Scott W. Henggeler, Ph.D.
(Contact) Marshall E. Swenson, MSW, MBA,
Manager of Program Developement
710 Johnnie Dodds Blvd.
Mt. Pleasant, SC 29464
(843) 856-8226 ext. 215 Fax: (843) 856-8227
Multisystemic therapy (MST) is an intensive family-based treatment that
addresses the known determinants of serious antisocial behavior in adolescents and their families. As such, MST treats
those factors in the youth's environment that are contributing to his or her behavior problems. Such
factors might pertain to individual characteristics of the youth (e.g., poor problem solving skills),
family relations (e.g., inept discipline), peer relations (e.g., association with deviant peers), and school
performance (e.g., academic difficulties). On a highly individualized basis, treatment goals are
developed in collaboration with the family, and family strengths are used as levers for therapeutic
change. Specific interventions used in MST are based on the best of the empirically validated
treatment approaches such as cognitive behavior therapy and the pragmatic family therapies. The
primary goals of MST are to reduce rates of antisocial behavior in the adolescent, reduce out-of-
home placements, and empower families to resolve future difficulties.
Several programmatic features are crucial to the success of MST. The use of a home-based model
of service delivery (i.e., low caseloads, time limited duration of treatment) removes barriers of access
to care and provides the high level of intensity needed to successfully treat youths presenting serious
clinical problems and their multi-need families. Second, the philosophy of MST holds service
providers accountable for engaging the family in treatment and for removing barriers to successful
outcomes. Such accountability clearly promotes retention in treatment and attainment of the
treatment goals. Third, outcomes are evaluated continuously, and the overriding goal of supervision
is to facilitate the clinicians' attempts to attain favorable outcomes. Fourth, MST programs place
great emphasis on maintaining treatment integrity, and as such, considerable resources are devoted to
therapist training, ongoing clinical consultation, service system consultation, and other types of quality
Rigorous evaluation is a hallmark of MST. Well designed randomized clinical trials with chronic and
violent juvenile offenders have demonstrated the capacity of MST to reduce long-term rates of
criminal activity, incarceration, and concomitant costs. Other randomized trials have demonstrated
that favorable outcomes are linked to therapist adherence to the MST treatment protocol. Current
studies are examining the effectiveness of MST in treating a variety of serious clinical problems,
evaluating variables that predict the successful dissemination of MST, and assessing the clinical and
cost effectiveness of an MST-based continuum of care.
Multisystemic Therapy (MST) is conducted by therapists who are part of a MST "team." Two to
four MST therapists and their on-site supervisor make up a MST team which works together for
purposes of group and peer supervision, and to support the 24 hour/7 day/week on-call needs of the
team's client families. MST therapists are full-time Master's-level or highly
clinically-skilled Bachelor's-level mental health professionals. MST supervisors
are typically assigned to the program a minimum of 50% time and may carry a small caseload if assigned
full-time. MST supervisors are either doctoral-level or highly competent Master's-level
MST staff must be highly accessible to their clients and often have both pagers and cellular phones.
Typically MST programs budget for mileage reimbursement to cover 8,000 to 12,000 miles a year
per therapist. Internet access for administrative staff is required for scoring of required Quality
Control measures. It is recommended that a small amount of flexible funds be available to the MST
team ($100 per client family) for occasional and/or emergency needs. An annual program-licensing
fee is required and is based upon the size of the MST program.
Program support and training in MST is provided on-site by MST Services, Inc. using essentially the
same protocol that has been used in successful clinical trials of MST with violent and chronic juvenile
offenders. Therapists and supervisors receive training in MST in three ways. First, five days of
intensive on-site orientation training are provided. Second, 1.5-day "booster" sessions occur on-site
on a quarterly basis. Third, treatment teams and their supervisors receive weekly telephone
consultation from MST experts.
In addition to the elements of clinical training, the package of program support and training services
includes a pre-training site assessment, assistance with program specification and design (including
the development of quality control and outcome tracking system), and ongoing assistance with
overcoming barriers to achieving successful clinical outcomes. The cost of program support and
training is based on an all-inclusive annual per team fee. Fees range from $15,000 to $24,000 per
team, plus travel expenses based upon the nature and size of the program.
Staff training in MST is an on-going process. A primary objective of MST Services is to assist
organizations in building capacity to provide for part or all of their MST program's long-term training
needs. In this context, program support and training expenses should be viewed as the annual cost
of a Quality Assurance (QA) program. Based upon an average annual service capacity of 15
families per therapist per year, the total long-term QA costs (program support and training) is usually
in the range of $400 to $550 per youth served.