Volume 3, Issue 2 • Spring 2014

Table of Contents

Editor's Note

The Prevalence of Adverse Childhood Experiences (ACE) in the Lives of Juvenile Offenders

Effectiveness of Multisystemic Therapy for Minority Youth: Outcomes Over 8 Years in Los Angeles County

Personal and Anticipated Strain Among Youth: A Longitudinal Analysis of Delinquency

Evaluation of a Program Designed to Promote Positive Police and Youth Interactions

Implications of Self-Reported Levels of Hope in Latino and Latina Youth on Probation

Commentary: Do Youth Mentoring Programs Work? A Review of the Empirical Literature

Effectiveness of Multisystemic Therapy for Minority Youth: Outcomes Over 8 Years in Los Angeles County

Terry Fain and Sarah Michel Greathouse,
Rand Corporation, Santa Monica, California

Susan F. Turner,
University of California, Irvine

H. Dawn Weinberg,
Los Angeles County Probation Department, Los Angeles, California

Terry Fain, Safety and Justice Program, RAND Corporation; Sarah Michel Greathouse, Department of Behavioral Science, RAND Corporation; Susan F. Turner, Department of Criminology, Law and Society, University of California, Irvine; H. Dawn Weinberg, Probation Department, Los Angeles County.

Correspondence concerning this article should be addressed to Terry Fain, RAND Corporation, 1776 Main Street, Santa Monica, CA 90405. E-mail: Terry_Fain@rand.org

Keywords: MST, juveniles, effective programs, recidivism, probation

Abstract

Previous research on Multisystemic Therapy© (MST), an intensive family and community-based treatment for juvenile offenders between 12 and 18 years of age, has been based on small samples that have included very few Hispanic youth. This paper examines juvenile justice outcomes and costs for 757 MST participants and 380 comparison group youth over an 8-year period in Los Angeles County. More than 90% of youth were either Hispanic or Black. Hispanic MST participants had significantly more positive outcomes on three of six juvenile justice measures, compared to Hispanic comparison youth. Black MST participants did not show more positive outcomes than Black comparison youth.

Introduction

In recent years, criminal justice agencies have increasingly focused on the delivery of evidence-based practices; i.e., programs and principles that have been rigorously evaluated and shown to be effective. One of the more prominent programs is Multisystemic Therapy (MST)©. Positive program outcomes have earned MST a place among recommended programs by many evaluators of youth violence reduction programs, including the U.S. Surgeon General (U.S. Department of Health and Human Services, 1999), the Blueprints for Violence Prevention, and the Office of Juvenile Justice and Delinquency Prevention’s Guide for Implementing the Comprehensive Strategy for Serious, Violent, and Chronic Juvenile Offenders (Howell, 1995). MST continues to be implemented with increasing frequency in the United States, as well as internationally. As reported by MST’s website, MST therapy is employed in 34 U.S. states, the District of Columbia, and in 13 countries around the world (MST, Inc., 2010).

MST is an intensive family- and community-based treatment for serious, violent, and chronic juvenile offenders between 12 and 17 years of age (Henggeler, 1997). Grounded in the social ecological theory of antisocial behavior among youth (Bronfernbrenner, 1979), MST addresses the multiple determinants of serious antisocial behavior, viewing individuals as embedded within a complex network of interconnected systems, including individual, family, and extra-familial (peer, school, neighborhood) factors (Henggeler, 1997; Tighe, Pistrang, Casdagli, Baruch, & Butler, 2012). Intervention may occur in any one or a combination of these systems (Henggeler, Mihalic, Rone, Thomas, & Timmons-Mitchell, 2001).

The primary goal of MST is to empower parents with the skills and resources needed to independently address the difficulties that arise in raising teenagers and to empower youth to cope with family, peer, school, and neighborhood problems. As a result, MST addresses multiple factors related to delinquency across the key settings within which youth are embedded. The program strives to promote behavioral change within the youth’s natural environment, using the strengths of each system (e.g., family, peers, school, neighborhood, indigenous support network) to facilitate change. Within a context of support and skill building, the MST therapist places developmentally appropriate demands on the adolescent for responsible behavior and on the family for encouraging responsible behavior. Intervention strategies include strategic family therapy, structural family therapy, behavioral parent training, and cognitive behavioral therapies (Henggeler et al., 2001).

Although MST has largely been positively received, questions remain, including for whom and under what conditions MST is most effective. In particular, two areas have been inadequately addressed in the literature: (a) Most evaluations of MST have been based on small samples and therefore lack statistical power, and (b) previous evaluations of MST have included very few Hispanic youth, if any. The current examination of MST directly addresses these gaps in knowledge. This article examines family and criminal justice outcomes over 8 years of MST programming in Los Angeles County juvenile probation. Specifically, we focus on selected juvenile justice outcomes and measures of youth and family functioning.

