Long-term effects of multisystemic therapy for problem sexual behaviors: A 24.9-year follow-up to a randomized clinical trial.

Objective: Although there is evidence that the positive impact of multisystemic therapy for problem sexual behaviors (MST-PSB) reaches as far as young adulthood, the longer-term effects of MST-PSB into midlife are unknown. The present study examined criminal and civil court outcomes for sexually offending youths who participated on average 24.9 years earlier in a clinical trial of MST-PSB (Borduin et al., Journal of Consulting and Clinical Psychology, 2009, 77, p. 26). Method: Participants were 48 individuals who were originally randomized to MST-PSB or usual community services (UCS) and were at high risk of continued criminality. Arrest, incarceration, and civil suit data were obtained in middle adulthood when participants averaged 39.4 years of age. Results: Intent-to-treat analyses showed that MST-PSB participants had 85% fewer sexual offenses and 70% fewer nonsexual offenses than did UCS participants. In addition, MST-PSB participants were sentenced to 46% fewer days of incarceration and had 62% fewer family-related civil suits. Moreover, the favorable effects of MST-PSB on participants' crimes and civil suits were mediated by improved peer and family relations during treatment. Conclusion: The current study represents the longest and most comprehensive follow-up to date of an MST-PSB clinical trial and demonstrates that the positive effects of an evidence-based youth treatment for sexual crimes can last well into adulthood. Implications of the findings for policymakers, service providers, and researchers are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An Evaluation of Mechanisms of Change in Multisystemic Therapy for Juvenile Justice-Involved Youths A Decade Following Treatment.

Although researchers have identified the more immediate mechanisms of change in family-based treatments for juvenile justice-involved youths, it is not known whether these same mechanisms continue to prevent criminal offending into adulthood. The present study evaluated whether caregiver-directed improvements in family relations, youth prosocial peer relations, and youth academic performance during multisystemic therapy (MST) for serious and violent juvenile offenders had an impact on young adult involvement in criminal activity and sentencing 10.2 years following treatment. The results showed that improvements in family relations were associated with reduced odds of criminal outcomes a decade later for former MST participants. Furthermore, improvements in youth prosocial peer relations and academic performance were also related to lower odds of long-term criminal activity. These results are consistent with the underlying theory of change in family-based treatments and demonstrate that caregivers are critical to achieving and sustaining decreased antisocial behavior for youths with serious and violent criminal histories.

The social ecology of aggression in youths with autism spectrum disorder.

This study examined the social-ecological correlates of aggressive behavior in 120 youths with autism spectrum disorder. Youths were divided into three groups based on caregiver reports of the youth's aggressive acts: youths who engaged in acts of both physical and verbal aggression, youths who engaged only in acts of physical aggression, and nonaggressive youths. Caregivers and youths completed self-report instruments and behavior rating inventories that assessed youth individual functioning, family relations, and extrafamilial factors (i.e., peer relations, academic performance). Results showed that youths who engaged in both verbal and physical aggression were characterized by poor sleep quality and victimization by peers, and their caregivers evidenced high levels of distress and avoidant coping. In contrast, youths who were physically but not verbally aggressive were distinguished by difficulties in social interaction and communication. In general, each group of youths who were aggressive experienced more problems with repetitive behaviors, family relations, and academic performance than did their nonaggressive counterparts. The implications of these findings for theory, research, and treatment are discussed. Autism Res 2019. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The present study demonstrated that youths with autism spectrum disorder may be classified by the types of aggressive behaviors that they exhibit: youths who are verbally and physically aggressive, physically aggressive only, or not aggressive. Compared to the nonaggressive group, both groups of youths who were aggressive experienced difficulties in their individual, family, peer, and academic functioning. Youths with both verbal and physical aggression showed the most problems in their functioning.

Effects of multisystemic therapy on caregivers of serious juvenile offenders: A 20-year follow-up to a randomized clinical trial.

