Youth in a Difficult World: Multisystemic Therapy

Not all children enjoy the "carefree" days of childhood. Unfortunately, when things start to go wrong, people often despair of being able to repair the damage. NIMH has made research on diagnosis, early intervention, and treatment of children an absolute priority.

Arguments are waged as to the management of children who attempt suicide, commit crimes or even those who are abandoned and neglected. Our society has impoverished resources to answer such questions and while some hospitals are available, all too often the answer is prison. Research has demonstrated, however, that children do not need to be hospitalized or incarcerated to get the help they need. A home-based model of therapy, called Multisystemic Therapy or MST, offers treatment services to young people and their families in their homes. Youth with serious emotional or behavioral problems, such as antisocial behaviors, substance abuse, delinquency, or severe depression and suicidality, have been successfully treated through MST.

This approach shows a more hopeful and positive approach and focuses on how to help parents assist their children and how to teach young people to deal with their schools and communities. This program has been found to be an effective alternative to hospitalization and to jails.

The magnitude of the problem is this: 1 in 10 children and adolescents suffer from mental illness severe enough to cause some level of impairment.¹

Nonetheless, fewer than 1 in 5 of these ill children receives treatment.² There is heated debate in our society about the proper roles of medications and psychotherapies for children at risk and children already suffering. But, one thing is clear: children who go untreated, suffer, cannot learn, and may not form healthy relationships with peers and family. Some children are placed on a trajectory for jail rather than college at a very early age.

MST is a mental health service that focuses on changing how youth function in their natural settings that is, at home, in school, and in their neighborhoods.^3,4,5 It is designed to promote positive social behavior while decreasing problematic behavior, including delinquency, depression, or substance abuse. MST therapists focus on strengthening the ability of parents or caretakers to raise children who have complex problems. Therapists working in the home identify strengths in the families and use these strengths to develop natural support systems and to improve their parenting. Therapy is approached as a collaboration between the family and the MST therapist. The family sets treatment goals and the therapist suggests strategies to accomplish them.

Specific treatments are used within MST. The interventions are individualized to the family's strengths and weaknesses and address the needs of the child, family, school, peers, and neighborhood. Therapists working in the home have small caseloads and are available 24 hours a day, 7 days a week. Treatment teams usually consist of professional counselors, crisis caseworkers, and psychiatrists or psychologists who provide clinical supervision.