Background

MST programs have been repeatedly evaluated using randomized designs and have largely been found to be effective in reducing delinquent behaviors (e.g., Henggeler et al., 1986; Henggeler, Melton, & Smith, 1992; Borduin et al., 1995; Schaeffer & Borduin, 2005; Butler, Baruch, Hickey, & Fonagy, 2011; Gervan, Granic, Solomon, Blokland, & Ferguson, 2012; Asscher, Deković, Manders, van der Laan, & Prins, 2013). The most frequently cited evidence for the effectiveness of MST come from studies in Memphis, Tennessee (Henggeler et al., 1986), Simpsonville, South Carolina (Henggeler et al., 1992) and Columbia, Missouri (Borduin et al., 1995). Collectively, these studies found that juveniles undergoing MST were arrested less often and spent less time incarcerated than juveniles who received standard treatments. While most of these studies examined the effects of MST within a relatively short period of time following treatment, one recent study conducted a long-term follow-up with 176 treatment and control participants included in an earlier study and published by Borduin et al. in 1995. An average of 21.9 years later, MST participants displayed significantly lower recidivism rates compared to control participants (Sawyer & Borduin, 2011).1

1 The 21.9 years reflects the time between measurements, not the time between publications.

To date, more than 26 studies have examined the effects of MST on serious juvenile offenders (MST, Inc., 2012). The vast majority of MST studies have been conducted by MST developers and their associates (Littell, Popa, & Forsythe, 2005). While these examinations of MST have largely produced favorable findings, it is important that these effects can be replicated by researchers other than those who have developed MST.

The handful of independent studies of MST thus far has produced mixed results. In a meta-analysis of MST research, Littell and colleagues (2005) included eight randomized controlled evaluations of MST in their analysis. After rating these studies on level of methodological rigor, they reported that the most methodologically rigorous and only fully independent analysis of MST did not find significant differences in outcomes between MST and usual juvenile justice services. Furthermore, pooled analyses failed to find significant differences across a range of outcomes, including incarceration and arrest rates. The authors do note that the general pattern of effects favors MST and acknowledge that low statistical power due to small sample sizes may have prevented the ability to detect significant differences. On the other hand, one of the only other independent studies conducted on MST (Timmons-Mitchell, Bender, Kishna, & Mitchell, 2006) found that randomly assigned MST participants had significantly lower recidivism and arrest rates compared to treatment-as-usual participants. Relatedly, more recent meta-analyses across several types of juvenile interventions, including MST (Lipsey, 2009; Lipsey, Howell, Kelly, Chapman, & Carver, 2010), found that the factors influencing effectiveness were a therapeutic intervention philosophy, serving high-risk offenders, and quality of implementation. The current study would add to the much needed and thus far small body of independent research on the effects of MST.

The MST literature has also made note of differences in the effectiveness of MST in efficacy studies, in which treatment is often administered by well-trained graduate students and supervised by MST developers, compared to community-based effectiveness studies in which therapists not intensely supervised by MST experts carry out the treatment. In their examination of MST effects in a community-based treatment setting, Henggeler, Melton, Brondino, Scherer, and Hanley (1997) failed to find significant differences between randomly assigned MST participants who were treated by community-based therapists, trained in MST but not closely supervised by MST experts, and participants who received the standard juvenile treatment. In another recent meta-analysis of seven randomized controlled MST studies, the authors found that type of study moderated the strength of MST effects (Curtis, Ronan, & Borduin, 2004). Specifically, efficacy studies resulted in significantly higher treatment effects (ES = .81) compared to effectiveness studies (ES = .27). High arrest rates by MST participants were found to be significantly associated with low ratings of therapist adherence to MST principles (Henggeler et al., 1997). In the present research, MST was carried out in the community by therapists trained in MST and supervised by MST-trained supervisors, providing a real-world opportunity for critical examination of MST.

Most MST studies use relatively small sample sizes. For example, Henggeler et al. (1992) included 84 juvenile offenders, Borduin et al. (1995) consisted of 176 juveniles, and Timmons-Mitchell et al. (2006) examined 93 offenders. With 757 juvenile probationers and 380 comparison group youth, the present research contains one of the largest sample sizes of any MST study, outside of meta-analyses, and provides a strong test of the effectiveness of MST within a community-based setting.

Ethnicity of MST Participants

The “Memphis study” (Henggeler et al., 1986) is often cited as evidence of the effectiveness of MST in treating inner city youth (cf. Borduin et al., 1995, p. 570), whereas other studies occurred in less urbanized populations (e.g., Simpsonville, SC [Henggeler et al., 1992]; Columbia, MO [Borduin et al., 1995]). At the time the Memphis study was conducted, the population of Memphis was approximately 650,000. Although Memphis has recently seen a marked increase in its Hispanic population (Mendoza, Ciscel, & Smith, 2001), the Memphis MST study reports a sample that was 65% Black. It is not noted that any Hispanics were included in the study.

The “Columbia study” (Borduin et al., 1995) is one of the few that specifically mentions the inclusion of Hispanics in its study sample, with 2% of the 176 adolescents being Hispanic (Borduin et al., 1995). Minority populations in other MST evaluations have primarily been Black (e.g., Rowland et al., 2005); we have not been able to identify any MST evaluation using a study sample that is primarily Hispanic. Los Angeles County, with a population of more than 9.8 million, nearly half of whom are Hispanic (U.S. Census Bureau, 2010), offers a unique opportunity to evaluate the effectiveness of MST on a sample that includes a significant percentage of Hispanic juveniles.

Between 2000 and 2010, the number of Hispanics in the United States increased by 43%, from about 35 million to more than 50 million, making them the fastest growing segment of the U.S. population (Ennis, Rios-Vargas, & Albert, 2011). By 2011, Hispanics were the largest segment of the Los Angeles County youth population, making up 38.1% of all youth under age 18 (U.S. Census Bureau, 2011). Hispanic youth are disproportionally involved in the juvenile justice system compared to White youth, and are more likely than White youth to be petitioned, adjudicated delinquent, detained, and to receive out-of-home placement (Arya, Villarruel, Villanueva, & Augarten, 2009).

