Multisystemic Therapy for emerging adults (MST-EA) is an adaptation of MST
Pete was a 17-year-old with many problems. Some were of his own making. Others were forced on him. His mother was no longer around and his father was in the late stages of a terminal illness, contributing to Pete’s anxiety and depression. Pete had been trying to care for his father, but he missed too much school and was moved into foster care once this was reported to authorities. There, his behavior deteriorated. He refused to attend school and started breaking into cars.
His foster caregiver couldn’t keep him at home and away from his ex-girlfriend, with whom he had a toxic, physically aggressive relationship. On top of this, he relied heavily on daily marijuana to cope with his depression and anxiety.
The officials with whom Pete came in contact struggled to figure out what to do for him. There just wasn’t much out there for adolescents his age. He was too old for children’s services, he was turning 18 soon, and he would soon be swept into the adult justice system.
There are few research-based interventions that have been tested for young people with Pete’s troubles. Not much is known about how to best address the primary causes of their behavior in ways that reduce recidivism and improve other outcomes. Standard Multisystemic Therapy (MST) research is based on youth aged 12 to 17, and to be effective, there must be a parent or caregiver in the young person’s life. So, this was not available to young adults like Pete.
There are thousands of Pete’s out there. Over 2 million young adults are admitted to adult jails each year and 20% of individuals in juvenile justice facilities are 18 to 20 years old. Nearly 30 percent of people arrested are young adults, and young adults have higher recidivism rates than other age groups, as well as the highest rates of mental illness and substance abuse.
That is why researchers Ashli Sheidow and Michael McCart adapted the MST model for this population in desperate need of effective treatment.
Addressing the needs of young people aging out of the juvenile justice system
Multisystemic Therapy for Emerging Adults (MST-EA) was designed for young people 17 to 26 at the highest risk for negative long-term outcomes. MST-EA has been tested thus far with young adults who have been involved in the justice system and have behavioral health disorders (including mood, anxiety, trauma, psychotic and/or substance-abuse disorders). These are the individuals who have the highest rates of recidivism and risk for expensive placements.
Pete was a perfect candidate for this treatment.
Initially, Pete didn’t want to work with MST-EA, or "misty" for short. He said that he could get himself out of legal trouble on his own and did not need mental health or substance-abuse treatment. Early in treatment, Pete was arrested for assaulting his ex-girlfriend and was detained for two weeks. His engagement with the MST-EA program deteriorated. Finally, his MST-EA therapist, Shara, determined that Pete believed any successes he showed would make the program "hang onto him" as a "good client." This was based on his years of real experiences with juvenile justice and other programs. Shara used cognitive behavioral therapy (CBT) techniques and motivational interviewing specifically to target this attitude. As concrete steps were achieved, Pete became more comfortable with his therapist, who used active therapeutic tasks and kept assuring Pete that he was "in the driver’s seat" when it came to the treatment.
Setting goals and a timeline for achieving them
As the treatment progressed, Pete focused on building independent living skills and frustration management that would help him succeed in completing school, living on his own and holding down a job, goals he set for himself. Shara and Pete created task lists and set dates for completing them, as well as a concrete date for Pete to graduate from the MST-EA program.
Pete came to realize how his thought patterns impacted his mood. This helped him develop sustainable strategies that lowered his anxiety and depression. During the last three months of treatment, Pete stopped stealing and Shara assisted him in presenting his needs to his foster parent and social-services worker.
He was no longer physically aggressive and reduced his verbal aggression after he completed individualized aggression and communication training. After Shara improved communication and understanding between Pete and his foster parent, Pete spent more time at his foster home, which meant distancing himself from negative peers, including his ex-girlfriend. Pete ultimately realized that engaging in criminal and aggressive behavior would keep him from his long-term goals of attending college and being a successful, independent young adult. Despite being told by school administrators that he would not be able to graduate that year, Pete successfully made his case and was allowed to complete enough credits to graduate. He was then accepted into an automotive-technician program.
Building a support system
With help from his therapist and a better relationship with the foster parent, Pete worked on completing his community service with the pastor at the foster parent’s church. This increased his interactions with positive peers, who became a permanent support system for Pete.
He also decreased his substance use, identifying that using substances frequently caused him to be less motivated and increased his depression. Shara closed Pete’s case as a complete success with all goals met, and Pete was taken off of his probation officer’s roster for good.
For additional information on MST-EA implementation, contact MSTEAinfo@mstservices.com.
To learn more about what makes MST an effective intervention, download this white paper.
