Substance misuse within families is a significant and growing concern within the child welfare system. The challenges are multifaceted and deeply entrenched, often leading to devastating outcomes for both parents and their children. According to recent data, parental substance use is a contributing factor in approximately 26% of substantiated cases of child maltreatment and plays a role in over one-third of cases where a child is removed from the home.
The dual challenge of addressing parental substance misuse while ensuring child safety is a complex and delicate balancing act. Substance misuse not only impairs a parent's ability to care for their children but also exposes the child to increased risks of abuse and neglect. The trauma associated with these experiences can have long-lasting effects on a child's emotional and psychological well-being and physical health. As such, family therapy interventions for substance misuse must go beyond addressing the substance misuse itself; they must also ensure that the child's safety and developmental needs are met and that adult and child mental health difficulties are addressed.
Holistic family-based interventions for substance misuse, such as Multisystemic Therapy – Building Stronger Families (MST-BSF), can reduce the stigma that so often hinders parents from seeking help by prioritizing early identification, equitable access to treatment and ongoing family-centered support. This dual-focus strategy leads to better outcomes, such as reduced out-of-home placement, higher rates of reunification if children are placed due to safety factors, and improved family stability.
What is MST-BSF?
Multisystemic Therapy - Building Stronger Families (MST-BSF) is an evidence-based treatment model specifically designed to support families with children aged 6-17 who are involved in child protective services due to the dual challenges of parental substance misuse and child maltreatment (e.g., physical abuse or neglect). MST-BSF stands out as a comprehensive and tailored approach that addresses the complex and interwoven issues these families face, offering a pathway to recovery and stability that is both effective and sustainable.
Foundationally, MST-BSF operates on the principle that parental maltreatment of a child is influenced by multiple systems, including parent, family, peers, school, and social network. By targeting these interconnected areas, MST-BSF brings about meaningful change in a family’s environment, promoting positive behaviors and reducing the likelihood of adverse outcomes.
MST-BSF incorporates the foundational principles of Multisystemic Therapy (MST) with two other evidence-based models:
- MST for Child Abuse and Neglect (MST-CAN): A specialized adaptation of MST that focuses on families dealing with physical abuse and neglect, offering strategies to improve parenting skills and mental health difficulties, enhance family safety, and reduce risk factors.
- Reinforcement-Based Treatment (RBT): RBT is a behavioral intervention that targets substance misuse disorders by helping parents understand what triggers their use, monitoring substance use, reinforcing sobriety, and reducing the influence of negative, substance-related behaviors.
The integration of MST, MST-CAN, and RBT within the MST-BSF framework allows for a truly comprehensive family-based intervention for substance misuse.
MST-BSF: A Comprehensive Family-Based Intervention for Substance Misuse
Traditional treatment models often focus solely on the individual struggling with addiction, neglecting the broader context in which substance misuse occurs.
In contrast, MST-BSF addresses the multifaceted nature of addiction by simultaneously targeting the individual, the family, and the community. This comprehensive family-based intervention for substance abuse not only helps in overcoming addiction but also addresses the underlying factors that contribute to substance misuse, such as trauma, stress, and unhealthy family dynamics. In addition, because MST-BSF families are referred due to child physical abuse and/or neglect, interventions that address children’s mental health and safety and are a critical part of treatment.
By targeting both individual and systemic factors, MST-BSF provides a comprehensive framework that builds a foundation for healing and lasting recovery.
Behavior Therapy: Reinforcing Positive Change with RBT
As mentioned, RBT plays a crucial role in helping parents develop healthier coping skills and eliminate substance misuse. This approach to family-based intervention for substance abuse helps parents replace harmful habits with constructive actions, empowering them to regain control over their lives, make meaningful progress toward recovery and keep their children at home safely.
Emotional and Psychological Needs: Supporting Holistic Well-being
Substance misuse often stems from or exacerbates emotional distress, trauma, and mental health challenges. MST-BSF provides targeted interventions such as Cognitive Behavioral therapies for adult and child trauma. and other evidence-based therapies that help families process and heal from their emotional wounds.
By addressing these deeper psychological needs, MST-BSF ensures that recovery looks beyond sobriety and includes factors that sustain both sobriety, positive mental health, child safety, and family relations.
Achieving Recovery Through Engagement of the Entire Family
Substance misuse is not an isolated issue; it affects the entire family. MST-BSF recognizes this interconnectedness and actively involves the family, including extended family, in treatment to build a sense of collective responsibility and empowerment.
By improving communication, strengthening family bonds, and creating a safer home environment, MST-BSF ensures that the recovery journey is a collective effort. The approach of this family-based intervention for substance misuse is critical to the program's success, as it fosters a supportive atmosphere where each member contributes to and benefits from the treatment.
Community Support: Building a Stronger Network
Substance misuse and child welfare issues are often influenced or exacerbated by external factors such as social environment, peer influence, and community dynamics. MST-BSF works within the family's broader ecological system to address these challenges, building a supportive network that reinforces positive outcomes.
By engaging with schools, community organizations, and other support systems, MST-BSF creates a safety net that helps families navigate the complexities of recovery and maintain their progress. This community-based approach ensures that families are not isolated in their journey but are instead supported by resources and relationships that bolster their resilience.
MST-BSF does not treat substance misuse in isolation. It addresses it as the complex web of factors that it is.
A Case Example of MST-BSF Treatment
This case is an example of a typical MST-BSF family but is not from one actual family.
The Corbin family is comprised of two parents (Susana and Bradley), 3 children (ages 3, 7, and 10), and an auntie (Father’s sister, age 21). An infant boy died in the past year due to sudden infant death syndrome. The family came under the guidance of Child Protective Services (CPS) after the mother, Susana, hit her 7-year-old daughter, Khaki, with a belt leaving marks. Mother was intoxicated at the time. She was angry with Khaki because she did not wash the dishes and the kitchen was cluttered. Bradley was at work and auntie was not home. CPS went to the home when a call of suspected abuse was made and determined that mother would go to a sober friend’s home for 2 days and father and auntie would take care of the children, and they would refer the family to MST-BSF.
