Child and family characteristics in multisystemic therapy for child abuse and neglect (MST-CAN): Are there associations with treatment outcome?

Evidence-based indication for targeted interventions is a central approach in the field of child welfare and psychotherapy. This study explored the characteristics of children and families referred to Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) in Switzerland and their associations with treatment outcomes. We sought to identify subgroups of children and families referred to MST-CAN and understand their specific needs and alignment with the program. We identified five distinct subgroups of children: (a) those characterized by clinically significant "social withdrawal" and "anxiety/depression," (b) with multiple clinically significant emotional and behavioral problems, (c) with predominantly externalizing problems, (d) with no pathological findings at all, with parents who were less stressed and had fewer mental health problems, and (e) with mainly internalizing problems and parents whose mental health problems deteriorated during treatment. Investigating the fit of children and families referred to treatment programs can enhance the understanding of their healthcare needs and enable more individualized interventions.

Development of a family-based treatment for co-occurring intimate partner violence and child maltreatment: the MST-IPV model.

Intimate partner violence (IPV) is a significant global problem that affects the health of children, parents/caregivers and extended family. The effects can be lifelong and span generations. Treatments for IPV are focused largely on individual work with men as the primary aggressor. Even when the situation includes child maltreatment, generally all family members are referred to a host of providers for varied treatments. Traditionally, couples and family work does not occur. In this article, we detail the development and practice of a comprehensive treatment model for complex cases of co-occurring IPV and child maltreatment that is inclusive of the family and couple. Of particular note, the development of this model, Multisystemic Therapy for Intimate Partner Violence (MST-IPV), involved input from the IPV stakeholder community.

Multisystemic therapy for child abuse and neglect: Parental stress and parental mental health as predictors of change in child neglect.

BACKGROUND: Despite high prevalence, child neglect has long been passed over in research. Serious long-term consequences call for effective intervention programs. However, as a result of the lack of research, there is a lack of effective interventions. In order to develop such intervention programs and to maximize the effectiveness of existing programs, it is necessary to examine what factors are related to the reduction of neglect and, subsequently, what change mechanisms their effectiveness is based on. OBJECTIVE: In this intervention study we investigated whether changes in parental mental health and parental stress after Multisystemic Therapy for Child Abuse and Neglect (MST-CAN), an effective evidence-based intervention program for child neglect, are related to changes in child neglect. PARTICIPANTS AND SETTING: Study participants were 144 parent-child dyads participating in the MST-CAN program. METHODS: We analyzed changes from pre- to post-treatment in child neglect, parental mental health, and parental stress, and conducted a multiple regression analysis to examine whether changes in parental mental health and parental stress predict changes in child neglect. RESULT: Our results showed that child neglect, as well as parental stress, significantly decreased and parental mental health significantly improved during the program. While improvements in parental mental health were not related to the reduction of child neglect, a decrease in parental stress significantly predicted the reduction of child neglect. CONCLUSION: These findings suggest that parental stress might be a promising target for evidence-based intervention programs to reduce the occurrence of child neglect. Implications and suggestions for further research are discussed.

Multisystemic Therapy - Building Stronger Families (MST-BSF): Substance misuse, child neglect, and parenting outcomes from an 18-month randomized effectiveness trial.

BACKGROUND: Parental substance misuse impacts millions of children globally and is a major determinant of repeat maltreatment and out-of-home placement. There is little published research on family-based, comprehensive treatment models that simultaneously address parental substance misuse and child maltreatment. OBJECTIVE: This study reports outcomes from a randomized clinical trial examining the effectiveness of the Multisystemic Therapy - Building Stronger Families (MST-BSF) treatment model with families involved with Child Protective Services due to physical abuse and/or neglect plus parental substance misuse. PARTICIPANTS AND SETTING: Ninety-eight families who had an open case with Child Protective Services in two areas of the state of Connecticut participated. METHOD: Families referred by the Connecticut Department of Children and Families were randomly assigned to MST-BSF or Comprehensive Community Treatment (CCT). Both interventions were delivered by community-based therapists. Outcomes were measured across 5 assessments extending 18 months post-baseline. RESULTS: Intent-to-treat analyses showed that MST-BSF was significantly more effective than CCT in reducing parent self-reported alcohol and opiate use and in improving child-reported neglectful parenting. Although means were in predicted directions, new incidents of abuse across 18 months did not differ between groups. The study features high recruitment and engagement rates for a population experiencing multiple involvements with child protection. CONCLUSION: The outcomes of this study support the effectiveness of MST-BSF, an intensive family- and ecologically- based treatment, for significantly reducing parental alcohol and opiate misuse and child neglect. These findings help in our understanding of how best to address the understudied issue of interventions for child neglect.

Economic Impact of Multisystemic Therapy for Child Abuse and Neglect.

This study evaluated the economics of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) by applying the Washington State Institute for Public Policy (WSIPP) cost-benefit model to data from a randomized effectiveness trial with 86 families (Swenson et al. in JFP 24:497-507, 2010b). The net benefit of MST-CAN, versus enhanced outpatient treatment, was $26,655 per family at 16 months post-baseline. Stated differently, every dollar spent on MST-CAN recovered $3.31 in savings to participants, taxpayers, and society at large. Policymakers and public service agencies should consider these findings when making investments into interventions for high-need families involved with child protective services.

A Multisystemic Approach to the Prevention and Treatment of Child Abuse and Neglect.

