Mult-Systemic Therapy, or MST Posted by:Max--Wednesday, March 09, 2011

PSST Parent Wilma has often mentioned she is using "MST" in her home with Bam-Bam. I keep asking her "what do you mean by that again?" Wilma kindly sent me information on Multi-Systemic Therapy, or MST. This is new to Allegheny County within the last 2 years. It is a home-based therapy where the goal is to keep the child in the home and not sent to a facility. It may not be right for everyone, but it may be a good alternative to know about for others. Please read on if you think these services can help your family.

Wilma's family is using a place called Harbor Creek Youth Services (MST at Harbor Creek www.hys-erie.org) The following information is from them, and is not endorsed by Juvenile Probation or PSST. It is simply information we would like you all to be aware of. Harbor Creek is now seeing patients with Managed Care insurance, so they may not have updated brochures yet. Wilma had a psych eval for son Bam-Bam conducted by a master level therapist who works for a psychological practice called Lancaster-Hugh Smith PhD Associates. New referrals will most likely start out with a psychological evaluation, so the child is properly assessed, as these services will not be appropriate for everyone. IMPORTANT HINT** If you have had previous evaluations for your kid, always offer them to a new tester, as it is valuable information for comparison. Also, any anecdotal information from forms filled out by teachers or previous therapists are also good to have on hand. The more well rounded picture of your teen, the more appropriate and targeted treatment can be.

MST Frequently Asked Questions:
Is MST for everyone?
No. In general, the MST program targets youth at risk for out-of-home placement for behaviors that are viewed as “willful misconduct”. Please contact the MST supervisor for a list of inclusionary and exclusionary criteria if there are questions regarding specific behaviors/criteria.

How is 24/7 availability defined?
This is always driven by the families needs; specifically, 24/7 means that the family has access to the primary therapist or a member of the MST team – at any time – who knows the details of the case and the appropriate response to the family’s needs or concerns.

How is MST different from a Crisis Team?
The crisis team is designed for short-term crisis intervention, and can be contacted by the family (or temporary caregiver) at any time. MST Therapists are also prepared to respond to crises when families call. Also, for families who appear to be at risk for crisis development, MST Therapists receive on-going supervision and consultation to develop “safety plans”. Such plans would include calling the therapist. If, in the event of a crisis, the family chooses to utilize services other than, or in addition to, MST, the MST Therapist should be contacted as soon as possible in an effort to develop a collaborative plan of action for future crises. Ideally, this contact should be made by the family, but could also be made by a member of the Crisis Team (with proper consents).

How is a MST referral made?
A referral can be made by faxing the referral packet to the MST office. This packet should include the 412 referral form (CYF), Harborcreek Youth Services referral form, and all other relevant information pertaining to the case. After the referral is received, the MST Supervisor will contact the caseworker or JPO to obtain any additional information required for the acceptance/denial of the referral and a decision will be made at that time.

How persistent is MST?
Since MST Therapists are held accountable for case outcomes, every effort will be made to engage families in treatment. At the outset, engagement of the family is seen as a treatment challenge that can be addressed. Various strategies that are professional, persistent, and utilize assets within the ecology, will be attempted to engage the family in treatment.

Can MST initiate services before the targeted youth is home?
Yes. MST can begin 30 days prior to the youth’s return into the home. During this time, MST will prepare the parents/caregivers for the youth’s return home as well as work with the placement to ensure there is a smooth transition back into the home, school, and community.

How long do MST services last?
MST services typically last between 4-6 months. When there are indications that longer treatment will result in significant improvement in the youth’s behavior, treatment can be extended. The program supervisor and consultant must approve all extensions of treatment.

What does MST do about adolescents using/abusing substances?
The scientific literature indicates that adolescent substance use/abuse is maintained by the same factors that maintain other delinquent behavior. These include being with other peers who use/abuse substances, family factors, and school factors. As such, the MST Therapist works with the ecology surrounding the youth to change these factors…the same as the MST Therapist would do in reducing criminal behavior, aggressive behavior, or school truancy.

Who provides individual therapy?
The MST Therapist, but only in certain well-defined circumstances. In general, individual treatment of the adolescent is done when other ecological interventions have been implemented consistently and the youth’s behavior has not changed. In caregivers, individual treatment is done when a barrier to engagement or goal achievement is found. During individual treatment, empirically supported interventions are the focus of treatment (e.g., CBT).

Harbor Creek is not the only group doing MST. For other resources, please google MST Allegheny County.