Adolescent Externalizing Behaviors
Joshua Leblang EdS LMHC
Division of Public Behavioral Health and Justice Policy
Our youth now love luxury They have bad manners
contempt for authority they show disrespect for their elders
hellip they contradict their parentshellipand tyrannize their
teachers
Socrates (c 470-399 BC)Socrates (c 470-399 BC)
The number of boy burglars boy robbers and boy murderers is so astoundingly large as to alarm all good men
New York Times editorial in 1857
Disruptive disorders such as oppositional defiant disorder and conduct disorder are characterized by antisocial behavior
It presents as collection of behaviors rather than a coherent pattern of mental dysfunction As such there is no ldquomagic bulletrdquo to fix the problem
Normal Adolescent Development
(AACAP 2005) Movement towards independence More cohesive sense of identity Ability to think ideas through Conflict with parents begins to decrease Increased ability for delayed
gratification and compromise Increased concern for others Peer relationships important and
take an appropriate place among other interests
Morals Values and Self-Direction
Greater capacity for setting goals Interest in moral reasoning Capacity to use insight Increased emphasis on personal
dignity and self-esteem Social and cultural traditions
regain some of their previous importance
For adolescents that you may encounter
It is rare that an adolescent self-refers themselves to counseling
Externalizing youth are rarely interested in ldquoinsightrdquo
Engagement with the youth is important but equally important is parentcaregivermdash Ensure attendance at sessions Reinforcing any new behaviors Provider of ldquoreliablerdquo information about
behaviors
What Evidence What Evidence mattersmatters
Why do we need to know what works
First many programs despite their good intentions are either ineffective or actually do more harm than good
Second ineffective or harmful programs are a waste of scarce resources
Blueprints for Violence
Prevention
Biases against Evidence-based Biases against Evidence-based PracticesPractices
ldquoldquoThey are too rigid and cookbookrdquo ldquoDoesnrsquot apply to real world kids with real world
multi-problem historiesrdquo ldquoDeveloped in some labrdquo ldquoOverly simplisticrdquo ldquoToo difficult to implement in community settingrdquo ldquoJust a band-aid and doesnrsquot address underlying
issues and concernsrdquo ldquoAnother passing fadrdquo ldquoMy training and expertise are not valuedrdquo
Why use EBTrsquosWhy use EBTrsquosInterventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective
National Institute of Mental Health (National National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and and Adolescent Mental Health Intervention and Deployment 2001)Deployment 2001)
Office of the Surgeon General (1999 2004) Office of the Surgeon General (1999 2004) Presidentrsquos New Freedom Commission on Mental Presidentrsquos New Freedom Commission on Mental Health (2003)Health (2003)
Rationale for Using Evidence-based Practices
Programs that are integrative in nature (practice research theory) and use systematic clinical protocols rdquoclinical mapsrdquo
Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to
unique ldquooutcomerdquo needs of the clientfamilyModels that have strong scienceresearch
support
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Our youth now love luxury They have bad manners
contempt for authority they show disrespect for their elders
hellip they contradict their parentshellipand tyrannize their
teachers
Socrates (c 470-399 BC)Socrates (c 470-399 BC)
The number of boy burglars boy robbers and boy murderers is so astoundingly large as to alarm all good men
New York Times editorial in 1857
Disruptive disorders such as oppositional defiant disorder and conduct disorder are characterized by antisocial behavior
It presents as collection of behaviors rather than a coherent pattern of mental dysfunction As such there is no ldquomagic bulletrdquo to fix the problem
Normal Adolescent Development
(AACAP 2005) Movement towards independence More cohesive sense of identity Ability to think ideas through Conflict with parents begins to decrease Increased ability for delayed
gratification and compromise Increased concern for others Peer relationships important and
take an appropriate place among other interests
Morals Values and Self-Direction
Greater capacity for setting goals Interest in moral reasoning Capacity to use insight Increased emphasis on personal
dignity and self-esteem Social and cultural traditions
regain some of their previous importance
For adolescents that you may encounter
It is rare that an adolescent self-refers themselves to counseling
Externalizing youth are rarely interested in ldquoinsightrdquo
Engagement with the youth is important but equally important is parentcaregivermdash Ensure attendance at sessions Reinforcing any new behaviors Provider of ldquoreliablerdquo information about
behaviors
What Evidence What Evidence mattersmatters
Why do we need to know what works
