How one community successfully established MST
Adopting an evidence-based practice such as Multisystemic Therapy (MST) is not for the faint of heart, as Maria Picone, Family and Community Services Department director at Catholic Charities of Buffalo, discovered. But she also discovered, it is well worth the effort.
During the mid-1990s, Catholic Charities noticed a troubling trend. While their preventive services were successful with younger at-risk children, outcomes for adolescents were not as strong. As Picone said, “What we were doing for delinquent adolescents wasn’t working.” So the organization began to search for a better way to serve these at-risk youth. That took them to the library.
After reviewing the literature, several promising programs were identified, including MST and Functional Family Therapy (FFT). Diane Greenaway, then a department leader for the organization, spent time reading about the models before setting aside Friday afternoons to get questions answered by phoning the different developers. “It turns out that Scott [Henggeler, of MST] was frequently at his desk on Friday afternoons...He was really responsive.”
MST—the model of choice
In 1996, Catholic Charities picked several key leaders for a road trip to visit the developers and practitioners of various models. While they recognized that the evidence base was strong for all the models, they decided to adopt MST. Picone recalled how the decision was made. “Based on the studies and the visits, [we] determined that MST was much closer in philosophy and closer to our nature in terms of concentrating on families. Their thoughts about families were similar to ours.”
Once MST was selected, Catholic Charities needed to get it funded. There was an existing contract with the Erie County Department of Social Services to provide preventive services to at-risk children. But no further money would be forthcoming from the county. However, it did allow Catholic Charities to use a portion of the already allocated funds for MST. Additionally, they agreed to some greater discretion in how referrals would be made to fit the model.
The timing was right as focus on this group was increasing and services in the county to divert adolescents away from the court system were just beginning. Catholic Charities was able to present this to local government as a win-win, making them willing to try the experiment.
MST expands over the years
Catholic Charities’ first two standard MST teams started in 1997. The coming years brought growth into neighboring counties. Today, they have eight MST teams serving four counties in Western New York with local governments funding the teams. When asked why she thought the evidence-based practice found success in the organization and community, Picone said, “Erie County was worried about adolescents.” She added, “People in the county wanted services to count.” Within Catholic Charities, she felt some of the success was because the first two teams were comprised of therapists and supervisors who chose to “opt in” as opposed to being assigned to the new service. The community stayed committed because of the cost savings. In the first year in Niagara County, more than $1 million was saved by successfully diverting youth from placement. “This was working for families, and it was working for the county.”
Picone spoke of some challenges, as well. Professionals within the organization were worried that the then-unconventional practice of being on-call 24/7, the transparency of the work and high accountability for overcoming treatment and engagement barriers would become expected in other services. There was some resentment over the small MST caseloads, as well as the attention the new service garnered. Picone said that to ameliorate this, as well as the difficulties involved with such high accountability and the need for persistent and flexible engagement strategies, the teams focused on real team building and support to get around the obstacles, as well as organization growing pains. Celebrations of milestones and activities that built trust and intimacy within the teams were instrumental to success.
Suggestions for those thinking of starting an evidence-based practice
What advice would Picone give other agencies weighing the adoption of evidence-based practices? First, she says you need to pull together with as many people within the organization and community as possible, including the target population for services, and ask tough questions. “Make sure you know your goals...all therapies work, but they work differently.” You need to choose a model that “fits where your heart is.” Once you’ve explored and found one that is a natural for your organization’s culture, values and goals, Picone says, “You have to trust the developers of the model and the expert. You’ve got to be all in. Don’t jump in until you are sure.” She believes that when teams close after a couple years, it is likely due to jumping in too soon. Finally, she advises that once you do commit, you should have some faith. It takes a while to “get over the shock...and see the outcomes.”
“It takes a lot of heart to do MST,” according to Picone. “It takes such courage and commitment, and you’ve got to be sharp.”