MULTISYSTEMIC THERAPY IN THE NETHERLANDS

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MULTISYSTEMIC THERAPY IN THE NETHERLANDS

• Maja Dekovic
• Utrecht University

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Multisystemic Therapy (MST)

• treatment for youth who show serious, violent and
  chronic antisocial behavior (Henggeler et al.)

PROMISSING? WHY?
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REASONS

• Theoretical foundation
• - theories about development and maintenance of
  antisocial behavior
• - theories of change

• Characteristics of treatment
• - address multiple causes of antisocial behavior
  (broad focus)
• - home- and community-based (ecological
  validity)
• - intensive
• - continuous monitoring of treatment adherence

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EVIDENCE

• Empirical support from controlled clinical trials
  in the USA
• reduction of antisocial behavior and
  prevention of recidivism in serious adolescent
  offenders
• (d.50, Curtic, Ronan, Borduin, 2004)

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HOWEVER

• Difference between the USA and The Netherlands
  in
• social and political climate, organization of
  mental health services, availability of different
  treatments, type of clients

• Need for independent research
• (see also critique on design and reports of MST
  evalaution studies by Littell, 2005)

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Dutch study

• Project team
• Utrecht University, University of Amsterdam, NSCR
  
• M. Dekovic, P. van der Laan P. Prins
  (project leaders)
• J. Asscher (main investigator)
• research assistants
• Clinical setting
• De Waag (Utrecht and Amsterdam)
• S. van Arum (supervisor MST teams)
• J. Mulder (director De Waag)

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AIMS

• to examine short and long term effectiveness of
  MST compared to treatment as usual (TAU)

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Effectiveness in terms of

• Reduction of antisocial behavior
  (frequency and
  seriousness)
  PRIMARY
  OUTCOME

Reduction of other type of problems
(internalizing, substance use, school problems)
SECONDARY OUTCOME
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MST
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6 months
Design of the study
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Assessment OUTCOMES
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Hypothesized effects
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AIMS

• to examine short and long term effectiveness of
  MST compared to treatment as usual (TAU)
• to understand the processes through which the MST
  works by testing the hypothesized mediators of
  beneficial treatment

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How does MST work?

• By affecting theory-relevant and empirically
  proven risk and protective factors for antisocial
  behavior
• increase of competence of both adolescent and
  his/her parents (i.e. problem solving skills,
  self-efficacy)
• improvement in parental child rearing skills and
  the quality of the parent-adolescent relationship
• decrease in adolescent involvement with deviant
  peers and increase in involvement with
  conventional (prosocial) peers

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Assessment MEDIATORS
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Hypothesized effects
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AIMS

• to examine short and long term effectiveness of
  MST compared to treatment as usual (TAU)
• to understand the processes through which the MST
  works by testing the hypothesized mediators of
  beneficial treatment
• to understand differential pathways to change by
  determining circumstances in which MST yields or
  does not yield beneficial outcomes

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For whom (under which conditions) MST works?

• The effect of MST may depend on
• Participant characteristics
• age, ethnicity, SES, initial level and severity
  of antisocial behavior, personality, marital
  relations
• Treatment characteristics
• treatment adherence, cooperation with therapist,
  satisfaction with treatment

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Assessment MODERATORS
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SWOT analysis

• Strengths / opportunities
• - naturalistic setting (external validity)
• - strong empirical support (RCT)
• - evidence of specificity (comparison to TAU)
• - test of theory (mediators analyses)
• - differential effects (moderator analyses)

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• Weaknesses / threats
• - naturalistic setting (extremely complex Dutch
  system)
• identifying paths the potential clients
  follow
• defining treatment as usual
• - random assignment (resistance of clinical
  staff)
• - recruiting and retaining the families

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Working in evidence-based manner?
RCT is conditio sine qua non