First many programs despite their good intentions are either ineffective or actually do more harm than good
Second ineffective or harmful programs are a waste of scarce resources
Blueprints for Violence
Prevention
Biases against Evidence-based Biases against Evidence-based PracticesPractices
ldquoldquoThey are too rigid and cookbookrdquo ldquoDoesnrsquot apply to real world kids with real world
multi-problem historiesrdquo ldquoDeveloped in some labrdquo ldquoOverly simplisticrdquo ldquoToo difficult to implement in community settingrdquo ldquoJust a band-aid and doesnrsquot address underlying
issues and concernsrdquo ldquoAnother passing fadrdquo ldquoMy training and expertise are not valuedrdquo
Why use EBTrsquosWhy use EBTrsquosInterventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective
National Institute of Mental Health (National National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and and Adolescent Mental Health Intervention and Deployment 2001)Deployment 2001)
Office of the Surgeon General (1999 2004) Office of the Surgeon General (1999 2004) Presidentrsquos New Freedom Commission on Mental Presidentrsquos New Freedom Commission on Mental Health (2003)Health (2003)
Rationale for Using Evidence-based Practices
Programs that are integrative in nature (practice research theory) and use systematic clinical protocols rdquoclinical mapsrdquo
Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to
unique ldquooutcomerdquo needs of the clientfamilyModels that have strong scienceresearch
support
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
The number of boy burglars boy robbers and boy murderers is so astoundingly large as to alarm all good men
New York Times editorial in 1857
Disruptive disorders such as oppositional defiant disorder and conduct disorder are characterized by antisocial behavior
It presents as collection of behaviors rather than a coherent pattern of mental dysfunction As such there is no ldquomagic bulletrdquo to fix the problem
Normal Adolescent Development
(AACAP 2005) Movement towards independence More cohesive sense of identity Ability to think ideas through Conflict with parents begins to decrease Increased ability for delayed
gratification and compromise Increased concern for others Peer relationships important and
take an appropriate place among other interests
Morals Values and Self-Direction
Greater capacity for setting goals Interest in moral reasoning Capacity to use insight Increased emphasis on personal
dignity and self-esteem Social and cultural traditions
regain some of their previous importance
For adolescents that you may encounter
It is rare that an adolescent self-refers themselves to counseling
Externalizing youth are rarely interested in ldquoinsightrdquo
Engagement with the youth is important but equally important is parentcaregivermdash Ensure attendance at sessions Reinforcing any new behaviors Provider of ldquoreliablerdquo information about
behaviors
What Evidence What Evidence mattersmatters
Why do we need to know what works
First many programs despite their good intentions are either ineffective or actually do more harm than good
Second ineffective or harmful programs are a waste of scarce resources
Blueprints for Violence
Prevention
Biases against Evidence-based Biases against Evidence-based PracticesPractices
ldquoldquoThey are too rigid and cookbookrdquo ldquoDoesnrsquot apply to real world kids with real world
multi-problem historiesrdquo ldquoDeveloped in some labrdquo ldquoOverly simplisticrdquo ldquoToo difficult to implement in community settingrdquo ldquoJust a band-aid and doesnrsquot address underlying
issues and concernsrdquo ldquoAnother passing fadrdquo ldquoMy training and expertise are not valuedrdquo
Why use EBTrsquosWhy use EBTrsquosInterventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective
National Institute of Mental Health (National National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and and Adolescent Mental Health Intervention and Deployment 2001)Deployment 2001)
Office of the Surgeon General (1999 2004) Office of the Surgeon General (1999 2004) Presidentrsquos New Freedom Commission on Mental Presidentrsquos New Freedom Commission on Mental Health (2003)Health (2003)
Rationale for Using Evidence-based Practices
Programs that are integrative in nature (practice research theory) and use systematic clinical protocols rdquoclinical mapsrdquo
Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to
unique ldquooutcomerdquo needs of the clientfamilyModels that have strong scienceresearch
support
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Disruptive disorders such as oppositional defiant disorder and conduct disorder are characterized by antisocial behavior
It presents as collection of behaviors rather than a coherent pattern of mental dysfunction As such there is no ldquomagic bulletrdquo to fix the problem
Normal Adolescent Development
(AACAP 2005) Movement towards independence More cohesive sense of identity Ability to think ideas through Conflict with parents begins to decrease Increased ability for delayed
