Psychologist finds great alternative for youth with Multisystemic Therapy
As a young clinical psychologist, fresh out of graduate school working for a private community mental-health agency, I was referred a 16-year-old white male for an “evaluation and assessment.” The evaluation and assessment is a common task in the child-serving system. Though it has different names, different funding streams and can be performed at a myriad of points in the process, it is always done for the same basic reason: to receive an expert’s opinion on what next steps should be taken in a child’s care. For the young man before me, it wasn’t quite clear what that step should be.
This was not because his case was unique or particularly complicated. He was the only child of a single mother. The two of them got along “fine.” School, also, was “fine.” As was his social life, his relationship with his estranged father . . . and most anything else I asked about. He had gotten in some trouble that put him into the juvenile-justice system, and apparently this put some strain on his relationship with his mother, but he was not on probation. He was visibly demonstrating a moderate depression, though being as he was an adolescent, this was experienced more as agitation—though he denied being upset about anything. (You guessed it: He was “fine.”) When I asked him why he was coming in for the evaluation, being as everything was fine, he gave a vague answer about doing it for his mother, who couldn’t be with him to corroborate anything he said. Ultimately, I was left with limited information with which to make a decision about the disposition for his treatment.
My thought was that this was a kid who needed a place to process through some things going on with his life. Ideally, I knew, this would be family therapy, but without the client’s mom available, it was a tenuous prospect at this time. I also knew the other programs my agency offered would not be right. He wasn’t in need of something as intensive as partial hospitalization or residential placement. He didn’t need case management, and his needs weren’t at the level necessary to qualify for our intensive, team-led family therapy program. So I did my best motivational interviewing, encouraged him to make the outpatient therapy session I was scheduling for him in our clinic and sent him on his way, saying I would forward my finished report in about a week.
Looking for More Answers
Something bothered me about this case, however, the moment he left my room. I just felt I did not have enough collateral information to know what was really going on with him and decided that before I finished the report, I should at least do due diligence and contact some of the people he had mentioned in the interview—including the person from probation who was “not” his probation officer. I called over and introduced myself and the case at hand. It turned out the boy was in more trouble than he had indicated. The probation officer said, “Yeah, he’ll be on probation by the end of the week. We wanted him referred for MST.”
It hit me like a ton of bricks. Of course, Multisystemic Therapy was the perfect program for this child. Involvement with juvenile probation, problems with the primary caregiver, adolescence . . . he was the poster-child of the service. And MST was something that I knew worked for this population. Unlike my “hoping” that he would be open to outpatient therapy and that he would eventually get his mother (and perhaps father) involved in a larger family-therapy intervention, MST was a program with years of evidence that would engage these necessary supports and work to bring lasting change to a child with exactly his type of problem. Why didn’t I think of MST off the bat?
Making Sure a Treatment Is the Right One
The reason for this is simple. I had forgotten about MST. It wasn’t something my agency provided, and thus, it wasn’t on my radar, even when faced with its prototypical client. Further, my assessment, though structured and professional, didn’t mean that I would look beyond my agency and find a program that would work best for the child. Instead, I tried to find a treatment within the system that would be “good enough.”
Luckily, in this case, we were able to change my recommendation, and this child and family got the treatment they needed. But this incident taught me some lasting truths about assessment and evaluation in the mental-health field. It is a complicated process that requires more than just questions that identify information for a report. It needs to be a process that objectively assesses every child’s unique needs and strengths and then refers him or her optimally—not just give a referral to one of the evaluator’s ready-to-hand programs.
The failures of “treatment as usual” in the mental-health system are not due to people not caring. They are due to our system being too complicated to run exclusively on human connection and requires the rigors of data, technology-driven decision support and objective-outcomes monitoring to be able to truly give our clients the care they need. Programs like MST have done the hard work of crafting interventions that we know, through objective data, bring change to those clients who match its needs. The rest of the system has to now catch up and provide clinicians the tools they need to make sure the right people get to these programs so that the benefits of that work and science can be experienced by our clients.