However, Hispanics have not fared well in traditional psychological treatment, with a higher drop-out rate than Whites after the first session. Cultural and language differences between therapist and client seem to be significant barriers to successful treatment. Even bilingual clients may fare better with a Spanish-speaking therapist (Dingfelder, 2005).

The combination of these factors—the prevalence of Hispanic youth in Los Angeles County, their overrepresentation in the juvenile justice system, and the barriers to successful treatment—show the importance of evaluating the success of MST with Hispanic youth.

MST in Los Angeles County

In Los Angeles County, the Juvenile Justice and Crime Prevention Act (JJCPA) is the source of the vast majority of MST participants (K. Streich, personal communication, February 2-5, 2013). In 2000, the California Legislature passed the Schiff-Cardenas Crime Prevention Act (subsequently renamed Juvenile Justice and Crime Prevention Act), which authorized funding for county juvenile justice programs. This effort was designed to provide a stable funding source to counties for juvenile programs that have been proven effective in curbing crime among at-risk and young offenders. All counties in California requested funds from the state to implement evidence-based programs that were reviewed and approved at the state level.

JJCPA currently funds 12 programs in Los Angeles County, one of which is MST. Annually, more than 35,000 youth participate in one or more of the dozen programs (cf. Fain, Turner & Ridgeway, 2012). MST is used within this continuum for chronic probationers in need of intensive services for both youth and family, and typically serves approximately 150 youth per year (K. Streich, personal communication, February 2-5, 2013). Within the Los Angeles County JJCPA, MST is provided using a home-based model of services delivery. The goals of this approach are to overcome barriers to service access, increase family retention in treatment, allow for the provision of intensive services (i.e., therapists have low caseloads), and enhance the maintenance of treatment gains. The usual duration of MST treatment is approximately 60 hours of contact over 4 months, but frequency and duration of sessions are determined by family need. As we noted above, MST services are delivered by MST-certified therapists, supervised by MST-certified supervisors.

Research Design

Ideally, we would have performed an experimental evaluation, with random assignment of eligible youth to either MST or a comparison group. However, within Los Angeles County, MST capacity almost exactly matches the demand for MST services, making random assignment impractical. As a result, JJCPA has adopted a quasi-experimental design, utilizing as a comparison group youth who qualified for MST participation based on MST eligibility criteria,2 but who were not accepted for MST, most often because of a lack of Medicaid coverage.

2 In Los Angeles County, MST targets chronic probationers who exhibit violent or seriously anti-social behavior. To meet eligibility criteria, both MST participants and comparison group youth demonstrated these characteristics. This is consistent with the criteria typically used to select participants for MST (c.f Henggeler, 1997).

To improve statistical power, we pooled 8 years of data on MST and comparison youth. Our sample includes 757 juveniles who were accepted into the MST program over an 8-year span between January 1, 2003, and December 30, 2010. The comparison group consists of 380 youth who met MST eligibility criteria between January 1, 2001, and December 31, 2010, but who did not participate in the program.3

3 To maximize compatibility between MST and comparison youth, we excluded youth from the comparison group if they were unreceptive to program services at the intake session, as well as those whose families were not receptive to MST services.

JJCPA legislation mandated six specific juvenile justice outcome measures to be reported annually. These include arrests, incarcerations, successful completion of probation, successful completion of restitution, successful completion of community service, and probation violations. These six outcomes were measured for 6 months following entry to the program (for MST participants) or 6 months following qualification for the program (for comparison youth). Data for these outcomes come from automated databases maintained by the Los Angeles County Probation Department.

MST programs generally evaluate youth and their families in five areas upon admission to the program and at the time of discharge from the program. These areas are parenting skills, family relations, network of social supports, success in educational or vocational settings, and involvement with prosocial peers. The Los Angeles County MST program measured these outcomes as well, with the goal of reducing variability within and between teams of MST staff. These measures also allowed us to compare the functioning of the participant and family before and after MST treatment within these five functional areas using specified criteria scored by MST caseworkers.4 For example, improvement in parenting skill required that the parent evidenced at least two of the following: (a) increased limit setting, (b) established and enforced consequences, and (c) increased monitoring. These measures were available for 7 years, beginning in FY 2004–2005.

4 A complete list of the specific criteria used for these ratings is available upon request.

Results

MST participants and comparison group youth matched well on demographic and criminal history characteristics. Approximately 77% of both groups were male. The mean age at program start for MST participants was 15.3 while the mean age at date of qualification for the program (for comparison group youth) was 15.4, a difference that is not statistically significant. Almost all (97.1% of MST participants and 95.0% of comparison group youth) had at least one arrest prior to program entry or rejection. The type of instant offense (violent, property, drug, other) was almost identically distributed across both groups.

The two groups did differ significantly, however, in ethnicity. Significantly more MST participants were Hispanic (77.1%, compared to 69.0% of comparison group youth). The comparison group included significantly more Blacks (23.5%) than MST participants (17.0%). Only 5.9% of MST participants and 7.5% of comparison youth were White or another ethnicity. As we explain below, the difference in ethnicity between MST and comparison groups was not a significant factor in MST outcomes. Within ethnicity, there were no significant differences in age, gender, age at first arrest, or type of instant offense (violent, property, drug, other) between MST and comparison youth.