gratification and compromise Increased concern for others Peer relationships important and
take an appropriate place among other interests
Morals Values and Self-Direction
Greater capacity for setting goals Interest in moral reasoning Capacity to use insight Increased emphasis on personal
dignity and self-esteem Social and cultural traditions
regain some of their previous importance
For adolescents that you may encounter
It is rare that an adolescent self-refers themselves to counseling
Externalizing youth are rarely interested in ldquoinsightrdquo
Engagement with the youth is important but equally important is parentcaregivermdash Ensure attendance at sessions Reinforcing any new behaviors Provider of ldquoreliablerdquo information about
behaviors
What Evidence What Evidence mattersmatters
Why do we need to know what works
First many programs despite their good intentions are either ineffective or actually do more harm than good
Second ineffective or harmful programs are a waste of scarce resources
Blueprints for Violence
Prevention
Biases against Evidence-based Biases against Evidence-based PracticesPractices
ldquoldquoThey are too rigid and cookbookrdquo ldquoDoesnrsquot apply to real world kids with real world
multi-problem historiesrdquo ldquoDeveloped in some labrdquo ldquoOverly simplisticrdquo ldquoToo difficult to implement in community settingrdquo ldquoJust a band-aid and doesnrsquot address underlying
issues and concernsrdquo ldquoAnother passing fadrdquo ldquoMy training and expertise are not valuedrdquo
Why use EBTrsquosWhy use EBTrsquosInterventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective
National Institute of Mental Health (National National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and and Adolescent Mental Health Intervention and Deployment 2001)Deployment 2001)
Office of the Surgeon General (1999 2004) Office of the Surgeon General (1999 2004) Presidentrsquos New Freedom Commission on Mental Presidentrsquos New Freedom Commission on Mental Health (2003)Health (2003)
Rationale for Using Evidence-based Practices
Programs that are integrative in nature (practice research theory) and use systematic clinical protocols rdquoclinical mapsrdquo
Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to
unique ldquooutcomerdquo needs of the clientfamilyModels that have strong scienceresearch
support
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Normal Adolescent Development
(AACAP 2005) Movement towards independence More cohesive sense of identity Ability to think ideas through Conflict with parents begins to decrease Increased ability for delayed
gratification and compromise Increased concern for others Peer relationships important and
take an appropriate place among other interests
Morals Values and Self-Direction
Greater capacity for setting goals Interest in moral reasoning Capacity to use insight Increased emphasis on personal
dignity and self-esteem Social and cultural traditions
regain some of their previous importance
For adolescents that you may encounter
It is rare that an adolescent self-refers themselves to counseling
Externalizing youth are rarely interested in ldquoinsightrdquo
Engagement with the youth is important but equally important is parentcaregivermdash Ensure attendance at sessions Reinforcing any new behaviors Provider of ldquoreliablerdquo information about
behaviors
What Evidence What Evidence mattersmatters
Why do we need to know what works
First many programs despite their good intentions are either ineffective or actually do more harm than good
Second ineffective or harmful programs are a waste of scarce resources
Blueprints for Violence
Prevention
Biases against Evidence-based Biases against Evidence-based PracticesPractices
ldquoldquoThey are too rigid and cookbookrdquo ldquoDoesnrsquot apply to real world kids with real world
multi-problem historiesrdquo ldquoDeveloped in some labrdquo ldquoOverly simplisticrdquo ldquoToo difficult to implement in community settingrdquo ldquoJust a band-aid and doesnrsquot address underlying
issues and concernsrdquo ldquoAnother passing fadrdquo ldquoMy training and expertise are not valuedrdquo
Why use EBTrsquosWhy use EBTrsquosInterventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective
National Institute of Mental Health (National National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and and Adolescent Mental Health Intervention and Deployment 2001)Deployment 2001)
Office of the Surgeon General (1999 2004) Office of the Surgeon General (1999 2004) Presidentrsquos New Freedom Commission on Mental Presidentrsquos New Freedom Commission on Mental Health (2003)Health (2003)
Rationale for Using Evidence-based Practices
Programs that are integrative in nature (practice research theory) and use systematic clinical protocols rdquoclinical mapsrdquo
Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to
unique ldquooutcomerdquo needs of the clientfamilyModels that have strong scienceresearch
support
