Out-of-Home was Only Option Until Multisystemic Therapy

Posted by Danielle Spadine

May 19, 2016 9:00:00 AM

Pennsylvania family ready to give up on 14-year-old Son

I first met Anthony at his Inter-Agency Service Planning Team (ISPT) meeting. Sitting at the head of the table wearing an ankle bracelet and a big smile on his face, he told me he was ready to go home. He had been in two juvenile placements and was finishing up a stay at a drug-rehabilitation center. 

During the meeting, his parents acknowledged they were at their wit's end. They had supported sending their son away three times, and nothing seemed to change. In fact, I learned that before Anthony went into placement the last time, mom told the public defender that she didn't feel that she could keep him safe. She shared that made her feel like a bad mother, but at that time, she really believed placement was her only choice. Now they were ready to do whatever it took to keep Anthony home. They talked about their willingness to sleep on the living-room floor, guarding the house, so that he couldn’t leave and his older, anti-social peers couldn’t come in.

They reported that along with using drugs (Spice and marijuana) and alcohol (vodka most recently), Anthony was verbally aggressive when reprimanded or punished, had poor school attendance and hung around with 18- and 19-year-olds. The parents knew right from the start his peers were a big part of the problem.

 And so treatment began

As we began working together, we learned how entrenched substances use was in this family. I think even mom and step-dad were surprised as we uncovered that 90 percent of the family used marijuana. This caused a momentary doubt that Multisystemic Therapy (MST) would be effective, but they were willing to carry on. 

When I dug a little deeper, I learned that not only was there heavy drug use within their immediate and extended family, but they had also lost twin babies the past spring. Mom told me that ever since the babies died, she was always worried about losing Anthony and admitted this helped encourage her when she felt like giving up. She did not want to see her son run away or be put back into placement. She knew he needed to be home for change to really occur.

From then on, I knew both caregivers were going to be proactive in working with me. They were willing to try new interventions and became creative with ideas about how to involve social supports, increase supervision and monitoring —which was critical—apply rewards and consequences for behaviors, and learned not to step into the trap of Anthony’s button pushing.

Things often get worse before they get better

Young people will often up the ante to see if families are going to stay the course. We teach our families that things often get worse before they get better. They have to hang in there just a bit longer, past the initial hiccups, and things will get better.

True to form, Anthony, the smiling excited youth, tested positive for marijuana. The juvenile probation officer was admittedly concerned. She had high expectations. He had finished a drug-and-alcohol placement, and he was in MST. To her credit, she was willing to talk this through with the family and me. She wanted to know my opinion and what progress the family truly had made. It was a great opportunity for me to explain that this was exactly the type of behavior we had been preparing for. Mom had the skills, and with the support of her husband and older son, the family could implement the consequences needed to hold Anthony accountable. There was no need for probation to come in and sanction the adolescent. I recommended that the systems hold tight—and let the family do exactly what MST had prepared them for. 

The family delivered

At first, Mom was devastated by the news of the drug screen. I reminder her “things often get worse before they get better,” and this was just what we predicted and planned for. 

Mom went to work. She told Anthony that if he wanted “house arrest,” she could give him house arrest. When he wasn’t in school, Anthony had to go to work with her or her husband. If they went out and couldn’t take him, their older son came over and provided monitoring so Anthony couldn’t leave the home. They were now empowered—and Anthony knew they meant business. 

Together, they worked with me to help find a “big ticket” item to support Anthony’s drug-free lifestyle. Even though this was something very difficult for them—they had to get some financial support—they purchased a four-wheeler for Anthony to use. This was effectively to reinforce Anthony for producing clean drug screens, going to school and following all household rules. I know not all families can do something this big, but the key point was that together, we identified what the young person really valued, and the family thought through what they could do to help reinforce the behaviors they wanted. Along with increasing supervision and monitoring, increasing his pro-social peer involvement, finding the right “carrot” as a reward was key to Anthony’s success. 

As treatment nears ending

Recently, I got a great text from mom. “I CAN NOT BELIEVE WHAT I AM SEEING” with a photo attached of Anthony sitting at the kitchen table doing his homework. 

Just this past week when I met with the family, Mom turned to me and said with much pride, “This is so cool to see where my kid was and where he is now!”

As we did the “what-if planning” when the ankle monitor came off, Mom said the biggest difference is that even when he does go out, he always comes back every 15 minutes. The other day he asked for a few bucks and came home with juice box to drink when he went four-wheeling. She looked at me and emphasized, “Juice box, not vodka.” She was smiling and said he was acting 14 again.

Danielle Spadine is an MST Therapist at Community Solutions.

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Topics: MST Success Stories