OBJECTIVE: Caregivers of serious juvenile offenders often hold favorable attitudes about criminality and frequently have histories of involvement in antisocial behaviors themselves. In the present study, the authors examined the long-term criminal and noncriminal outcomes for caregivers of serious juvenile offenders who had participated two decades earlier in a randomized clinical trial of multisystemic therapy (MST; Borduin et al., 1995). METHOD: Participants were 276 caregivers of serious juvenile offenders who were originally randomized to MST or individual therapy (IT). Criminal and civil suit data for caregivers were obtained during a 20.7-year follow-up when caregivers were on average 61.5 years old. RESULTS: Caregivers in the MST condition had 94% fewer felonies and 70% fewer misdemeanors than did caregivers in the IT condition. In addition, caregivers in the IT condition were sentenced to 92% more days of incarceration and had 50% more family-related civil suits. Moreover, the favorable long-term effects of MST on caregiver criminality and civil suits were mediated by improved family relations during treatment. CONCLUSION: The present study represents the only follow-up to date of caregivers in an MST clinical trial and demonstrates the broader clinical benefits of a family-based treatment for serious juvenile offenders. Implications of the findings for policymakers and researchers are discussed. (PsycINFO Database Record

Family-based treatments for serious juvenile offenders: A multilevel meta-analysis.

OBJECTIVE: Researchers have identified several family-based treatments that hold considerable promise in reducing serious juvenile offending; however, these treatments remain underutilized by youth service systems. In the present study, we used meta-analysis to summarize the findings of research on family-based treatments for serious juvenile offenders. METHOD: We conducted a multilevel meta-analysis that modeled dependencies between multiple effect sizes from the same study. The meta-analysis synthesized 324 effect sizes from 28 studies that met inclusion criteria. Potential moderators (e.g., characteristics of samples, treatments, methods, and measures) were entered as fixed effects in the meta-analytic model. RESULTS: Across studies, family-based treatments produced modest, yet long-lasting, treatment effects (mean d = 0.25 for antisocial behavior, 0.24 overall) relative to comparison conditions. Furthermore, certain characteristics moderated the magnitude of treatment effects; for example, measures of substance use showed the largest effects and measures of peer relationships showed the smallest effects. CONCLUSIONS: Policymakers, administrators, and treatment providers may find it useful to consider the effects of family-based treatments for serious juvenile offenders in their selection of treatments for this population. In addition, investigators who seek to develop and study such treatments may wish to consider the current findings in their future research efforts. (PsycINFO Database Record

Evidence-Based Treatments for Youths Who Engage in Illegal Sexual Behaviors.

Effective treatments for youths who have engaged in illegal sexual behaviors are needed to reduce the societal impact of sexual crimes. This article reviews the state of the evidence base for treatments that target this clinical population. We conducted a comprehensive literature review to identify studies that evaluated outcomes of treatments for youths who have engaged in illegal sexual behaviors. Based on the results of our review, we characterized each treatment using established criteria for five evidence-based treatment classifications. We identified 10 treatment studies that met inclusion criteria. We classified one treatment-multisystemic therapy for problem sexual behaviors-as Probably Efficacious (Level 2), and two treatments-cognitive-behavioral therapy and behavior management through adventure-as Experimental (Level 4). Cognitive-behavioral therapy has limited research support with youths who have engaged in illegal sexual behaviors, but it is widely used in the United States and Canada. In contrast, multisystemic therapy for problem sexual behaviors had the highest level of research support but is used much less extensively with this population. We discuss implications of the present findings for treatment providers, policymakers, and researchers who seek to improve clinical services in this area.

Long-term effects of prevention and treatment on youth antisocial behavior: A meta-analysis.

Youth antisocial behavior exacts a tremendous toll on society and often persists into adulthood. Although researchers have identified a number of psychosocial interventions that prevent or reduce youth antisocial behavior in the short term, evidence of long-term intervention benefits has only recently become available. In addition, research on such interventions spans two substantial but largely separate bodies of literature: prevention and therapy. The present study used meta-analysis to integrate research on the long-term effects of preventive and therapeutic interventions for youth antisocial behavior and examined potential moderators of these effects. Results from 66 intervention trials (i.e., 34 prevention, 32 therapy) indicated that a broad range of youth psychosocial interventions demonstrated modest effects on antisocial behavior (mean d=0.31, 95% confidence interval=0.23-0.39) for at least one year beyond the end of interventions relative to control conditions. Among other findings, moderator analyses revealed that inclusion of a peer group intervention component was associated with reduced intervention effects for samples consisting predominantly of boys or older youths. The results of this study have important implications for service providers, administrators, and policymakers involved in the implementation of preventive and therapeutic interventions targeting youth antisocial behavior.

Economic impact of multisystemic therapy with juvenile sexual offenders.

