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JustResearch no. 12
Multisystemic Therapy as a Response to Serious Youth Delinquency
Research in Profile (cont'd)
Multisystemic Therapy as a Response to Serious Youth Delinquency
By Jeff Latimer [1]
INTRODUCTION
One of the more pressing social concerns of the last few decades in Canada has been the prevention and treatment of youth delinquency. A substantial amount of research has been conducted in an effort to better understand how and why youth engage in criminal behaviour. The results generally confirm that the antecedents of youth delinquency comprise a tangled and inter-related set of factors. A significant and robust subset of factors, which is amenable to counselling intervention, however, can be grouped under the family domain. In crime prevention discourse, the family is a major focus, not only as a principal contributory factor, but also as a meaningful solution.
In Canada, the National Crime Prevention Centre (NCPC) adopted, as one of its principles, the notion that “the responsibility of parents and others raising young people is to be affirmed and the contributions of extended families and community members are to be encouraged”
(1995, p. 1). In addition, the NCPC stated that support for and involvement with families should be the tools used to promote parental responsibility and reduce delinquency. The new Youth Criminal Justice Act , which replaced the Young Offenders Act in April 2003, also reaffirms the importance of the family in the Declaration of Principle. Section 3(c)(iii) states that measures taken against young persons who commit offences should:
be meaningful for the individual young person given his or her needs and level of development and, where appropriate, involve the parents, the extended family , the community, social or other agencies in the young person's rehabilitation and reintegration (emphasis added).
The positive role of the family in the treatment of delinquent behaviour has also received support from evaluations of numerous treatment programs (e.g., Gordon, Graves & Arbuthnot, 1995; Henggeler, Melton & Smith, 1992; Klein, Alexander & Parsons, 1977), and meta-analyses (e.g., Dowden & Andrews, under review, Latimer, 2001; Latimer, Dowden & Morton, 2004). Howell and Hawkins (1998) concluded that interventions designed to provide parent training to positively manage children has been found to significantly reduce delinquency. In fact, Roberts and Camasso (1990) surveyed the ten most commonly used interventions for delinquents during the 1980s and found that only family therapy produced clearly positive and convincing results.
Not only have family focused interventions been shown to be effective, they are also the preferred approach among professionals working with youth delinquents. Mulvey and Repucci (1984) surveyed court, mental health and welfare workers and discovered that all of these professionals ranked family therapy for young offenders as the most preferred intervention for both first-time and repeat offenders. In a survey of police officers' views on diversion, it was determined that police would be much more supportive of diverting youth away from the criminal justice system if it placed the responsibility back on to the family (Canadian Youth Foundation, 1999). Officers believed that offering support to young offenders' parents, and making them more accountable for the behaviour of their children, are effective measures to prevent future delinquency.
Unfortunately, complex social problems, such as delinquency, cannot always be effectively treated through simplistic or single-focused responses. There are numerous intervening factors at work that moderate the relationship between the family and delinquency, such as antisocial peers, poor school attachment, substance abuse, and criminogenic communities (Hawkins et al., 1998; Lipsey & Derzon, 1998). Therefore, while family dysfunction is a critical criminogenic need of delinquent youth, targeting additional needs is also important to increase the overall effectiveness of interventions.
For example, Andrews and Bonta (2002) identified several criminogenic needs that are appropriate to target in the treatment of offenders including anti-social attitudes, pro-criminal associates, personality factors, family factors and low levels of educational and employment attainment. In addition, Latimer et al. (2003) identified negative parenting, poor school attachment, victimization, anti-social peers, and aggression as the five core factors associated with delinquency in a national sample of youth.
In other words, effective counselling that has the potential to reduce criminal behaviour among youth should both focus on the family and target the known factors associated with delinquency. Multisystemic Therapy (MST) has been promoted as one such approach. Multisystemic Therapy has been described as a family preservation model, based on the philosophy that the most effective and ethical route to helping youth engaged in delinquency is through helping their families. MST views families as valuable resources, even when they are characterized by serious and multiple needs. It is argued, however, that MST goes beyond simple family interventions by attempting to remove offenders from deviant peer groups and providing school and vocational interventions to enhance the youth's capacity for future employment and financial success. Henggeler (1999) claims that MST attempts to change the real world functioning of youth by altering their natural settings (e.g., home, school, and neighbourhood) in a manner that promotes pro-social behaviour while decreasing antisocial behaviour.