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Morals Values and Self-Direction
Greater capacity for setting goals Interest in moral reasoning Capacity to use insight Increased emphasis on personal
dignity and self-esteem Social and cultural traditions
regain some of their previous importance
For adolescents that you may encounter
It is rare that an adolescent self-refers themselves to counseling
Externalizing youth are rarely interested in ldquoinsightrdquo
Engagement with the youth is important but equally important is parentcaregivermdash Ensure attendance at sessions Reinforcing any new behaviors Provider of ldquoreliablerdquo information about
behaviors
What Evidence What Evidence mattersmatters
Why do we need to know what works
First many programs despite their good intentions are either ineffective or actually do more harm than good
Second ineffective or harmful programs are a waste of scarce resources
Blueprints for Violence
Prevention
Biases against Evidence-based Biases against Evidence-based PracticesPractices
ldquoldquoThey are too rigid and cookbookrdquo ldquoDoesnrsquot apply to real world kids with real world
multi-problem historiesrdquo ldquoDeveloped in some labrdquo ldquoOverly simplisticrdquo ldquoToo difficult to implement in community settingrdquo ldquoJust a band-aid and doesnrsquot address underlying
issues and concernsrdquo ldquoAnother passing fadrdquo ldquoMy training and expertise are not valuedrdquo
Why use EBTrsquosWhy use EBTrsquosInterventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective
National Institute of Mental Health (National National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and and Adolescent Mental Health Intervention and Deployment 2001)Deployment 2001)
Office of the Surgeon General (1999 2004) Office of the Surgeon General (1999 2004) Presidentrsquos New Freedom Commission on Mental Presidentrsquos New Freedom Commission on Mental Health (2003)Health (2003)
Rationale for Using Evidence-based Practices
Programs that are integrative in nature (practice research theory) and use systematic clinical protocols rdquoclinical mapsrdquo
Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to
unique ldquooutcomerdquo needs of the clientfamilyModels that have strong scienceresearch
support
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
For adolescents that you may encounter
It is rare that an adolescent self-refers themselves to counseling
Externalizing youth are rarely interested in ldquoinsightrdquo
Engagement with the youth is important but equally important is parentcaregivermdash Ensure attendance at sessions Reinforcing any new behaviors Provider of ldquoreliablerdquo information about
behaviors
What Evidence What Evidence mattersmatters
Why do we need to know what works
First many programs despite their good intentions are either ineffective or actually do more harm than good
Second ineffective or harmful programs are a waste of scarce resources
Blueprints for Violence
Prevention
Biases against Evidence-based Biases against Evidence-based PracticesPractices
ldquoldquoThey are too rigid and cookbookrdquo ldquoDoesnrsquot apply to real world kids with real world
multi-problem historiesrdquo ldquoDeveloped in some labrdquo ldquoOverly simplisticrdquo ldquoToo difficult to implement in community settingrdquo ldquoJust a band-aid and doesnrsquot address underlying
issues and concernsrdquo ldquoAnother passing fadrdquo ldquoMy training and expertise are not valuedrdquo
Why use EBTrsquosWhy use EBTrsquosInterventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective
National Institute of Mental Health (National National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and and Adolescent Mental Health Intervention and Deployment 2001)Deployment 2001)
Office of the Surgeon General (1999 2004) Office of the Surgeon General (1999 2004) Presidentrsquos New Freedom Commission on Mental Presidentrsquos New Freedom Commission on Mental Health (2003)Health (2003)
Rationale for Using Evidence-based Practices
Programs that are integrative in nature (practice research theory) and use systematic clinical protocols rdquoclinical mapsrdquo
Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to
unique ldquooutcomerdquo needs of the clientfamilyModels that have strong scienceresearch
support
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
What Evidence What Evidence mattersmatters
Why do we need to know what works
First many programs despite their good intentions are either ineffective or actually do more harm than good
Second ineffective or harmful programs are a waste of scarce resources
Blueprints for Violence
Prevention
Biases against Evidence-based Biases against Evidence-based PracticesPractices
ldquoldquoThey are too rigid and cookbookrdquo ldquoDoesnrsquot apply to real world kids with real world
multi-problem historiesrdquo ldquoDeveloped in some labrdquo ldquoOverly simplisticrdquo ldquoToo difficult to implement in community settingrdquo ldquoJust a band-aid and doesnrsquot address underlying
issues and concernsrdquo ldquoAnother passing fadrdquo ldquoMy training and expertise are not valuedrdquo
