Multisystemic Therapy for Antisocial Behavior in Children and Adolescents

337 Pages·2009·2.12 MB·English

by  Scott W. Henggeler Phd

Multisystemic Therapy for Antisocial Behavior
in Children and Adolescents

Multisystemic Therapy
for Antisocial Behavior
in Children and Adolescents
S e c o n d e d i t i o n
Scott W. Henggeler
Sonja K. Schoenwald
charles M. Borduin
Melisa d. Rowland
Phillippe B. cunningham
THE GUILFORD PRESS
new York London
© 2009 The Guilford Press
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Printed in the United States of America
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Last digit is print number: 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Multisystemic therapy for antisocial behavior in children and adolescents / Scott
W. Henggeler ... [et al.]. — 2nd ed.
p. ; cm.
Rev. ed. of: Multisystemic treatment of antisocial behavior in children and
adolescents / Scott W. Henggeler . . . [et al.]. c1998.
Includes bibliographical references and index.
ISBN 978-1-60623-071-8 (hardcover : alk. paper)
1. Conduct disorders in children—Treatment. 2. Conduct disorders in
adolescence—Treatment. 3. Antisocial personality disorders—Treatment.
4. Combined modality therapy. 5. Family psychotherapy. I. Henggeler,
Scott W., 1950– II. Multisystemic treatment of antisocial behavior in children
and adolescents.
[DNLM: 1. Social Behavior Disorders—therapy. 2. Adolescent. 3. Child.
4. Combined Modality Therapy—methods. 5. Psychotherapy—methods.
6. Social Support. WS 350.8.S6 M961 2009]
RJ506.C65M84 2009
618.92′858206—dc22
2008050425
About the Authors
Scott W. Henggeler, PhD, is Professor of Psychiatry and Behavioral Sci-
ences at the Medical University of South Carolina. He is also Director of the
University’s Family Services Research Center, which recently received the
Annie E. Casey Foundation Families Count Award, as well as the Points of
Light Foundation President’s Award in recognition of excellence in com-
munity service directed at solving community problems. Dr. Henggeler has
published more than 250 journal articles, book chapters, and books, and is
on the editorial boards of nine journals. His research and social policy inter-
ests include the development and validation of innovative methods of men-
tal health and substance abuse services for disadvantaged children and their
families; efforts for redistributing mental health and substance abuse treat-
ment resources to services that are clinically effective and cost-effective, and
preserve family integrity; and investigating the transport of evidence-based
treatments to community settings.
Sonja K. Schoenwald, PhD, is Professor of Psychiatry and Behavioral Sci-
ences at the Medical University of South Carolina. She served as Associ-
ate Director of the Family Services Research Center from 1994 to 2004.
Dr. Schoenwald pioneered the development, refinement, and empirical
testing of the training and quality assurance protocols used to transport
multisystemic therapy to usual care settings. Her research focuses on the
transportability, implementation, and dissemination of effective commu-
nity-based treatments for youth and families. She has published numerous
peer-reviewed papers and book chapters, and has coauthored three books
and several treatment manuals and monographs.
Charles M. Borduin, PhD, is Professor of Psychology at the University of
Missouri–Columbia and Director of the Missouri Delinquency Project. He
has published more than 100 journal articles, book chapters, and books
on the development and validation of effective mental health services for
youth with complex clinical problems, and has served as a national and
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vi About the Authors
international consultant to government and private agencies on the reform
of children’s mental health services.
Melisa D. Rowland, MD, is Associate Professor of Psychiatry and Behavioral
Sciences in the Family Services Research Center of the Medical University
of South Carolina. Her research interests focus on developing, implement-
ing, and evaluating clinically effective family-based interventions for youth
presenting with serious emotional and behavioral problems. Dr. Rowland
is the coinvestigator in charge of clinical and project implementation on a
National Institute on Drug Abuse–funded study designed to evaluate the
relative effectiveness of three training protocols with increasing intensity
in supporting the implementation of contingency management by practi-
tioners treating adolescent substance abusers in the South Carolina mental
health and substance abuse sectors. She is also the coinvestigator in charge
of clinical implementation for an Annie E. Casey Foundation–funded project
designed to develop an evidence-based continuum of services for youth with
antisocial behaviors at risk of out-of-home placement in New York City.
Phillippe B. Cunningham, PhD, is Professor of Psychiatry and Behavioral
Sciences in the Family Services Research Center of the Medical University
of South Carolina. He has had a long-standing commitment to addressing
the psychosocial needs of children and adolescents, especially those who
are disadvantaged and underserved. Dr. Cunningham is a recipient of the
2000 Theodore H. Blau Early Career Award from the American Psychologi-
cal Association’s Society of Clinical Psychology. In 2006, he participated in
the First Lady’s Conference on Helping America’s Youth.