Families experiencing physical abuse and/or neglect are at risk of continued difficulties that may involve long-term monitoring by Child Protective Services (CPS) and perhaps even removal of the child. Interventions needed to help the family remain intact safely and reduce both the clinical challenges they are experiencing and risk of further maltreatment will need to meet the multiple needs of all family members and involve a positive, collaborative working relationship with CPS. If services that are typically provided at outpatient clinics are used, the CPS case worker may be tasked with linking the family to many providers. When the family cannot make all the appointments, they are at further risk of removal of their child. In this article we present Multisystemic Therapy for Child Abuse and Neglect (MST-CAN), an ecologically based treatment for families experiencing physical abuse and/or neglect in which research-supported mental health services are delivered in the home by one clinical team to families who have serious clinical needs. To date, MST-CAN has been implemented with families experiencing the most serious levels of risk, but application is feasible for families with lower risk levels. Among high-risk families, MST-CAN has been shown effective for reducing out-of-home placement, abusive or neglectful parent behavior, and parent and child mental health difficulties and for increasing natural social supports. Two specialty population programs based on MST-CAN are also presented. These are MST - Building Stronger Families, a specialty program for parents who are experiencing abuse or neglect co-occurring with substance abuse, and MST for Intimate Partner Violence for families experiencing abuse or neglect and intimate partner violence. All models are based on the core Standard MST model. We trace the history of model development to dissemination.

Multisystemic Therapy for Externalizing Youth.

Externalizing problems are multidetermined and related to individual, family, peer, school, and community risk factors. Multisystemic therapy (MST) was originally developed to address these risk factors among youth with serious conduct problems who are at-risk for out-of-home placement. Several decades of research have established MST as an evidence-based intervention for adolescents with serious clinical problems, including serious offending, delinquency, substance abuse, and parental physical abuse and neglect. This article presents an overview of the clinical procedures and evidence base of MST for externalizing problems as well as 2 adaptations: MST for Substance Abuse and MST for Child Abuse and Neglect.

Therapy implications of child abuse in multi-risk families.

OBJECTIVES: Our aim is to critique Australian child maltreatment policy, outline abuse trends and provide data on family risk factors. METHOD: We identified policy gaps and reviewed family profiles within selective child maltreatment databases. Data sources included international and Australian literature, Queensland Department of Child Safety reports and a research clinical database. RESULTS: Data reviewed suggest that a pattern of co-occurring complex multiple system family problems characterize substantiated abuse cases. CONCLUSIONS: The presence of multiple family problems suggests the need for a new treatment paradigm. Multisystemic Therapy for child physical abuse and neglect is an evidence-based intervention that matches the therapeutic needs of such families.

Comprehensive treatment for co-occurring child maltreatment and parental substance abuse: outcomes from a 24-month pilot study of the MST-Building Stronger Families program.

This manuscript presents outcomes from a pilot study of Multisystemic Therapy-Building Stronger Families (MST-BSF), an integrated treatment model for the co-occurring problem of parental substance abuse and child maltreatment among families involved in the child welfare system. Participants were 25 mother-youth dyads who participated in MST-BSF and an additional 18 families with similar demographic and case characteristics who received Comprehensive Community Treatment (CCT). At post-treatment, mothers who received MST-BSF showed significant reductions in alcohol use, drug use, and depressive symptoms; they also significantly reduced their use of psychological aggression with the youth. Youth reported significantly fewer anxiety symptoms following MST-BSF treatment. Relative to families who received CCT, mothers who received MST-BSF were three times less likely to have another substantiated incident of maltreatment over a follow-up period of 24 months post-referral. The overall number of substantiated reabuse incidents in this time frame also was significantly lower among MST-BSF families, and youth who received MST-BSF spent significantly fewer days in out-of-home placements than did their CCT counterparts. These promising preliminary outcomes support the viability of a more rigorous (i.e., randomized) evaluation of the MST-BSF model.

Multisystemic Therapy for Child Abuse and Neglect: a randomized effectiveness trial.

The primary purpose of this study was to conduct a randomized effectiveness trial of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) for physically abused youth (mean age = 13.88 years, 55.8% female, 68.6% Black) and their families. Eighty-six families being followed by Child Protective Services due to physical abuse were randomly assigned to MST-CAN or Enhanced Outpatient Treatment (EOT), with both interventions delivered by therapists employed at a community mental health center. Across five assessments extending 16 months post baseline, intent-to-treat analyses showed that MST-CAN was significantly more effective than EOT in reducing youth mental health symptoms, parent psychiatric distress, parenting behaviors associated with maltreatment, youth out-of-home placements, and changes in youth placement. Also, MST-CAN was significantly more effective at improving natural social support for parents. Effect sizes were in the medium to large range for most outcomes examined. Although fewer children in the MST-CAN condition experienced an incident of reabuse than did counterparts in the EOT condition, base rates were low and this difference was not statistically significant. The findings of this study demonstrate the potential for broad-based treatments of child physical abuse to be effectively transported and implemented in community treatment settings.

Medical, legal, and mental health service utilization by physically abused children and their caregivers.

The use of medical, legal, and mental health services was examined among 37 Medicaid-eligible, physically abused children and their caregivers. Fewer than half of the children received a medical examination related to the physical abuse, but the majority had received basic wellness care, including immunizations. Roughly half of the cases were heard in family court. Fewer than half of the children were receiving mental health services. Children were more likely to receive services if the maltreating caregiver was not in the home. More maltreating caregivers received mental health services than did their children, but this still only accounted for half of the parents. Caregivers were more likely to receive treatment if they acknowledged the abuse. Children who participated in treatment showed reductions in parent-reported problem behaviors but showed increases in anxiety in comparison to children who did not participate in treatment.