Table 1 shows detailed demographic and criminal history characteristics of MST participants and comparison group members.

Table 1. Demographic and Criminal History Characteristics of MST and Comparison Youth

  MST (%) Comparison (%)

Gender

 

 

Male

77.3

77.4

Ethnicity

 

 

White

4.1

5

Black

17

23.5a

Hispanic

77.1a

69

Other

1.8

2.5

Age

 

 

< 14

9.4

8.7

14

14.9

16

15

24.4

24.7

16

30.7

26.3

17

19.6

22.8

18

0.9

1.6

Prior Arrest

97.1

95

Instant Offense

 

 

Violent

29.6

29.7

Property

20.9

22.5

Drug

5.1

6.1

Other

44.5

41.7

Note. Percentages are based on nonmissing data for each characteristic. Statistical significance was measured by chi-square and Fisher’s exact tests.

a Difference is statistically significant (p < 0.05).

Criminal Justice Outcomes

Outcome analyses for criminal justice outcomes examined 757 MST youth and 380 comparison youth. MST youth had significantly lower incarceration rates, 11.2% versus 20.3%, than comparison youth. MST youth also had significantly higher rates of completion of community service, with 8.5% of MST youth successfully completing community service, compared to 2.6% of comparison group youth. The two groups did not differ significantly in percentage arrested, completing probation, or completing restitution, although MST youth showed more favorable outcomes than comparison group youth on all of these measures. Comparison group youth had significantly lower rates of probation violation, 7.9%  compared to 12.2% of MST participants.5 Juvenile justice outcomes are shown in Table 2.

5 This difference appears to be due to very low rates of probation violation among non-Hispanic comparison-group youth. Within any given race/ethnicity, however, differences in rates of probation violations between MST and comparison youth were not statistically significant.

Table 2. MST Outcomes

BSCC Mandated Outcome MST Comparison
Percentage Sample Size Percentage Sample Size

Arrest

24.8

757

30

380

Incarceration

11.2a

757

20.3

380

Completion of probation

8.7

724

6

353

Completion of restitution

22.4

477

21.2

255

Completion of community service

8.5a

363

2.6

153

Probation violation

12.2

722

7.9a

353

a Difference is statistically significant (p < 0.05).

In addition to the bivariate analyses presented above, we also conducted logistic regression analyses for each of the six outcome measures. These analyses had two purposes: to determine whether the difference in race/ethnicity between the MST and comparison groups had a significant effect on outcomes, and to discover whether MST participants had better outcomes when demographic and criminal justice factors were taken into account. To achieve these dual goals, we conducted three logistic regressions for each outcome variable: (a) with only MST treatment as the independent variables, (b) with race/ethnicity plus MST treatment, and (c) with race/ethnicity, MST treatment, age, gender, and type of instant offense.

The multivariate analyses supported the bivariate relationships between MST participation and three outcomes (incarceration, successful completion of community service, and probation violations). When ethnicity was added, MST participation was also significantly related to a lower rate of arrest, and probation violations were not significantly related to MST participation. Adding additional factors (age, gender, type of instant offense) still resulted in significant relationship between MST participation and arrests, incarcerations, and completion of community service.

However, Blacks and Hispanics showed very different outcome patterns when we conducted separate analyses for each race/ethnicity. These analyses make clear that MST is associated with different outcomes for Blacks than for Hispanics.6 As Table 3 shows, Hispanic youth in the MST program had significantly lower rates of arrest and incarceration, as well as significantly higher rates of completion of probation, compared to Hispanic comparison youth. There were no significant differences between the two groups in the other three measured outcomes. Blacks in the MST program, by contrast, had significantly higher arrest rates than Black comparison youth. Differences between Black MST participants and Black comparison group youth for other juvenile justice outcomes were not statistically significant.

6 Additional logistic regressions for Blacks and Hispanics that included gender, age, and instant offense produced similar findings to those that involved MST participation as the lone predictor variable. These additional analyses could not be done for Whites or other ethnicities because there were too few in either the MST or comparison group.

Table 3. Juvenile Justice Outcomes, by Race/Ethnicity

  Black Youth Only Hispanic Youth Only
MST (%) Comparison (%) MST (%) Comparison (%)

Arrest

34.1

20.2a

23.7a

37.2

Incarceration

15.1

11.9

10.7a

25.5

Completion of probation

17.5

11.2

7.0a

3.3

Completion of restitution

24.6

18.4

21.9

18.6

Completion of community service

19

5

6.2

2

Probation violation

7.6

2.5

12.8

10.4

Note. Sample sizes for Blacks ranged from 98 for community service to 210 for arrests and incarcerations. Sample sizes for Hispanics ranged from 372 for community service to 817 for arrests and incarcerations. Whites and “other race” are excluded from this table because their numbers were very small in comparison to Blacks and Hispanics, and they showed no significant differences between MST and comparison youth in any of the measured outcomes. Among Hispanics, there were no significant differences between MST and comparison youth in demographic factors. Hispanic MST participants were more likely to have had a prior arrest than Hispanic comparison youth. Other criminal history factors were not significantly different for the two Hispanic groups. Among Blacks, there were no significant differences between the two groups in demographic or criminal history factors.

a Difference is statistically significant (p < 0.05).

