. A., & Cunningham, P. (2007). Multisystemic therapy decreases parent overestimation of adolescent responsibility for type 1 diabetes management in urban youth. Families, Systems, & Health, 25, 178–189.

    Article  Google Scholar 

  35. Naar-King, S., Ellis, D., Kolmodin, K., Cunningham, P., Jen, C., Saelens, B., et al. (2009). A randomized pilot study of multisystemic therapy targeting obesity in African American adolescents. Journal of Adolescent Health, 45, 417–419.

    PubMed  Article  Google Scholar 

  36. Ogden, T., & Halliday-Boykins, C. A. (2004). Multisystemic treatment of antisocial adolescents in Norway: Replication of clinical outcomes outside of the US. Child and Adolescent Mental Health, 9, 77–83.

    Article  Google Scholar 

  37. Painter, K. (2010). Multisystemic therapy as an alternative community-based treatment for youth with severe emotional disturbance: Empirical literature review. Social Work in Mental Health, 8, 190–208.

    Article  Google Scholar 

  38. Paukert, A. L., Phillips, L. L., Cully, J. A., Romero, C., & Stanley, M. A. (2011). Systematic review of the effects of religion-accommodative psychotherapy for depression and anxiety. Journal of Contemporary Psychotherapy, 41, 99–108.

    Article  Google Scholar 

  39. Rowland, M. D., Halliday-Boykins, C. A., Henggeler, S. W., Cunningham, P. B., Lee, T. G., Kruesi, M. J. P., et al. (2005). A randomized trial of multisystemic therapy with Hawaii’s felix class youths. Journal of Emotional and Behavioral Disorders, 13, 13–23.

    Article  Google Scholar 

  40. Schoenwald, S. K., Sheidow, A. S., Letourneau, E. J., & Liao, J. G. (2003). Transportability of evidence-based treatments: Evidence for multi-level influences. Mental Health Services Research, 5, 223–239.

    PubMed  Article  Google Scholar 

  41. Schoenwald, S. K., Ward, D. M., Henggeler, S. W., & Rowland, M. D. (2000). MST vs. hospitalization for crisis stabilization of youth: Placement outcomes 4 months post-referral. Mental Health Services Research, 2, 3–12.

    PubMed  Article  Google Scholar 

  42. Sheidow, A. J., Bradford, W. D., Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C., Schoenwald, S. K., et al. (2004). Treatment costs for youths receiving multisystemic therapy or hospitalization after a psychiatric crisis. Psychiatric Services, 55, 548–554.

    PubMed  Article  Google Scholar 

  43. Swenson, C. C., Schaeffer, C. M., Henggeler, S. W., Faldowski, R., & Mayhew, A. M. (2010). Multisystemic therapy for child abuse and neglect: A randomized effectiveness trial. Journal of Family Psychology, 24, 497–507.

    PubMed  Article  Google Scholar 

  44. Tolman, R. T., Mueller, C. W., Daleiden, E. L., Stumpf, R. E., & Pestle, S. L. (2008). Outcomes from multisystemic therapy in a statewide system of care. Journal of Child and Family Studies, 17, 894–908.

    Article  Google Scholar 

  45. Wolfe, D. A., & Mash, E. J. (Eds.). (2006). Behavioral and emotional disorders in adolescents: Nature, assessment, and treatments. New York: The Guilford Press.

    Google Scholar 

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Acknowledgments

This work was partly supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and the Houston VA Health Services Research and Development Center of Excellence (HFP90-020). The views expressed are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the United States government or Baylor College of Medicine.

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Correspondence to Heather T. Pane.

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Pane, H.T., White, R.S., Nadorff, M.R. et al. Multisystemic Therapy for Child Non-Externalizing Psychological and Health Problems: A Preliminary Review. Clin Child Fam Psychol Rev 16, 81–99 (2013). https://doi.org/10.1007/s10567-012-0127-6

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Keywords

  • Multisystemic
  • Treatment
  • Internalizing
  • Maltreatment
  • Health problems