This study investigated the economics of multisystemic therapy for problem sexual behaviors (MST-PSB), a family-based treatment that has shown promise with juvenile sexual offenders. We evaluated the cost and benefits of MST-PSB versus usual community services using arrest data obtained in an 8.9-year follow-up from a randomized clinical trial with 48 juvenile sexual offenders, who averaged 22.9 years of age at follow-up (Borduin, Schaeffer, & Heiblum, 2009). The net benefit of MST-PSB over usual community services was calculated in terms of (a) the value to taxpayers, which was based on measures of criminal justice system expenses (e.g., police and sheriff's offices, court processing, community supervision); and (b) the value to crime victims, which was based on measures of both tangible (e.g., property damage and loss, health care, lost productivity) and intangible (e.g., pain, suffering, reduced quality of life) losses. Lower rates of posttreatment arrests in the MST-PSB versus usual community services conditions were associated with lasting reductions in expenses for both taxpayers and crime victims, with an estimated total benefit of $343,455 per MST-PSB participant. Stated differently, every dollar spent on MST-PSB recovered $48.81 in savings to taxpayers and crime victims over the 8.9-year follow-up. These findings demonstrate that a family-based treatment such as MST-PSB can produce lasting economic benefits with juvenile sexual offenders. Policymakers and public service agencies should consider these findings when making decisions about interventions for this challenging clinical population.

The family context of relational aggression in "difficult to treat" female juvenile offenders.

Female juvenile offenders often engage in socially aggressive behaviors that make them more difficult to treat than male juvenile offenders. This social (i.e., relational) aggression may be developed or maintained through transactions with family members. To investigate this issue, we measured relational aggression in the family interactions of 140 adolescents divided by gender and offender status into four equal-sized groups (female juvenile offenders, male juvenile offenders, female nonoffenders, and male nonoffenders). Adolescents and caregivers completed a family discussion task, and raters coded relationally aggressive behaviors at the dyadic level. Results showed that female juvenile offenders and their mothers directed more relational aggression toward each other than did mother-adolescent dyads in the other groups. Implications of these results for treatment and research are discussed.

The economic impact of multisystemic therapy through midlife: a cost-benefit analysis with serious juvenile offenders and their siblings.

OBJECTIVE: This study investigated the economic benefits of multisystemic therapy (MST) versus individual therapy (IT) using arrest data from 176 serious juvenile offenders and 129 of their closest-in-age siblings who participated, on average, 25 years earlier in a randomized clinical trial (Borduin et al., 1995). METHOD: Two types of benefits of MST were evaluated: (a) The value to taxpayers was derived from measures of criminal justice system expenses (e.g., police and sheriffs' offices, court processing, community supervision), and (b) the value to crime victims was derived from measures of both tangible (e.g., property damage and loss, health care, lost productivity) and intangible (e.g., pain, suffering, reduced quality of life) losses. RESULTS: Reductions in criminality in the MST versus IT conditions were associated with lasting benefits to both taxpayers and crime victims, with cumulative benefits of MST estimated at $35,582 per juvenile offender and $7,798 per sibling. Overall, every dollar spent on MST recovered $5.04 in savings to taxpayers and crime victims in the 25 years following treatment. CONCLUSIONS: This study represents the most comprehensive cost-benefit analysis of an MST clinical trial to date and demonstrates that an evidence-based treatment such as MST can produce modest economic benefits well into adulthood. Implications of the authors' findings for policymakers and public service agencies are discussed.

Multisystemic therapy for disruptive behavior problems in youths with autism spectrum disorders: a progress report.

Youths with autism spectrum disorders (ASD) often engage in serious disruptive behaviors that interfere with their ability to successfully manage day-to-day responsibilities and contribute to relationship problems with caregivers, peers, and teachers. Effective treatments are needed to address the factors linked with disruptive behavior problems in this population of youths. Multisystemic therapy (MST) is a comprehensive family- and community-based treatment approach that has been effective with other difficult-to-treat populations of youths and holds promise for youths with ASD. In this article, we review the broad range of factors associated with disruptive behaviors among youths with ASD and discuss how MST interventions can be adapted to address those factors. We also present a framework for our adaptation of the MST model for youths with ASD. This framework includes a recently completed pilot study as well as an ongoing efficacy trial that together have served to identify key interventions for our adaptation of the MST model.

Long-term prevention of criminality in siblings of serious and violent juvenile offenders: a 25-year follow-up to a randomized clinical trial of multisystemic therapy.