Measures of Functioning

Improvements in criminal justice outcomes among MST participants were accompanied by corresponding improvements in the areas targeted by MST intervention, namely the youth’s functioning in the areas of family, peers, school, and community. Table 4 shows the evaluations of MST practitioners in five measured areas of functioning. Performance in each area was rated as either “satisfactory” or “unsatisfactory.” As noted earlier, each youth in the MST program was evaluated at program entry and again at program exit, or at 6 months following program entry, whichever came first; specific criteria must be met in each area of functioning in order to receive a “satisfactory” rating. As Table 4 indicates, MST participants showed significant improvement in all five areas. For example, at program entry, only 21.2% of MST youth had satisfactory family relations, compared to 77.8% at program exit. Improvement in the other areas was even greater, with parenting skills going from a 4.3% satisfactory rating at program entry to a 72.7% rating at program exit. Statistically significant differences between baseline and follow-up levels of functioning were found within each race/ethnicity, as well as in the overall sample.

Table 4. Percentage of MST Participants with Satisfactory Functioning (N = 508)

Functional Area At entry (%) At exit (%)

Parenting skills

4.3

72.8a

Family relations

21.3

78.0a

Network of social supports

10.2

74.6a

Educational/vocational success

8.7

66.5a

Involvement with prosocial peers

9.2

70.3a

Note. Statistical significance was measured using McNemar’s test. Levels of functioning were not measured in FY 2003–2004. If participants were in the program more than 6 months, functioning was measured at 6 months rather than at program exit. Differences between baseline and follow-up for all measures were statistically significant within each race/ethnicity.

a Difference is statistically significant (p < 0.05).

Discussion

This study compared criminal justice outcomes for 757 juvenile probationers in Los Angeles County who participated in MST with 380 juvenile probationers who qualified for MST participation, but did not receive MST services for reasons that do not appear to be related to risk. We also compared measures of family and personal functioning at the time of program entry and exit. Overall, our results suggest that MST reduces recidivism and increases positive outcomes for youth in the Los Angeles County’s probation system. MST participation was associated with less incarceration and increased completion of community service.7 We believe comparison group youth had significantly fewer violations than MST youth because MST is an intensive intervention; therefore, MST participants would have had more contact with their probation officers. This could mean that violations by MST participants were more likely to be observed than those of youth in the comparison group.

7 MST youth also improved school attendance and had fewer suspensions and expulsions in the term after entering the program, compared to the previous term. However, we had educational data on fewer than half of all MST participants, so it is possible this subset was not representative of all MST participants in Los Angeles County.

MST youth were also rated by therapists to have improved functioning within family, peer, school, and community settings. These findings align with much of the MST research, both experimental and quasi-experimental, that has overall found favorable effects for MST across a host of different outcomes (e.g., Henggeler et al., 1986; Henggeler et al., 1992; Borduin et al., 1995; Schaeffer & Borduin, 2005).

Despite generally favorable findings within the MST literature, there are still a limited number of studies that have been conducted independent of MST developers. As a result, questions remain about the robustness of MST and under what conditions MST is most effective (Littell et al., 2005). As we discuss below, our research contributes information to some of these outstanding questions and adds to our current knowledge about conditions under which MST is effective.

Research has found that the effect size of juvenile interventions in which researchers are involved is larger than the effect size for community-based interventions (Lipsey & Wilson, 1998). The majority of MST studies has been conducted with relatively small sample sizes, many with fewer than 100 participants (see Henggeler, 2011, for a review of prior research and corresponding sample sizes). With a sample size of 1,137 (757 MST youth and 380 comparison youth), the present research represents one of the largest examinations of MST to date, providing greater statistical power in our analyses. This makes our findings more robust than studies with smaller sample sizes.

Within the MST literature, questions have been raised about the effectiveness of MST when programs are conducted not in a university setting, but within a community setting in which MST therapists are not as closely supervised. Some effectiveness studies within the community setting have failed to find an effect or failed to find as strong an effect as efficacy studies (Littell, et al., 2005; Henggeler et al., 1997; Henggeler, 2011). In the present study, MST was conducted within a community setting by MST-trained therapists supervised by MST-certified supervisors. Within the community-based setting examined in our research, we did observe significant differences in juvenile justice outcomes between MST participants and participants in the comparison group. For juvenile justice outcomes, differences between MST and comparison youth varied from –4.3% for probation violations to 9.1% for incarcerations. We note that both MST participants and comparison group youth were among the higher risk groups within JJCPA in Los Angeles County, providing justification for targeting these youth for participation in an intensive, high-cost program such as MST. In addition to the juvenile justice outcomes, measures of functioning by MST participants8 showed large improvements between program entry and exit, varying from 56.6% improvement for family relations to 68.4% improvement in parenting skills.

8 We did not have data on levels of functioning for comparison group youth.

As we have noted above, few studies have included Hispanic youth as part of their samples. The vast majority of research participants have been Black or White; if a study did include Hispanic youth, the percentages were extremely small (cf. Borduin et al., 1995; Henggeler et al., 1992).