Upon referral, the MST-BSF supervisor and CPS caseworker conducted a joint visit with the parents and explained the program, that it was home-based, sessions were at least 3 times per week for 6-9 months, with an on-call service available for crises. RBT treatment was described to mother. The parents decided that they wanted their family to participate. After the family signed on for treatment, a safety assessment was conducted to assure that all drugs and alcohol were out of the home, that any weapons were secured, and that any unsafe situations were fixed (e.g., broken window). A pill count was conducted of all prescription medications. This same safety assessment would be conducted weekly over the next month. The therapist visited the family and developed a family substance misuse safety plan with them. Susana had a long history of using alcohol and cocaine dating back to her teens. She had experimented with fentanyl a year prior to the report after the baby’s death. Her periods of sobriety were generally when she was pregnant. At the present time she acknowledged use of alcohol only (verified on a urine drug screen). She was drinking to the level that she experienced withdrawal symptoms when she tried to stop. Her substance misuse treatment started with a 5-day inpatient detoxification. During these 5 days a great deal of planning was conducted with the family to support Susana’s sobriety. Bradley was not using substances.
When Susana returned home, the team, with support from father and auntie, immediately began helping mother monitor her drug use by taking a 12-panel urine drug screen and a fentanyl test 3 times per week. A urine sample was submitted to a lab for an 80-hour Etg test to better measure alcohol use. When mother’s screens were negative, she would earn vouchers that could be used to purchase things that she wanted to purchase. The results of her screens were graphed with her. Work was conducted with Susana to engage in drug free activities and support networks such as AA. Importantly, assessment of the reasons why Susana drank and the circumstances around her drinking was conducted. MST-based models refer to these factors as “fit” factors or drivers. The team discovered that a primary reason Susana drank is because she was trying to cope with extensive sexual abuse as a child by her mother’s boyfriend and some of his friends. Susana’s mother had an alcohol addiction and had parties at the house, leaving Susana in an unsafe situation. In addition, Susana was grieving the loss of baby Brad. The entire family was grieving the loss.
In addition to RBT for Susana, a variety of treatments were used with the family. Prolonged Exposure trauma treatment was conducted with Susana to help her recover from the sexual abuse. Couples' sessions were conducted with Father and Susana to address their ongoing conflict and strengthen their relationship and problem solving. Trauma Focused Cognitive Behavioral Therapy was used to address the trauma Khaki was experiencing from physical abuse. Behaviorally based parenting strategies were taught to parents so that they could structure their home and so that Susana could stop the use of physical abuse. Instead, they were taught positive parenting and they practiced and received feedback from the therapist. Family therapy sessions were the venue to address the grief the family was feeling over the loss of baby Brad and for the children to express how mother’s alcohol use affected them. Near the end of treatment, Susana worked with her therapist to write a letter to Khaki and all the family to take responsibility for the physical abuse and the drinking and to apologize. Several drafts of the letter were written to make sure it would be healing for the family.
Treatment spanned 9 months. Susana experienced 3 relapses. Each time, she was asked to leave the home, returning only after testing negative for all substances. Bradley and his sister cared for the children. Each relapse yielded additional information for Susana and the team to use to alter existing plans making it more effective for Susana to remain abstinent. At the end of treatment, she had attained 6 months of sobriety and was working a job. She was no longer experiencing trauma symptoms. Khaki was also no longer experiencing trauma symptoms. Susana and Bradley had established a closer relationship, and they expressed a strong commitment to continue. The family context was positive, and the home was well structured. The 3-year-old was making developmental gains and had started preschool. The 10-year-old was doing well in school and was playing sports in the community. Auntie started college and moved to campus. The family met their treatment goals and CPS closed their case as a success.
The Broader Implications of MST-BSF for Child Welfare
As more states, agencies, and countries increasingly demand evidence-based solutions that can effectively tackle the duality of healing parental addiction and child physical abuse and neglect, MST-BSF presents itself as a standout family-based intervention for substance misuse.
As a rigorously tested, proven model, MST-BSF can deliver measurable outcomes by offering a blueprint for how child welfare systems can shift from reactive, crisis-driven responses to proactive, preventive strategies.
Continued support and expansion of MST-BSF are essential if policymakers and child welfare agencies want to answer the growing demand with an intervention that can deliver lasting change.
Having reached over 432 families from 2017 to 2023, the positive clinical outcomes speak for themselves:
- 92.3% of families completed treatment, averaging 220 days.
- 91% of parents have no new reports of child maltreatment.
- 97.1% of children remain engaged in school or join the workforce.
- 97.4% of children remain safely in the home with their family.
Download our clinical outcomes fact sheet to learn more about MST-BSF's impact.
By investing in and scaling family-based interventions for substance misuse such as MST-BSF, we can ensure that more families have access to the resources they need to overcome their challenges, lean into their strengths, and build healthier, more stable futures—together and not apart.
MST-BSF is an evidence-based treatment for families experiencing parental substance misuse plus child physical abuse and/or neglect. MST-BSF effectively treats children and their families by providing a variety of research-supported interventions within the home, community, and school settings. Treatment is tailored to the strengths and needs of the family and includes evidence-based interventions such as cognitive behavioral treatments for adult and child trauma, anger management, communication and problem-solving, and adult substance misuse. Treatment has a significant focus on safety and the parent taking responsibility for the maltreatment.
If you or someone you know is interested in learning more about Multisystemic Therapy – Building Stronger Families, contact us here.
