MST therapist works with all systems surrounding child to keep him at home, in school and out of trouble.
Andrew was living with his grandmother and had lost touch with his absent parents. He fought verbally and physically with his older sister, and his grandmother did not know how to intervene. She was seeking placement for him outside the home in order to get him help for his behaviors. At school, Andrew was disruptive in classes, fought with peers, and threatened teachers, resulting in the school taking steps toward a long-term suspension from school. He was on a diversion contact with the Department of Juvenile Justice (DJJ), and the Court Counselor (CC) was planning to take Andrew to court to increase the level of supervision because of his aggressive behaviors. In other words, Andrew was on the brink of being placed outside the home, and things needed to change quickly.
Andrew’s grandmother expressed her hopes that Multisystemic Therapy (MST) would help, but she had her doubts that anything could be done in the home. She shared with the MST therapists that her heart was broken. She had shown the child so much love and gave him everything he needed, but was unable to address his escalating behaviors at home and school.
MST principles find the fit
Without blame or judgment, the MST therapist and Andrew’s grandmother assessed the “fit” of his aggression. They identified the factors that contributed to this behavior. The therapist adhered to the MST treatment principles and demonstrated strength, focus, flexibility, support in session and in times of crisis, as well as her sense of humor and “go with the flow attitude” which was evident even when the family dog literally ate her car tire.
With this approach and the resulting therapeutic relationship, Andrew’s grandmother was able to recognize that his behaviors were reinforced when his aggression led to his getting his way and that she, at times, gave in to him as she tried to compensate for the loss of his parents. His grandmother took this realization and instituted a behavior plan in which Andrew earned privileges only through remaining non-aggressive. Previously, Andrew’s grandmother gave him privileges in response to his aggression, either to calm him down or to pre-empt his behavior. Now Andrew would lose TV, computer, tablet, games and outings if he displayed aggression. Grandmother generalized the safety and behavior plan to Andrew’s sister, whose aggressive responses to Andrew’s aggression were also reinforcing and causing a widening divide between the siblings who loved and needed each other.
Getting family and school to work together
The MST therapist helped the family to work with the school, as well. The therapist was able to get the grandmother and school staff to recognize that the aggression resulted in part from the negative feedback loop that was occurring in classes. The teachers expected Andrew to act out, were cold toward him, and met their expectations. In addition, being sent home from school for the aggression was very reinforcing and created additional concerns as Andrew fell further behind in class. Andrew’s grandmother and the school staff, with support from the MST therapist, agreed to a behavior plan that targeted his behaviors toward staff as well as in-class expectations. It linked meaningful incentives and consequences that no longer included out-of-school suspension to his behavior. To keep the plan on track, grandmother was in weekly communication with the school and provided positive and negative consequences at home for school performance and compliance. With Andrew getting a consistent message at school and home, and the ability to be reinforced for his positive choices, things began to change.
The MST therapist facilitated meetings with all parts of Andrew’s ecology to include Andrew’s grandmother, school staff, as well as the Court Counselor. The link between these key systems led to increased support and responsiveness to Andrew’s needs. Additionally, by creating that united front between key players and stakeholders, his grandmother now had the support she needed. Andrew’s grandmother reported that she improved her parenting skills by monitoring behaviors, setting clear expectations, and following through with clear and motivating consequences and incentives.
Despite her doubts throughout treatment, the grandmother reports that she now feels confident that she can successfully keep Andrew home and that she can continue to manage his behaviors and meet the needs of the child that she now understands better. She demonstrated this throughout treatment as Andrew’s aggressive behaviors waxed and waned, and even when the aggression predictably increased as Andrew tested the limits of the new plans. His grandmother remained consistent through the increase in behaviors, having been prepared by the therapist for the possibility.
As his grandmother persisted, Andrew’s behavior and grades improved. With increased success in school, he participates in more extracurricular activities that he finds motivating. Best of all, Andrew was discharged from probation based on his successful outcomes with MST treatment, and school and family reports. As work with the MST treatment model brought together all parts of Andrew’s ecology, shed light on the factors that were contributing to his aggression at home and school, and supported his grandmother in being an empowered authoritative parent, Andrew’s behaviors improved, and he is no longer at risk of being placed outside the home. His grandmother is prepared to keep him on this successful path and now states, “I see what I should have done, and now I know what I can and will do.”
Janice Wolfinger is an MST Supervisor with Easter Seals UCP, in Rocky Mount NC