Because Hispanics comprise the fastest-growing segment of the U.S. population and make up a significant proportion of the population under age 18, especially in certain urban areas such as Los Angeles County, it is important to assess whether MST is an effective mode of intervention for Hispanic youth. The present research is the only existing MST study, to our knowledge, that has included a significant proportion of Hispanic youth as part of the sample. Our findings suggest that MST is an effective form of treatment for Hispanic youth. We also found that Blacks and Hispanics differed markedly as to which outcome measures showed favorable results. While Hispanic MST participants performed significantly better than their comparison youth counterparts in rates of arrest, incarceration, and successful completion of probation, Black MST participants did not perform significantly better than their comparison group counterparts on any of the six juvenile justice outcomes and, in fact, had significantly higher rates of arrest than Black comparison youth. Given the amount of contact that MST youth have with the juvenile justice system, it seems possible that the reason for this finding is disproportional minority contact. As Harris and John (2008) have shown, in Los Angeles County a much higher proportion of Black juveniles are detained than White or Hispanic youth.

In analyses not reported above, we also examined the costs of providing MST to juveniles under probation within Los Angeles County.9 We estimated the initial cost of the 6-month MST program itself to be relatively expensive, more than $10,000 per participant, and that the cost of supervision and juvenile hall costs were higher in the 6 months following program entry than in the prior 6 months. Other studies of MST costs in other geographic locations have also found initial program costs to be quite large (Klietz & Borduin, 2007; Aos et al., 2004). Within our estimated costs, however, we found that arrest, camp, and court costs in the 6 months following program entry were considerably lower. If juvenile justice costs continued to be lower for participants following treatment, then the initial program costs could eventually be offset or even result in a long-term net benefit. Indeed, benefit-cost analyses of MST have found that although initial program costs of MST are high, decreased encounters with the criminal justice system over the long term has resulted in a net benefit. Klietz and Borduin (2007) estimated that every dollar spent on MST would provide $6.25 to $27.14 in future savings, and the Washington State Institute for Public Policy found a benefit-cost ratio of $2.64 for every dollar spent on MST (Aos et al., 2004). While our treatment of costs was rudimentary, it is consistent with other findings on costs, even with our unique study sample that consists primarily of Hispanic youth.

9 The cost analysis is not included, but the methodology used and the findings on an annual basis, beginning with fiscal year 2003-2004, can be found at http://www.rand.org.

Limitations

Because it was not possible to randomly assign youth to MST or a comparison group, this research evaluated outcomes through a quasi-experimental design in which MST participants were compared to youth who met program inclusion criteria but did not participate in the program. The treatment and comparison groups were well matched across a number of demographic (i.e., gender, age) and criminal history variables (i.e., prior arrests and type of instant offense). The treatment and comparison groups did differ on race/ethnicity, and our analyses revealed that Hispanic MST participants had significantly more positive juvenile justice outcomes than Hispanic comparison youth. Black MST participants, by contrast, did not perform better than Black comparison group youth on juvenile justice outcomes.10

10 Because our sample included so few Whites and other ethnicities, we were not able to accurately assess the effect of MST on these subgroups.

One potential issue with using juveniles who qualified for but did not receive MST as a comparison group is the question of whether these juveniles differed from those in the treatment group on important characteristics related to outcomes. According to program records, reasons for nonparticipation in MST were varied. The most common reason for exclusion was related to insurance issues—either the youth did not have Medicaid (called Medi-Cal in California) coverage or had private insurance that would not pay for participation in MST. Other reasons for exclusion included, in order of frequency: (a) receiving counseling elsewhere; (b) issues related to changing locations: moving, running away, changing schools, etc.; (c) being put on the waiting list because no MST therapist was available; (d) issues involving probation officers; (e) youth being detained (arrested, placement, etc.); and (f) language issues. Of these reasons, only being detained was significantly related to criminal justice outcomes (an unsurprising finding, since detention consists of some combination of arrest, incarceration, and placement); this was the case for only 20 of 263 comparison youth for whom a reason for nonparticipation was available. MST participants and comparison group youth were well matched on many other demographic and criminal justice variables.

We note also that our outcome follow-up period was relatively short—6 months following program completion. While the JJCPA initiative and contract requirements limited our examination to 6 months, a longer follow-up would have allowed us to examine whether improved outcomes for MST participants were sustained over a longer period of time. Although we are not able to address the long-term effects of MST with our sample, other research has observed beneficial outcomes for MST participants for a significant period of time following treatment—in some research, for as long as 9 to 13 years after treatment (Schaeffer & Borduin, 2005; Borduin et al., 2009).

Conclusions and Policy Implications

Although MST has shown great promise as a method of decreasing the likelihood of future delinquency and improving functioning capabilities of juveniles, questions as to whom MST is best suited, and even whether it can work as well within a community setting, remain. As an independent evaluation with one of the largest sample sizes to date, the present research provides some additional support for the use of MST within an urban community setting to address troubled youth. Furthermore, our results indicate for the first time that MST is an effective treatment for Hispanic youth, an ever-increasing proportion of the U.S. population, and one that is disproportionally involved in the juvenile justice system.

In making programmatic decisions in the current fiscal environment, policymakers and practitioners must often weigh the costs of a program against potential benefits in behavioral outcomes. As we have noted, MST targets high-risk juveniles: chronic, serious, violent, and anti-social probationers. As one would expect, initial program costs for MST are high. However, even within 6 months of program entry, we saw decreased overall juvenile justice costs, with lower costs for arrests, juvenile camp, and court appearances when compared to the 6 months prior to program entry. If this trend continues over time, the high program costs could eventually be outweighed by the benefits in decreased criminal justice costs for individuals at high risk of continued involvement in the criminal justice system, a consideration for practitioners seeking long-term cost reductions.