Why use EBTrsquosWhy use EBTrsquosInterventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective
National Institute of Mental Health (National National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and and Adolescent Mental Health Intervention and Deployment 2001)Deployment 2001)
Office of the Surgeon General (1999 2004) Office of the Surgeon General (1999 2004) Presidentrsquos New Freedom Commission on Mental Presidentrsquos New Freedom Commission on Mental Health (2003)Health (2003)
Rationale for Using Evidence-based Practices
Programs that are integrative in nature (practice research theory) and use systematic clinical protocols rdquoclinical mapsrdquo
Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to
unique ldquooutcomerdquo needs of the clientfamilyModels that have strong scienceresearch
support
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Why do we need to know what works
First many programs despite their good intentions are either ineffective or actually do more harm than good
Second ineffective or harmful programs are a waste of scarce resources
Blueprints for Violence
Prevention
Biases against Evidence-based Biases against Evidence-based PracticesPractices
ldquoldquoThey are too rigid and cookbookrdquo ldquoDoesnrsquot apply to real world kids with real world
multi-problem historiesrdquo ldquoDeveloped in some labrdquo ldquoOverly simplisticrdquo ldquoToo difficult to implement in community settingrdquo ldquoJust a band-aid and doesnrsquot address underlying
issues and concernsrdquo ldquoAnother passing fadrdquo ldquoMy training and expertise are not valuedrdquo
Why use EBTrsquosWhy use EBTrsquosInterventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective
National Institute of Mental Health (National National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and and Adolescent Mental Health Intervention and Deployment 2001)Deployment 2001)
Office of the Surgeon General (1999 2004) Office of the Surgeon General (1999 2004) Presidentrsquos New Freedom Commission on Mental Presidentrsquos New Freedom Commission on Mental Health (2003)Health (2003)
Rationale for Using Evidence-based Practices
Programs that are integrative in nature (practice research theory) and use systematic clinical protocols rdquoclinical mapsrdquo
Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to
unique ldquooutcomerdquo needs of the clientfamilyModels that have strong scienceresearch
support
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Biases against Evidence-based Biases against Evidence-based PracticesPractices
ldquoldquoThey are too rigid and cookbookrdquo ldquoDoesnrsquot apply to real world kids with real world
multi-problem historiesrdquo ldquoDeveloped in some labrdquo ldquoOverly simplisticrdquo ldquoToo difficult to implement in community settingrdquo ldquoJust a band-aid and doesnrsquot address underlying
issues and concernsrdquo ldquoAnother passing fadrdquo ldquoMy training and expertise are not valuedrdquo
Why use EBTrsquosWhy use EBTrsquosInterventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective
National Institute of Mental Health (National National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and and Adolescent Mental Health Intervention and Deployment 2001)Deployment 2001)
Office of the Surgeon General (1999 2004) Office of the Surgeon General (1999 2004) Presidentrsquos New Freedom Commission on Mental Presidentrsquos New Freedom Commission on Mental Health (2003)Health (2003)
Rationale for Using Evidence-based Practices
Programs that are integrative in nature (practice research theory) and use systematic clinical protocols rdquoclinical mapsrdquo
Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to
unique ldquooutcomerdquo needs of the clientfamilyModels that have strong scienceresearch
support
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Why use EBTrsquosWhy use EBTrsquosInterventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective
National Institute of Mental Health (National National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and and Adolescent Mental Health Intervention and Deployment 2001)Deployment 2001)
Office of the Surgeon General (1999 2004) Office of the Surgeon General (1999 2004) Presidentrsquos New Freedom Commission on Mental Presidentrsquos New Freedom Commission on Mental Health (2003)Health (2003)
Rationale for Using Evidence-based Practices
Programs that are integrative in nature (practice research theory) and use systematic clinical protocols rdquoclinical mapsrdquo
Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to
unique ldquooutcomerdquo needs of the clientfamilyModels that have strong scienceresearch
support
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Rationale for Using Evidence-based Practices
Programs that are integrative in nature (practice research theory) and use systematic clinical protocols rdquoclinical mapsrdquo
Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to