The goal of this paper is to examine the application of Multisystemic Therapy in criminological counselling with adolescents. First, this paper provides a general description of Multisystemic Therapy. Second, this paper examines the theoretical basis for such an approach. Third, the research into the effectiveness of MST is explored, including recent meta-analyses that have sought to aggregate individual evaluations as a more comprehensive approach to understanding the treatment of criminal behaviour. Finally, this paper critiques the MST approach by viewing MST through cultural, class, and gender lenses.
MULTISYSTEMIC THERAPY
Multisystemic Therapy was developed in the United States in the late 1970s in response to a perceived lack of success in treating serious juvenile offenders. It was argued that existing treatment efforts, in general, had failed to adequately address the complexities of delinquency. According to Henggeler et al. (1998), typical counselling programs at that time were individually oriented, narrowly focused, and delivered in settings that were incongruous with the problems being addressed (e.g., residential treatment centres, custody facilities). Given the overwhelming empirical evidence that antisocial behaviour is a very complex phenomenon, and oftentimes determined by the interplay of the individual, the family, peers, school, and neighbourhood factors, it is not surprising that treatment was largely ineffective (Henggeler et al., 1998).
The design and implementation of MST interventions is based on nine core principles (Schoenwald, Brown & Henggeler, 2000). First, the primary purpose of an MST assessment is to understand the fit between the identified problems and their broader systemic context. The therapist integrates information obtained from family members, teachers, referral sources, and other pertinent sources to determine which factors (i.e., individual, family, peer, school, neighbourhood) are contributing to the delinquency. Treatment goals are therefore particular to each youth and derived directly from an assessment.
Second, the actual therapeutic interactions between the youth, the family and the therapist emphasise the positive aspects of the youth's life and employ systemic strengths (e.g., school, family or community assets) to encourage change.
Third, the interactions are designed to promote responsible behaviour and decrease irresponsible behaviour among all family members. Parental responsibilities include providing structure and discipline, expressing love and nurturance, and meeting basic physical needs. Responsible behaviour for the youth includes increasing school performance, avoiding violence and assisting with domestic chores at home.
Fourth, MST requires that interactions are rooted in the present and solution-focused so that goals are clearly articulated and obtainable. This principle is important as it ensures each member of the family, as well as the therapist, are all working towards the same goal. It also provides a clear termination point in the process. In other words, when all of the targets have been met, the sessions can be halted.
Fifth, the therapist focuses on the issues within each system (i.e., family, school, peers, community) as well as the interaction between systems. For example, a youth's family environment or a particular peer group may play a role in decreasing school attachment and performance.
Sixth, the interactions are geared towards the developmental maturity and capacity of the youth, as well as the family. If the youth is quite young, the focus may be directed more at increasing parental competence (e.g., parenting skills); whereas for youth nearing the age of majority, the focus may be directed more at increasing the competencies of the youth (e.g., life skills).
Seventh, the interactions between the therapist and the family are designed to require weekly, and sometimes daily, effort by those involved. Since MST is usually reserved for serious delinquents, the assumption is that the families will typically present with serious problems that require intensive interventions.
Eighth, MST requires ongoing evaluation of both the treatment goals and the outcomes from multiple perspectives to ensure that the therapist is accountable for overcoming barriers to effective results. The three main factors that the therapist examines are the fit of the therapy to the family (e.g., solutions are linked appropriately to the basis of the problem), the effort of the family, and the viability of the interventions in achieving change.
Finally, the entire process is designed to ensure that treatment gains will not only materialize, but be maintained after the treatment has been concluded. To facilitate this, MST attempts to empower families to solve their own problems and link them with a community support network (e.g., friends, neighbours, and extended family).
Henggeler, et al. (1998) provide a good description of the manner in which services are provided in MST interventions:
- services are targeted to families with children at risk for out-of-home placement to foster care, group homes, residential treatment, or correctional facilities.;
- services are time-limited (one to five months);
- services are flexibly scheduled to meet the family's needs and are delivered in the home;
- services are tailored to the needs of family members;
- services are provided in the context of a family's values, beliefs and culture;
- services are available 24 hours a day, seven days a week; and,
- workers have small case loads (e.g., 2 to 6 families) and visit families several times per week for a total of approximately 8 hours of programming.