OBJECTIVE: Family-based treatment models that have shown effectiveness with juvenile offenders may also lead to reduced criminality in siblings of those offenders. However, the lasting effects of such treatments on siblings have not been evaluated. In the present study, the authors examined criminal outcomes for siblings of serious and violent juvenile offenders who had participated on average 25.0 years earlier in a clinical trial of multisystemic therapy (MST; Borduin et al., 1995). METHOD: Participants were 129 closest-in-age siblings of individuals who were originally randomized to MST or individual therapy (IT) during adolescence. Arrest and incarceration data were obtained in middle adulthood when siblings were on average 38.4 years old. RESULTS: Intent-to-treat analyses showed that arrest rates were significantly lower for siblings in the MST condition than in the IT condition (43.3% vs. 72.0%, respectively). In addition, siblings in the IT condition were about 3 times as likely to be convicted of a felony and more than twice as likely to be sentenced to incarceration and probation. CONCLUSION: The present study represents the longest follow-up to date of sibling participants in an MST clinical trial and demonstrates that the positive impact of an evidence-based treatment for serious and violent juvenile offenders can extend to other family members. Implications of the authors' findings for policymakers and service providers are discussed.

Two-year follow-up of a randomized effectiveness trial evaluating MST for juveniles who sexually offend.

Building on prior efficacy trials (i.e., university-based, graduate students as therapists), the primary purpose of this study was to determine whether favorable 12-month outcomes, obtained in a randomized effectiveness trial (i.e., implemented by practitioners in a community mental health center) of multisystemic therapy (MST) with juveniles who had sexually offended (JSO), were sustained through a second year of follow-up. JSO (n = 124 male youth) and their families were randomly assigned to MST, which was family based and delivered by community-based practitioners, or to treatment as usual (TAU), which was primarily group-based cognitive-behavioral interventions delivered by professionals within the juvenile justice system. Youth averaged 14.7 years of age (SD = 1.7) at referral, were primarily African American (54%), and 30% were Hispanic. All youth had been diverted or adjudicated for a sexual offense. Analyses examined whether MST effects reported previously at 1-year follow-up for problem sexual behaviors, delinquency, substance use, and out-of-home placement were sustained through a second year of follow-up. In addition, arrest records were examined from baseline through 2-year follow-up. During the second year of follow-up, MST treatment effects were sustained for 3 of 4 measures of youth problem sexual behavior, self-reported delinquency, and out-of-home placements. The base rate for sexual offense rearrests was too low to conduct statistical analyses, and a between-groups difference did not emerge for other criminal arrests. For the most part, the 2-year follow-up findings from this effectiveness study are consistent with favorable MST long-term results with JSO in efficacy research. In contrast with many MST trials, however, decreases in rearrests were not observed.

Effects of multisystemic therapy through midlife: a 21.9-year follow-up to a randomized clinical trial with serious and violent juvenile offenders.

OBJECTIVE: Although current evidence suggests that the positive effects of multisystemic therapy (MST) on serious crime reach as far as young adulthood, the longer term impact of MST on criminal and noncriminal outcomes in midlife has not been evaluated. In the present study, the authors examined a broad range of criminal and civil court outcomes for serious and violent juvenile offenders who participated on average 21.9 (range = 18.3-23.8) years earlier in a clinical trial of MST (C. M. Borduin et al., 1995). METHOD: Participants were 176 individuals who were originally randomized to MST or individual therapy (IT) during adolescence and averaged 3.9 arrests for felonies prior to treatment. Arrest, incarceration, and civil suit data were obtained in middle adulthood when participants were on average 37.3 years old. RESULTS: Intent-to-treat analyses showed that felony recidivism rates were significantly lower for MST participants than for IT participants (34.8% vs. 54.8%, respectively) and that the frequency of misdemeanor offending was 5.0 times lower for MST participants. In addition, the odds of involvement in family-related civil suits during adulthood were twice as high for IT participants as for MST participants. CONCLUSIONS: The present study represents the longest follow-up to date of an MST clinical trial and demonstrates that the positive impact of an evidence-based youth treatment such as MST can last well into adulthood. Implications of the authors' findings for policymakers and service providers are discussed.

Cost-benefit analysis of multisystemic therapy with serious and violent juvenile offenders.