About the Authors

Terry Fain, MA, MS, is a senior research manager in the Safety and Justice Program at the RAND Corporation. Mr. Fain has published numerous RAND reports in the areas of criminal justice and health, as well as articles in peer reviewed journals, including Criminology and Public Policy, Criminal Justice and Behavior, Crime & Delinquency, The Prison Journal, and Journal of Urban Health.

Sarah Michel Greathouse, PhD, is an associate behavioral scientist at the RAND Corporation. Her research uses social science theory and research methods to examine the efficacy of legal procedures within the criminal and civil justice systems. She has examined the efficacy of procedures within police departments, as well as within the courts. Dr. Greathouse has served as the editorial assistant for Law and Human Behavior, the official journal of the American Psychology-Law Society, and as managing editor of the Encyclopedia of Psychology and Law (Sage Publications). Dr. Greathouse received her PhD in experimental forensic psychology from the John Jay College of Criminal Justice at the City University of New York.

Susan F. Turner, PhD, is a professor in the Department of Criminology, Law and Society, University of California, Irvine. She also serves as director of the Center for Evidence-Based Corrections and is an appointee of the president of the University of California to the California Rehabilitation Oversight Board (C-ROB). Dr. Turner’s areas of expertise include the design and implementation of randomized field experiments and research collaborations with state and local justice agencies.

H. Dawn Weinberg, PhD, received her PhD in Clinical Psychology in 1993 and has worked in multiple positions as a forensic psychologist within Los Angeles County. In 2001, as an administrator within the Department of Mental Health, she collaborated with the Probation Department in implementing the first juvenile justice Multisystemic Therapy teams within Los Angeles County. Currently, Dr. Weinberg is a director for the Los Angeles County Probation Department, focusing on the administration of both juvenile and adult evidence-based programs.

References

Aos, S., Lieb, R., Mayfield, J., Miller, M., & Pennucci, A. (2004). Benefits and costs of prevention and early intervention programs for youth. Olympia, WA: Washington State Institute for Public Policy, Document Number 04-07-3901.

Arya, N., Villarruel, F., Villanueva, C., & Augarten, I. (2009). America’s invisible children: Latino youth and the failure of justice. Washington, DC: National Council of La Raza Policy Brief, Race and Ethnicity Series 3. Retrieved August 5, 2013, from http://www.nclr.org/index.php/publications/americas_invisible_children_latino_youth_and_the_failure_
of_justice/

Asscher, J. J., Deković, M., Manders, W. A., van der Laan, P. H., & Prins, P. J. (2013). A randomized controlled trial of the effectiveness of multisystemic therapy in the Netherlands: Post-treatment changes and moderator effects. Journal of Experimental Criminology, 9, 169–187. Retrieved August 23, 2013, from http://rd.springer.com/content/pdf/10.1007%2Fs11292-012-9165-9.pdf

Borduin, C. M., Mann, B. J., Cone, L. T., Henggeler, S. W., Fucci, B. R., Blaske, D. M., & Williams, R. A. (1995). Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence. Journal of Consulting and Clinical Psychology 63(4), 569–578.

Borduin, C. M., Schaeffer, C. M., & Heiblum, N. (2009). A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: Effects on youth social ecology and criminal activity. Journal of Consulting and Clinical Psychology, 77, 26–37.

Bronfernbrenner, U. (1979). Contexts of child rearing: Problems and prospects. American Psychologist 34(10), 844.

Butler, S., Baruch, G., Hickey, N., & Fonagy, P. (2011). A randomized controlled trial of multisystemic therapy and a statutory therapeutic intervention for young offenders. Journal of the American Academy of Child & Adolescent Psychiatry, 50(12), 1220–1235.

California Department of Justice (n.d.). Table 5: Total law enforcement dispositions of adult and juvenile arrests by level of offense, Los Angeles County, statistics: Law enforcement dispositions, 2000–2009. Retrieved August 5, 2013, from http://stats.doj.ca.gov/cjsc_stats/prof09/19/5.htm

Curtis, N. M., Ronan, K. R., & Borduin, C. M. (2004). Multisystemic treatment: A meta-analysis of outcome studies. Journal of Family Psychology 18(3), 411–419.

Dingfelder, S. F. (2005). Closing the gap for Latino patients. Monitor on Psychology, 36(1), 58. Washington, DC: American Psychological Association. Retrieved August 5, 2013, from http://www.apa.org/monitor/jan05/closingthegap.aspx

Ennis, S. R., Ríos-Vargas, M., & Albert, N. G. (2011). The Hispanic population: 2010. Washington, DC: U.S. Census Bureau Brief C2010BR-04. Retrieved August 5, 2013 from http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf

Fain, T., Turner, S., & and Ridgeway, G. (2012). Los Angeles County Juvenile Justice Crime Prevention Act: Fiscal year 2010–2011 report. Santa Monica, CA: RAND Corporation, TR-1239-LACPD.

Gervan, S., Granic, I., Solomon, T., Blokland, K., & Ferguson, B. (2012). Paternal involvement in Multisystemic Therapy: Effects on adolescent outcomes and maternal depression. Journal of Adolescence, 35(3), 743–751. Retrieved August 23, 2013 from http://www.sciencedirect.com/science/article/pii/S0140197111001321

Harris, M., & John, L. (2008). Los Angeles countywide disproportionate minority contact reduction plan 2008. Los Angeles: W. Haywood Burns Institute. Retrieved August 5, 2013 from http://ccjcc.lacounty.gov/LinkClick.aspx?fileticket=jsxTAqDt4g0%3d&tabid=602

Henggeler, S. W. (1997). Treating serious anti-social behavior in youth: The MST approach. U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.