Preface
In 1998 we published Multisystemic Treatment of Antisocial Behavior in Chil-
dren and Adolescents, which has provided the most extensive description
of multisystemic therapy (MST) clinical processes until the publication of
this volume. At the time of that publication, MST was being implemented in
several sites scattered across the United States and Canada. Today, in excess
of 400 MST programs are operating in more than 30 states and 10 nations,
serving approximately 17,500 youth and their families annually.
The proliferation of MST programs during the past decade is likely due
to several interrelated factors:
• Practitioners, families, and stakeholders appreciate the inherent logic
linking the MST theory of change, clinical procedures, and youth
outcomes.
• Many government entities and community stakeholders recognized
the limitations of traditional, restrictive services for juvenile offend-
ers and advocated for more effective services in their communities.
• MST outcome-related research conducted by many investigators has
typically continued to support the clinical and cost-effectiveness of
the model. And we have endeavored to improve the model by incor-
porating “lessons learned” in those few cases when results were sub-
optimal.
• MST implementation-related research has been in the forefront of
the emerging field of implementation science, and findings have been
used to reinforce a quality assurance system that effectively supports
treatment fidelity and youth outcomes across MST programs world-
wide.
• MST Services and its Network Partner organizations have been com-
mitted to disseminating the MST model with full integrity and fidel-
ity.
This second edition reflects our continuing efforts to communicate
the clinical foundations and practicalities of the MST model to practitio-
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viii Preface
ners. During the past decade, we have continued to be directly involved in
the operations of many MST programs and the training and supervision of
many MST therapists and supervisors. These experiences prompted several
changes in this edition:
• A new section on procedures to promote the safety of youth, families,
and practitioners was added to Chapter 2, on clinical foundations.
• We made the text of the clinical chapters (Chapters 3–7), on fam-
ily, peer, school, individual, and social support interventions, more
consumer friendly and less academic. More attention was devoted
to clinical description and less to theoretical and research rationale.
New case examples, figures, and tables were added for ease of com-
munication.
• A section on enhancing vocational outcomes was added to Chapter 5,
on school-related interventions, as educational options have become
limited for many youth in MST programs.
• Chapter 8, on treating substance abuse, a common problem among
juvenile offenders, was added; this topic was not addressed substan-
tively in the first edition.
• Chapter 9 updates MST outcomes for juvenile offending and over-
views outcomes of MST adaptations for treating substance abuse,
sexual offending, serious emotional disturbance, and chronic health
conditions.
• Chapter 10, on MST quality assurance and improvement, was added
to provide MST therapists, supervisors, and administrators with a
framework for understanding the strategies used to improve youth
outcomes through enhanced treatment and program fidelity.
We sincerely appreciate your interest in MST and hope that this volume
facilitates your work.
Acknowledgments
First, we thank the many families who have opened their doors and worked
side-by-side with us to effect change with their children, loved ones, schools,
and community. These families are the true unsung heroes of multisystemic
therapy (MST).
In addition, although many local, state, national, international, and
foundation sources have supported MST worldwide, we are particularly
appreciative of those sources that have funded our own research. These
include the National Institute of Mental Health, National Institute on Drug
Abuse, Annie E. Casey Foundation, National Institute on Alcohol Abuse
and Alcoholism, South Carolina Department of Health and Human Services,
Office of Juvenile Justice and Delinquency Prevention, Administration for
Children and Families (U.S. Department of Health and Human Services),
Center for Substance Abuse Treatment (Substance Abuse and Mental Health
Services Administration), and Missouri Department of Social Services.
The extensive validation of MST clinical and quality assurance protocols
would not have been possible without the generous support of these fund-
ing sources.
Further appreciation goes to MST Services and its Network Partners,
who represent the leading and often messy frontier of technology trans-
fer. These organizations are key architects of strategies used to navigate the
gray zones between procedures implemented on a small scale in a random-
ized trial and those required to support effective implementation on a larger
scale. Without them, the validation of quality assurance protocols and sev-
eral adaptations of MST could not have occurred.
Finally, this book is dedicated to the children in our own families: Jay,
Lauren, Lee, Noelle, Phillippe, Russell, Santos, Sterling, and Waylon. They
inspire us every day and keep us focused on what is really important in
life.
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