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