Henggeler, S. W. (2011). Efficacy studies to large-scale transport: The development and validation of multisystemic therapy programs. Annual Review of Clinical Psychology 7, 351–381.

Henggeler, S. W., Rodick, J. D., Borduin, C. M., Hanson, C. S., Watson, S. M., & Urey, J. R. (1986). Multisystemic treatment of juvenile offenders: Effects on adolescent behavior and family interactions. Developmental Psychology 22(1), 132–141.

Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology 60(6), 953–961.

Henggeler S. W., Melton, G. B., Brondino, M. J., Scherer, D. G., & Hanley, J. H. (1997). Multisystemic therapy with violent and chronic juvenile offenders and their families: The role of treatment fidelity in successful dissemination. Journal of Consulting and Clinical Psychology 65(5), 821.

Henggeler, S. W., Mihalic, S. F., Rone, L., Thomas, C., & Timmons-Mitchell, J. (2001). Multisystemic therapy. In D. S. Elliott (Ed.), Blueprints for violence prevention, book six. Boulder, CO: Center for the Study and Prevention of Violence.

Howell, J. C. (1995). Guide for implementing the comprehensive strategy for severe, violent, and chronic juvenile offenders. U.S. Department of Justice. Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.

Klietz, S. J., & Borduin, C. M. (2007). Cost-benefit analysis of multisystemic therapy with serious and violent juvenile offenders. Columbia, MO: University of Missouri–Columbia.

Lipsey, M. W. (2009). The primary factors that characterize effective interventions with juvenile offenders: A meta-analytic overview. Victims and Offenders, 4(2), 124–147. Retrieved August 23, 2013 from http://www.tandfonline.com/doi/full/10.1080/15564880802612573#tabModule

Lipsey, M. W., Howell, J. C., Kelly, M. R., Chapman, G., & Carver, D. (2010). Improving the effectiveness of juvenile justice programs. Washington, DC: Center for Juvenile Justice Reform. Retrieved August 22, 2013 from http://cjjr.georgetown.edu/pdfs/ebp/ebppaper.pdf

Lipsey, M. W., & Wilson, D. B. (1998). Effective intervention for serious juvenile offenders: A synthesis of research. In R. Loeber, & D. P. Farrington (Eds.), Serious and violent juvenile offenders: Risk factors and successful interventions (pp. 313–345). Thousand Oaks, CA: Sage Publications.

Littell, J. H., Popa, M., & Forsythe, B. (2005). Multisystemic therapy for social, emotional, and behavioral problems in youth aged 10-17. Oslo, Norway: Nordic Campbell Center.

MST, Inc. (2010). Our History. Retrieved August 5, 2013, from http://mstservices.com/index.php/mst-services/our-history

MST, Inc. (2012). Multisystemic Therapy (MST) Research at a Glance. Retrieved August 5, 2013, from http://mstservices.com/outcomestudies.pdf

Mendoza, M., Ciscel, D. H., & Smith B. E. (2001). Latino immigrants in Memphis, Tennessee: Their local economic impact. Memphis, TN: Center for Research of Women, The University of Memphis.

Rowland, M. D., Halliday-Boykins, C. A., Henggeler, S. W., Cunningham, P. B., Lee, T. G., Kruesi, M. J. P., & Shapiro, S. B. (2005). A randomized trial of multisystemic therapy with Hawaii’s Felix class youths. Journal of Emotional and Behavioral Disorders 13(1), 13–23.

Sawyer, A. M., & Borduin, C. M. (2011). Effects of multisystemic therapy through midlife: A 21.9-year follow-up to a randomized clinical trial with serious and violent juvenile offenders. Journal of Consulting and Clinical Psychology 79(5), 643.

Schaeffer, C. M., & Borduin, C. M. (2005). Long-term follow-up to a randomized clinical trial of multisystemic therapy with serious and violent juvenile offenders. Journal of Consulting and Clinical Psychology 73(3), 445–453.

Tighe, A., Pistrang, N., Casdagli, L., Baruch, G., & Butler, S. (2012). Multisystemic therapy for young offenders: Families’ experiences of therapeutic processes and outcomes. Journal of Family Psychology, 26(2), 187–197.

Timmons-Mitchell, J., Bender, M. B., Kishna, M. A., & Mitchell, C. C. (2006). An independent effectiveness trial of multisystemic therapy with juvenile justice youth. Journal of Clinical Child and Adolescent Psychology 35(2), 227–36.

U.S. Census Bureau (2010). Fact Sheet, Los Angeles County, California, 2010 Census. Retrieved August 5, 2013, from http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1

U.S. Census Bureau (2011). Sex by age by nativity and citizenship status, California: Los Angeles County. 2007-2011 American Community Survey 5-Year Estimates. Washington, DC: U.S. Census Bureau. Retrieved August 5, 2013, from http://www.census.gov/easystats/

U.S. Department of Health and Human Services (1999). Mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

OJJDP Home | About OJJDP | E-News | Topics | Funding
Programs | State Contacts | Publications | Statistics | Events