In summary, MST is a considered to be a pragmatic and goal-oriented intervention that targets specific factors in each youth's family and the external networks that appear to be contributing to his or her antisocial behaviour. Beyond reducing delinquency, Henggeler (1999) claims that MST interventions are typically designed to:
- improve caregiver discipline practices;
- enhance family affective relations;
- decrease youth association with deviant peers;
- increase youth association with pro-social peers;
- improve youth school or vocational performance;
- engage youth in pro-social recreational outlets; and,
- develop an indigenous support network for the family consisting of extended family, neighbours, and friends.
EFFECTIVENESS OF MST
One of the more positive aspects of MST has been the systematic and rigorous evaluations conducted on the approach. In fact, research into the effectiveness of MST research has consistently used randomised treatment and control designs with longer than average follow-up lengths. The MST Services website lists over 100 academic articles on the subject of Multisystemic Therapy, the vast majority of which are peer-reviewed publications in reputable journals. Henggeler, et al. (1998) reported that, for serious adolescent offenders, MST has demonstrated reductions of 25-70% in long-term rates of re-arrest, reductions of 47-64% in out-of-home placements (e.g., custody or child protection), extensive improvements in family functioning, and decreased mental health problems.
Rather than focus on individual studies, however, recent researchers have sought to aggregate the findings of a large number of studies on treatment effectiveness using meta-analytic techniques (e.g., Andrews et al., 1990; Latimer, 2001; Latimer, Dowden & Morton, 2004; Lipsey, 1995). Recently, Dowden and Andrews (under review) conducted a meta-analysis on the effectiveness of several forms of family therapy on reducing recidivism among youth. They found that MST was associated with significant program improvements (e.g., reductions in recidivism) when compared to other types of interventions. The importance of this research is that it contained all available evaluations on MST, including unpublished material. As such, this finding represents the results of an entire body of research.
The finding was not surprising as MST was recently classified as a ‘Blueprint for Violence Program' by the Center for the Study and Prevention of Violence. Such programs are selected by an expert panel and are deemed to have demonstrated considerable utility in decreasing adolescent violent crime, aggression, delinquency, and substance abuse. It should also be noted that, according to Dowden and Andrews (under review), MST closely adheres to the principles of risk, need, and responsivity (Andrews & Bonta, 2002; Andrews, Bonta, & Hoge, 1990), which have garnered considerable empirical evidence regarding their rehabilitative utility for correctional populations (Andrews & Bonta, 2002; Andrews, et al., 1990; Dowden & Andrews, 1999; Dowden & Andrews, 2000).
MST has also been evaluated based upon ratings of therapists' adherence to the principles of the model. Schoenwald, et al. (2000) has recently demonstrated that high adherence to the MST principles predicts favourable long-term outcomes for violent and chronic juvenile offenders, whereas poor adherence predicts high rates of re-arrest and incarceration. In light of these findings, considerable training, supervisory, and consultative resources are devoted to maximizing therapist adherence to MST principles.
The cost/benefits of MST have also been examined through empirical research. The findings indicate that there is a considerable cost savings with MST, compared to standard responses to serious delinquency, such as incarceration or residential treatment. Henggeler, e t al. (1998) claim that at a cost of $4,500 per youth, MST was the most cost-effective program aimed at serious juvenile offenders.
All of this research, however, has been conducted in the United States. Are the benefits of MST transferable to Canadian youth? Since there are clear differences in what would constitute a comparison group (i.e., Canadian and American standard responses to serious delinquency could be significantly different), it is possible that MST would not necessarily thrive in the Canadian context. The only outcome study available on MST in Canada was conducted by the Centre for Children and Family Services in the Justice System (2002) out of the London Family Court Clinic. The study was conducted in four distinct sites in Ontario using a randomised treatment and control design.
The results were not consistent with previous research. The study reported that there were no significant differences between the MST group and the control group when compared across several outcomes including recidivism. In fact, the MST group were equally as likely to commit a new offence; moreover, the MST group committed the new offence earlier than the control group. In addition, members of the MST group were more likely to be sentenced to custody and more likely to serve longer sentences compared to members of the control group.