unique ldquooutcomerdquo needs of the clientfamilyModels that have strong scienceresearch
support
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Family Factors that Promote Resiliency
(National Resilience Resource Center)1048766 Parent and family connectedness1048766 ParentAdolescent activities1048766 Parental presence1048766 Parental school expectations1048766 Parents involvement and awareness of
sexual behaviors1048766 Limit access to substances and weapons1048766 Seek help for parental and familial
problemsconcerns1048766 Seek support from other parents1048766 Know community resources
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Program characteristics that
support positive youth development
1 Comprehensive time-intensive
2 Earliest possible intervention3 Timing is important4 High structure is better5 Fidelity to model is key to
effectiveness
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Positive Youth Development Positive Youth Development (conrsquot)(conrsquot)
6 Need adult involvement7 Active skills-oriented programs are
more effective8 Programs that target multiple
systems are most effective9 Programs that are sensitive to the
individualrsquos community and culture are best
10 Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective
Practice (From meta-analysis published in 2005)
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
3 Treatments top the list for adolescents
ALL focus on family caregivers
Functional Family TherapyMultidimensional Treatment Foster Care
Multisystemic Therapy
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
What is Functional Family What is Functional Family TherapyTherapy
Focus is to improve family communication Focus is to improve family communication and supportiveness while decreasing the and supportiveness while decreasing the intense negativity so often characteristic of intense negativity so often characteristic of these families these families
Many of the targeted interventions Many of the targeted interventions therefore emphasize communication skills therefore emphasize communication skills family interaction problem-solving and family interaction problem-solving and promoting constructive behaviors promoting constructive behaviors
Intervention ranges from on average 8 to Intervention ranges from on average 8 to 12 one-hour sessions up to 30 sessions of 12 one-hour sessions up to 30 sessions of direct service for more difficult situations direct service for more difficult situations
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
What is Functional Family What is Functional Family TherapyTherapy
Conducted both in clinic settings as an Conducted both in clinic settings as an outpatient therapy and as a home-based modeloutpatient therapy and as a home-based model
A treatment technique that is appealing A treatment technique that is appealing because of its clear identification of specific because of its clear identification of specific phases which organize intervention in a phases which organize intervention in a coherent manner thereby allowing clinicians coherent manner thereby allowing clinicians to maintain focus in the context of to maintain focus in the context of considerable family and individual disruptionconsiderable family and individual disruption
Each phase includes specific goals assessment Each phase includes specific goals assessment foci specific techniques of intervention and foci specific techniques of intervention and therapist skills necessary for successtherapist skills necessary for success
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Functional Family Therapy Functional Family Therapy
A treatment techniqueA treatment technique
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Multidimensional Treatment Foster Care (MTFC)
Program Overview
The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
MTFCMTFCMTFC treatment goals are accomplished by providing
Close supervision fair and consistent limits predictable consequences for rule breaking a supportive relationship with at least one mentoring adult and reduced exposure to peers with similar problems
The intervention is multifaceted and occurs in multiple settings The intervention components include Behavioral parent training and support for MTFC foster parents skills training for youth supportive therapy for youth school-based behavioral interventions and academic support and psychiatric consultation and medication management when
needed
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
MULTISYSTEMIC THERAPY Youthsrsquo behaviors are influenced by
their families friends and communities (and vice versa)
Families are the key to success so all aspects of treatment are designed with full collaboration from the family
Change can happen quickly but it demands daily and weekly efforts from the youth and all the important people in hisher life
Families can live successfully without involvement in social service agencies
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
How is MST DifferentHow is MST Different Discipline Offers a combination of
