MSTs analytical model

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• MSTs analytical model
• And a clinical case

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MST Treatment Principles

• 1. Finding the Fit
• The primary purpose of assessment is to
  understand the fit between the identified
  problems and their broader systemic context.
• 2. Positive Strength Focused
• Therapeutic contacts should emphasize the
  positive and should use systemic strengths as
  levers for change.
• 3. Increasing Responsibility
• Interventions should be designed to promote
  responsibility and decrease irresponsible
  behavior among family members.
• 4. Present-focused, Action-oriented
  Well-defined
• Interventions should be present-focused and
  action-oriented, targeting specific and
  well-defined problems.
• 5. Targeting Sequences
• Interventions should target sequences of
  behavior within and between multiple systems that
  maintain identified problems.
• 6. Developmentally Appropriate
• Interventions should be developmentally
  appropriate and fit the developmental needs of
  the youth.
• 7. Continuous Effort
• Interventions should be designed to require
  daily or weekly effort by family members.
• 8. Evaluation and Accountability
• Interventions efficacy is evaluated continuously
  from multiple perspectives, with providers
  assuming accountability for overcoming barriers
  to successful outcomes.
• 9. Generalization
• Interventions should be designed to promote
  treatment generalization and long-term
  maintenance of therapeutic change by empowering
  care givers to address family members needs
  across multiple systemic contexts.

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Team Reasons for Referral
Initial Goals\Desired
Outcome Superior MST goals
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Team Genogram
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Team
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Team
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Team Fit circle
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GENOGRAM OLA
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Terapeut 1001 Familie 0002 Dato 15/10 2003
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Desired Outcomes of Family and key participants
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A summary for supervision and consultation
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Weekly Case Summary for Supervision and
Consultation
Overarching\Primary MST Goals
I.

• Ola will be clean. This will be confirmed by
  negative urine specimen and information from
  parents, school and police.
• Ola will actively participate in a school
  sitiation adapted for him. Confirmed by
  information from school and parents.
• Ola will stop both verbal and physical
  aggression. Confirmed by information from school
  and parents.
• Ola will follow the family rules. Confirmed by
  information from parents.

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GETS WHAT HE WANTS/GETS POWER Confirmed by
parents
PEER STATUS Confirmed by child services
COMMUNICATION STYLE IN THE FAMILY Confirmed by
parents, Ola
COVERS UP SADNESS Confirmed by mom
VERBAL AND PHYSICAL AGGRES-SION
UNCLEAR RULES AND CONSE-QUENSES Confirmed by
parents
LOW IMPULS CONTOL Confirmed by school, mom
PHYSICALLT STOPPED BY DAD IN CONFLICT
SITUATIONS Confirmed by Ola, parents
INCONSITENT PARENTING Confirmed by parents, Ola
SUBSTANCE ABUSE Confirmed by parents
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EASY ACCESS TO DRUGS Confirmed by youth support
team, and Child Services
PEERS WHO USE Confirmed by youth support team,
parents
CURBS UNREST Confirmed by Ola, parents
SUBSTANCE ABUSE PROBLEMS IN THE FAMILY
Confirmed by parents
SUB-STANCE ABUSE
NO CONSEQUENSES Confirmed by parents
THRILL/RUSHConfirmed by Ola
NO PARTICIPATION IN AFTER SCHOOL
ACTIVITIES Confirmed by Ola
CONFLICTS AT HOME Confirmed by family
NO MONITORING Confirmed by parents
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FRIENDS NOT ATTENDING SCHOOL/NO JOB Confirmed by
school, Ola
NOR FRIENDS IN SCHOOL Confirmed by lead teacher
CONFLICT SCHOOL-HOME Confirmed by parents,
school
PROBLEM CONCENTRA-TING, SUBJECT. Confirmed by
school, rapport from Educational-Psychological
Service
TRUANCY
NO CONSEQUENSES AT HOME OR SCHOOL Confirmed by
school, parents
BAD RELATIONSHIP WITH TEACHER Confirmed by Ola
NO PARENT FOLLOW UP WITH SCHOOL Confirmed by
parents
SUBSTANCE ABUSE GETS HOME LATE
TIERED Confirmed by parents
PARENTS HAVE NO CONTROL OVER ACTIONS Confirmed
by parents
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Social Support

• Key particpants
• Identify need/tasks to ask for in support
• Make a plan for meeting participants individually
  or in a group
• Make agenda for meeting
• Therapist is secretary at the meeting and writes
  all agreements
• Examples of tasks
• Come to the home in difficult situations
• Help in search for youth
• Babysit other children when parents need
• Be support for parents as needed
• Be support for youth with activities

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Safety plan for Ola and his family
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Family Cohersion

• Identify strengths
• Help parents to rebuild warmth and support
• Establish clear expectations and rules
• Make family contract with predictable rewards and
  consequences
• Plan for family activities

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School interventions

• Identify strengths and needs
• Plan meeting with school with the parents
• Parents contact school for meeting
• Plan for comunication flow between parents and
  school
• Plan for implementation of rewards and
  consequences are made
• Plan for school routines
• Particpants in meeting (Principle) Class
  teachers, social support teacher, parents and
  therapist

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Family contract
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Peer interventions

• Identify peers
• Who, when and what they do
• Decide desired contact level
• Monitoring interventions
• Examples
• Contact parents of negative peers
• Establish a collaborative approaches
• Try to make agreements on limits and rules
• Plan for activities with prosocial peers

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Plan for finding Ola
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Physical and verbal aggression

• Make security plan
• Identify strengths and needs
• Rebuild family bonding
• Identify clear rules
• Identify triggers for aggresion
• Decide rewards for reducing verbal aggression
  (which is always covered in the family contract)

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OLA DID NOT RECEIVE MONEY
DAD YELLED AT OLA
OLA KNOWS IT HELPS -HE GETS WHAT HE WANTS
CONFLICT BETWEEN OLA AND PARENTS ALREADY PRESENT
OLA HIT DAD
DAD PHYSICALLY HELD HIM BACK
VAGUE RULES
DID NOT FOLLOW THE SECURITY PLAN
PARENTS GAVE CONFLICTING INSTRUCTIONS
OLA WAS INTOXI-CATED
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Drug Abuse Interventions

• Identify level of addiction
• Identify peers who also use, what, when and where
• Plans urine tests
• Make contract for stopping drug use