While the Young Offenders Act , which was the national guiding legislation in the area of youth justice, was in place in Canada during the evaluation, the provinces and territories had jurisdiction over the administration of justice . This means that youth correctional programming in Ontario could have been radically different than youth correctional programming in another province or territory. A study comparing MST to a traditional response in another province or territory might yield different results. Additional research is clearly needed in Canada.
CRITIQUE OF MST
It is difficult to critique Multisystemic Therapy as a response to serious delinquency. The major concerns one would have with most interventions have been addressed. MST is based on a sound theoretical model with published manuals, and MST ensures therapists receive appropriate training and supervision. Adherence to the model is measured. MST is based upon decades of empirical research into the antecedents of delinquency and evaluations of programs attempting to treat delinquency. MST targets the appropriate population (i.e., serious juvenile offenders) in an appropriate manner. It has been shown to be both effectual and cost-effective in numerous American studies.
Is MST suitable for different types of offenders? The cultural appropriateness of MST has been supported in several ways (MST Services, 2000). First, findings from randomised trials of MST with serious juvenile offenders showed that the favourable effects of MST were not moderated by youth ethnicity (African-American versus Caucasian youth). Second, since the therapists view family members as full collaborators in the treatment planning and delivery process and the treatment goals are driven primarily by parents, the likelihood that treatment goals are driven by biases of the dominant culture should be minimised. And, according to MST Services (2000), MST treatment teams usually reflect the ethnic make-up of the population that is being served.
What about issues of gender? According to the Youth Court Survey at the Canadian Centre for Justice Statistics, the vast majority of youth in the criminal justice system in Canada are male. Not surprisingly, the vast majority of research into MST effectiveness has also been conducted with male youth. Dowden and Andrews (under review), however, did find in their meta-analytic review that the positive effects of MST also held true for female youth. Otherwise, research into the effectiveness of MST with female youth is sparse.
In terms of a class analysis, MST is one of the only approaches that both acknowledges the criminogenic aspects of communities and attempts to address negative factors. MST acknowledges that criminogenic communities (e.g., high availability of drugs, poverty, unemployment, racism, exposure to violence, neighbourhood adults involved in crime) will continue to exert influence on an individual regardless of the interventions within a family and broader supports. As such, families are empowered to find their own solutions to future crises. Nonetheless, due to the subtle influences of poverty and unemployment on a family, one could argue that MST may ‘set-up' a family for failure. Counselling and treatment are not effective in removing some of the structural barriers (e.g., sexism, racism) that can prevent families from achieving success. The focus on parental responsibility can also be viewed, in some circumstances, as blaming parents. For example, parents may be judged as ineffectual in light of continued delinquent behaviour on the part of the youth regardless of their level of competence.
Finally, in a meta-analysis on the effectiveness of family-based interventions with youth, Latimer (2001) found that methodological rigour was significantly associated with program effectiveness. In other words, as the methodological rigour of a study increased, the reported effectiveness decreased. One of variables that was used to measure rigour was the level of independence of the researcher. The assumption was that independent researchers (i.e., evaluators with no ties to the program) would be more likely to be objective compared to involved researchers (i.e., evaluators who have developed the program, carried out the treatment, or supervised the staff). Latimer (2001) confirmed that involved evaluators were significantly more likely to produce positive results compared to independent evaluators. In the case of MST, almost all of the empirical research has been conducted by one organization and specifically Scott Henggeler. As such, the results of the numerous studies into MST effectiveness, while valid, are nonetheless open to questions of objectivity.
CONCLUSION
MST is an exemplary approach to dealing with youth engaged in criminal behaviour. It is grounded in theory and based on years of empirical research that has sought to better understand delinquency. It is focused on a specific population of offenders (youth involved in serious delinquency) and involves the major components of their lives, including the family, peer groups, the school and the community. The vast majority of research in the United States has demonstrated the effectiveness of MST in not only reducing recidivism, but also in increasing family functioning, reducing out-of-home placements, and improving school attachment.
MST has only recently been implemented and evaluated in Canada, however, and the results have not been nearly as impressive. The research did not find a significant difference between MST and the traditional responses to youth crime (e.g., custody). Additional research in Canada is therefore needed to better understand the portability of Multisystemic Therapy as an effective response to serious youth delinquency.
References
[1] Senior Research Officer, Research and Statistics Division, Department of Justice Canada