ldquobest practicerdquo treatments within a disciplined structure
Accountability At all levels providers are held accountable for outcomes through MSTrsquos rigorous quality assurance system
Ecological validity Working in the youthrsquos natural environment with existing family supports thereby ensuring cultural sensitivity
Focus on long-term outcomes Empowerment of caregivers to manage future difficulties focus on sustainability
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
How Does MST ldquoWorkrdquo
Intervention strategies MST draws from Intervention strategies MST draws from research-based treatment techniquesresearch-based treatment techniques
Behavior therapyBehavior therapy Parent management training Parent management training Cognitive behavior therapyCognitive behavior therapy Pragmatic family therapiesPragmatic family therapies
mdash Structural Family TherapyStructural Family Therapymdash Strategic Family TherapyStrategic Family Therapy
Pharmacological interventions (eg for Pharmacological interventions (eg for ADHD)ADHD)
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Why is MST Successful Treatment targets known causes of Treatment targets known causes of
delinquency family relations peer delinquency family relations peer relations school performance relations school performance community factorscommunity factors
Treatment is family driven and occurs Treatment is family driven and occurs in the youthsrsquo natural environment in the youthsrsquo natural environment
Providers are accountable for outcomesProviders are accountable for outcomes Staff are well trained and supportedStaff are well trained and supported Significant energies are devoted to Significant energies are devoted to
developing positive interagency developing positive interagency relationsrelations
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
9 Principles of MST9 Principles of MST
1 Finding the Fit2 Positive amp
Strength Based3 Increasing
Responsibility4 Present focused
Action-orientated
5 Targeting Sequences
6 Developmentally Culturally Appropriate
7 Continuous Effort
8 Evaluation amp Accountability
9 Generalization
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
CommunitySchool
Peers
Family
An ecological approach Work with the entire ecology By Work with the entire ecology By
addressing the multiple systems it addressing the multiple systems it is possible to make longer lasting is possible to make longer lasting changes for familieschanges for families
Youth
Bronfenbrenner 1979
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Condensed Longitudinal Model of
Youth Antisocial Behavior
Family
School
Antisocial Peers
Antisocial behavior
Prior antisocial behavior
Low MonitoringLow AffectionHigh Conflict
Low School InvolvementPoor Academic Performance
Explaining delinquency and drug use by DS Elliott D Huizinga and SS Ageton Beverly Hills CA Sage Publications 1985 176 pp
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Individual Factors
Antisocial behavior Mental health problems Low social conformity
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
FAMILY
Poor monitoring
Ineffective discipline
Low warmth High conflict Parental drug
useabuse
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
PEER
Association with drug-using peers
Low association with prosocial peers
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
SCHOOL
Low achievement Truancy Low commitment to school
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
COMMUNITY FACTORS
bullHigh crime
bullNeighbors who use drugs
bullTransience
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
What usually happens to What usually happens to youthyouth
Youth gets in troubleYouth gets in trouble
Sent to treatmentSent to treatment Meets other anti-
social peers
No changes at home
CYCLE CONTINUES
Returns home
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
What usually happens to What usually happens to youthyouth
Youth uses drugsYouth uses drugs
Meets other drug-using peers
CYCLE CONTINUES
Sent to Sent to treatment treatment groupgroup
Now has greater access to negative peers people to buy from
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Case ExampleCase Example
16 year old male16 year old maleHx of truancy (missing school Hx of truancy (missing school
2-3 daysweek)2-3 daysweek)Runaway (usually 1-2 nights Runaway (usually 1-2 nights
but as long as a week)but as long as a week)Defiantoppositional ndashrefuses Defiantoppositional ndashrefuses
to follow household rulesto follow household rules
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
Case Example 2
14 year old female14 year old femaleInvolved with negative Involved with negative peerspeersReportedly gang-involvedReportedly gang-involved
Alcoholmarijuana usageAlcoholmarijuana usageStealingshoplifting chargesStealingshoplifting charges
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this
House Bill 1373
hellipup to twenty outpatient therapy hours per calendar year including family therapy visits integral to a childs treatment
How can we best use this