10-year MST veteran shares thoughts on what makes the evidence-based model work

Marta Lear has been a Multisystemic Therapy (MST) supervisor for 10 years. In that time, she witnessed up close the elements that contribute to MST being such a powerful tool in helping chronic juvenile offenders get on the right track to becoming successful, productive adults.

One extremely important factor Lear found was the high level of support and guidance provided to therapists and supervisors by MST, which included the quality of booster trainings. In other programs, she says, therapists may get adequate training and even follow-up booster sessions. However, they often lack a focus on the sustainability of the program, as well as fidelity to the model. MST requires both.

MST: Backed Up by Research, Results Proven to Be Reproducible

An article in Science magazine stated that less than a third of psychology studies could be replicated. 

This finding produced a bit of negative coverage in the media, as well as some useful analysis.     

For me, however, it was a reminder of just how impressive the body of research behind MST is. Consider that since 1986, MST has undergone 15 separate randomized controlled trials using either juvenile offenders or youth with serious conduct problems. Of those, seven were conducted by independent researchers in five separate countries.

New Mexico finds MST cost-effective, saves the state $135 million

In December 2014, a report was published showing very positive results for troubled youth receiving Multisystemic Therapy (MST) treatment over a nine-year period in New Mexico. The state decided to take a closer look at the data from its Juvenile Justice Services System (JJS) focusing on whether using MST for delinquent youths at risk of out-of-home placements was paying off.

The study analyzed information gathered on 4,016 delinquent young people receiving MST from July 2005 to June 30, 2014, covering admission to six and 12 months after discharge. These were youths with very high rates of severity at admission to MST and showed great improvement in all areas examined, including improved functioning, decreased mental health and substance-abuse problems, and cost savings to the state through reductions in using Medicaid-funded behavioral health services.

Chance encounter brings joy and meaning to MST therapist

“Is he throwing rocks down the slide? He is. He’s throwing rocks down the slide. Maybe Bill will correct him...” My internal dialogue on whether to scold my 5-year-old nephew or wait for my husband didn’t last long. 

Whenever we babysit our nephews, Bill takes care of life-and-death situations. He makes sure to address those strongly and swiftly. Everything else? My domain. I spoke reluctantly, “Dylan, don’t throw rocks down the slide.” Typically, I’d give him a rationale. I’d explain that he could scratch or dent the slide, and he was holding up the children behind him. But I wanted to speak quickly, hoping that the moment wouldn’t be broken.

Former police officer goes from making arrests to preventing them

At first glance, there is little similarity between the field of law enforcement and the world of mental health. Although law-enforcement personnel regularly encounter mentally ill individuals, their objectives differ from those of mental health care providers. Despite these differences, there are similarities when one takes the time to look a little deeper.

Prior to moving to Los Angeles and becoming an MST supervisor, I was a police officer in a major city with the major objective of protecting life and property. From the systemic perspective, law enforcement is in place to ensure order in our society and laws are followed. They are, in essence, the initial step that society put into place to impose consequences, followed by the courts and the correctional system. 

See How MST helps Essex County Teens

Young people in the U.K. who enter social care typically have poor outcomes. They are more likely to re-offend, be suspended from school, and be unemployed by the time they turn 19. Out-of-home placement is also expensive for local authorities. They are responsible for children’s social care, but investing in prevention in times of austerity is challenging.

In 2012, there were 1,600 children in care in Essex County, and the number had risen by 28 percent over the previous five years. Essex County Council wanted to commission service with an evidence base for working with this group but was not in a position to take on the financial risk of failure. They decided to try Multisystemic Therapy (MST) to work with adolescent children on the verge of out-of-home placement. Two teams would handle 380 young people over five years. MST itself was not new to the U.K. What was new was a form of social investment called a Social Impact Bond (SIB). 

Michigan can reduce its $2-billion state prison budget partly by diverting juvenile offenders to treatment.

When Michigan Gov. Rick Snyder decided to present his ambitious plan for justice reform, he chose Goodwill Industries of Greater Detroit, which makes it a practice to hire former convicts, as his setting. He also chose to have representatives from the Livingston County juvenile court and a Multisystemic Therapy (MST) supervisor from Highfields, Inc. in attendance. Snyder’s staff learned of the court’s success in implementing programs that help kids, programs that save money.

Parents hold the key to turning their children around, MST helps unlock the door

Imagine this. You hear that two teenagers in your neighborhood are caught shoplifting. They are accused of stealing more than $1,000 worth of merchandise from a nearby department store. This isn’t their first offense, either. You heard they were caught breaking and entering cars and a neighbor’s home. You think they are even involved with drugs. Given this new arrest, they are facing the threat of being locked up for their crimes. Your first thought is “their parents are to blame. They should have taught their kids better.”

There is no debate that juvenile crime is of great concern in the United States. According to the FBI, youths younger than 18 commit almost 20 percent of all serious crimes, 13 percent of violent offenses, and 20 percent of crimes involving property. It’s also been found that a single lifetime of crime amounts to a $1.3 to $1.5 million burden on society. Knowing that makes it even more imperative to keep adolescents from becoming habitual criminals.

Where there is debate is how to deal with this problem and where to allocate funds earmarked for it. There are many who lean toward paying as little as possible upfront. Policymakers and those who sign the checks are under pressure to come up with programs that reduce crime without draining the budget. Often, they choose individual therapy instead of a program like Multisystemic Therapy (MST). What they overlook is the long-term savings when a treatment such as MST is implemented. It has been shown that youths commit fewer crimes following MST. That means lower future expenses for taxpayers and crime victims relative to the expenses associated with individual therapy.

We, as a nation, are sometimes riveted to something in our popular culture that we can’t stop talking about it and wait anxiously for the next episode or revelation. We speculated about Walter White’s motivation and moral compass as we collectively watched “Breaking Bad.” We repeated snippets of dialogue and mourned many deaths on “Downton Abbey.” Today, it’s not a TV show that has captured our national attention. it’s a podcast, “Serial.”

For many listeners, it’s a true “Did He Do It?” Did Adnan Syed, then 17, kill his former girlfriend? Did he, along with a small-time drug dealer named Jay, drive her body and ditch it in a park, as Jay told the police? Or was Syed at a library across from his high school, as one witness named Asia, who was never called to testify, maintains?

It’s a murky, complicated 15-year-old case that sent Syed, declaring his innocence, to jail for life. Most people were drawn to the podcast because of the mystery and anticipation for the next installment. They have theories about the case and how information was highlighted or downplayed, based on personal perspective. The Marshall Project interviewed legal minds right before episode 11, and it’s no surprise that lawyers leaned toward explanations and theories that were consistent with whether they “played offense or defense.”   I am drawn to it, in great part, because I filter everything through my MST lens.