This study investigated the economics of multisystemic therapy (MST) versus individual therapy (IT) using rearrest data from a 13.7-year follow-up (Schaeffer & Borduin, 2005) of a randomized clinical trial with serious juvenile offenders (Borduin et al., 1995). Two types of benefits of MST were evaluated: The value to taxpayers was derived from measures of criminal justice system expenses (e.g., police and sheriff's offices, court processing, jails, community supervision), and the value to crime victims was derived in terms of both tangible (e.g., property damage and loss, health care, police and fire services, lost productivity) and intangible (e.g., pain, suffering, reduced quality of life) losses. Results indicated that the reductions in criminality in the MST versus IT conditions were associated with substantial reductions in expenses to taxpayers and intangible losses to crime victims, with cumulative benefits ranging from $75,110 to $199,374 per MST participant. Stated differently, it was estimated that every dollar spent on MST provides $9.51 to $23.59 in savings to taxpayers and crime victims in the years ahead. The economic benefits of MST, as well as its clinical effectiveness, should be considered by policymakers and the public at large in the selection of interventions for serious juvenile offenders.

Mediators of change for multisystemic therapy with juvenile sexual offenders.

The mediators of favorable multisystemic therapy (MST) outcomes achieved at 12 months postrecruitment were examined within the context of a randomized effectiveness trial with 127 juvenile sexual offenders and their caregivers. Outcome measures assessed youth delinquency, substance use, externalizing symptoms, and deviant sexual interest/risk behaviors; hypothesized mediators included measures of parenting and peer relations. Data were collected at pretreatment, 6 months postrecruitment, and 12 months postrecruitment. Consistent with the MST theory of change and the small extant literature in this area of research, analyses showed that favorable MST effects on youth antisocial behavior and deviant sexual interest/risk behaviors were mediated by increased caregiver follow-through on discipline practices as well as decreased caregiver disapproval of and concern about the youth's bad friends during the follow-up. These findings have important implications for the community-based treatment of juvenile sexual offenders.

Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial.

Despite the serious and costly problems presented by juvenile sexual offenders, rigorous tests of promising interventions have rarely been conducted. This study presents a community-based effectiveness trial comparing multisystemic therapy (MST) adapted for juvenile sexual offenders with services that are typical of those provided to juvenile sexual offenders in the United States. Youth were randomized to MST (n = 67) or treatment as usual for juvenile sexual offenders (TAU-JSO; n = 60). Outcomes through 12 months postrecruitment were assessed for problem sexual behavior, delinquency, substance use, mental health functioning, and out-of-home placements. Relative to youth who received TAU-JSO, youth in the MST condition evidenced significant reductions in sexual behavior problems, delinquency, substance use, externalizing symptoms, and out-of-home placements. The findings suggest that family- and community-based interventions, especially those with an established evidence-base in treating adolescent antisocial behavior, hold considerable promise in meeting the clinical needs of juvenile sexual offenders.

A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: effects on youth social ecology and criminal activity.

A randomized clinical trial evaluated the efficacy of multisystemic therapy (MST) versus usual community services (UCS) for 48 juvenile sexual offenders at high risk of committing additional serious crimes. Results from multiagent assessment batteries conducted before and after treatment showed that MST was more effective than UCS in improving key family, peer, and academic correlates of juvenile sexual offending and in ameliorating adjustment problems in individual family members. Moreover, results from an 8.9-year follow-up of rearrest and incarceration data (obtained when participants were on average 22.9 years of age) showed that MST participants had lower recidivism rates than did UCS participants for sexual (8% vs. 46%, respectively) and nonsexual (29% vs. 58%, respectively) crimes. In addition, MST participants had 70% fewer arrests for all crimes and spent 80% fewer days confined in detention facilities than did their counterparts who received UCS. The clinical and policy implications of these findings are discussed.

The Effective Treatment of Juveniles Who Sexually Offend: An Ethical Imperative.

This article raises serious concerns regarding the widespread use of unproven interventions with juveniles who sexually offend and suggests innovative methods for addressing these concerns. Dominant interventions (i.e., cognitive-behavioral group treatments with an emphasis on relapse prevention) typically fail to address the multiple determinants of juvenile sexual offending and could result in iatrogenic outcomes. Methodologically sophisticated research studies (i.e., randomized clinical trials) are needed to examine the clinical and cost-effectiveness of cognitive-behavioral group interventions, especially those delivered in residential settings. The moral and ethical mandate for such research is evident when considering the alternative, in which clinicians and society are willing to live in ignorance regarding the etiology and treatment of juvenile sexual offending and to consign offending youths to the potential harm of untested interventions. Encouraging signs of a changing ethical climate include recent federal funding of a randomized clinical trial examining treatment effectiveness with sexually offending youths and the introduction of separate (i.e., developmentally informed) clinical and legal interventions for juvenile vs. adult sexual offenders.