Welcome to the Spring 2007 Issue of "In the Loop"

In this issue

• Innovative Care Keeps Kids Out of Trouble
• Announcements from MST Services and MST Institute
• News Briefs from Family Services Research Center at MUSC: New Research
• New MST-related Publications
• MST Community Updates and Announcements
• Network Partner Spotlight

Innovative Care Keeps Kids Out of Trouble

By: Belle Waring
Source: NIH Record Newsletter
Washington, DC
March 9, 2007

For over a century, youthful criminal offenders have been managed differently from adults; they receive rehabilitation instead of punishment. Incarcerated youths have high rates of mental disorders and the Department of Justice (DOJ) has recommended improved mental health services. Yet children in the juvenile system do not, in general, have an enforceable right to treatment and can receive only those services available in their jurisdictions. Without the necessary care, delinquent youths likely face further incarceration.

Dr. Sonja Schoenwald resourceful NIH grantee

In a recent visit to NIH, the Medical University of South Carolina's Dr. Sonja Schoenwald discussed psychosocial services for the highest-risk youth. Her talk, "Innovations in the Effectiveness of Care: Getting What We Know How to Do to Those Who Need to Do It," was part of the NIMH Director's Innovation Speaker Series.

Schoenwald focused on transporting multisystemic therapy (MST) from research to usual care settings. "Transport," she explained, "is a way to export a technology that you've tested in an efficacy or effectiveness trial and get it out into end-user contexts, so that you can see how the thing lives and breathes there."

MST is an intensive, short-term, family- and community-based treatment for youths with serious antisocial behavior. It is one of the few successful alternatives to the incarceration of violent, chronic juvenile offenders and appears to prevent re-arrest.

"If you can get them past 19," said Schoenwald, "the odds of their committing repeat crimes goes way down."

The stakes are huge. In 2005, drug abuse violations by juveniles approached 200,000, according to DOJ estimates. Violent crimes by juveniles topped 1.2 million, with 5,000 of these committed by children under 12.

MST is delivered in a home-based model, with therapists available 24-7. MST does not arrange or coordinate multiple services; rather, it addresses the known risk factors for delinquency, providing family, marital, youth, peer and school interventions.

MST was developed in the late 1970s, with studies multiplying in the mid 1980s. "The study targeted a group of kids that were getting locked up in juvenile prisons, residential treatment facilities and boot camps," Schoenwald said. The study outcomes showed that MST decreased crime 2.4-4 years post-treatment; decreased behavior problems and symptoms in the youths and their families; and produced cost savings. Lock-up costs were $45,000 to $100,000 per youth per year, compared to MST at $8,000 per treatment episode.

The study trials were done by model developers or clinicians trained by them. Schoenwald wanted to see if community settings could get good outcomes. In 1993, she took the lead in developing training protocols and support systems for therapists and staff in frontline settings. After several years, it was time to evaluate.

"What did we know about transportability then? Very little," she said. "The term had not yet made it into the major journals." Her requests for funding for transport studies were nixed by universities and foundations, so she and her colleagues used personal funds. "It was a little dicey," she said. "I could have lost my shirt."

Funding from the DOJ's Office of Juvenile Justice and Delinquency Prevention, among other sources, eventually came through. Now her group could develop manuals, measures and web-based infrastructure to monitor adherence and outcomes. As she began to collaborate with nine different provider organizations, she found that most had no computers.

"It isn't proven that we can do this out in the world," she told them, "so we just have to agree that we're experimenting together, then collect the data and see how it works."

She and her team developed treatment and supervision manuals and training/clinical procedures for therapists, supervisors and consultants. Eventually, her colleagues established a university-licensed tech-transfer entity, MST Services, as well as an institute through which adherence and outcomes could be shared. Now, if a county justice system requested a program, Schoenwald's team could offer a systematic approach.

In 1999, NIMH funding came through, allowing Schoenwald to test outcomes and adherence in 45 community sites. At one year post-treatment, she saw significant reductions in youth behavior problems that mirrored results in the randomized trials. There were also reductions in criminal charges through four years post-treatment.

A NIDA follow-up grant is supporting further studies testing the magnitude of the change in criminal drug use outcomes against those seen in prior randomized trials. Schoenwald is also investigating questions of staff turnover, expansion strategies, data analysis and how to train organizations to be their own experts.

What have they learned so far? She advised, "Before embarking on any large-scale dissemination, test, measure and evaluate." Involve end-users, so collaborators understand the benefits to them, not just researchers. Seeking funding? Get creative. Learn about tech-transfer protocols and venture out of your own world.

"If we had not gone outside our own academic discipline, we would've gone nowhere," said Schoenwald, who read widely in search of models, including business, education and the military. She quipped, "Now I know why pilots use flight simulators before they fly."

There are now more than 300 MST teams in the U.S. and internationally. "Even in community- based implementation," said Schoenwald, "I think we're going to be able to deliver...on the promise found in the trials: keeping kids out of trouble."

Announcements from MST Services and MST Institute

The revised TAM, aka the TAM-R, was implemented on the MST Institute Web site this past March.

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The new MST Institute Call Center vendor, Pioneer Marketing, is up and running. MST Institute has reduced its rate for TAM interviews from $35 per enrolled family per month to $20 per enrolled family per month. New fees will appear on invoices for March calls.

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New TAM-R reports will be implemented by the end of May with a series of in-service calls for system supervisors to be scheduled in mid-May.

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MST Expert In-services: MST Services will begin holding quarterly, hour-long in-service trainings by conference call for all MST experts, starting in May.

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The following updated materials are now available. Please check with your MST expert for details.

• Updated MST Organizational Manual
• Updated Supervisor Orientation materials
• Updated Supervisor Recruitment Toolkit
• Updated Therapist Recruitment Toolkit
• MST Adaptations and Pilots overview brochure

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Maryland Disability Law Center publication on the case for Maryland to provide Medicaid funding for MST and other evidence-based programs is available on our links page, #25, at www.mstservices.com/text/links.htm.

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Two new "MST Stores" are available online via the "Product Order Forms" link on the MST home page: one store is for MST materials and one is for MST promotional products. The traditional "MST Product Order Form" is now only available for use by licensed MST programs.

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New lists of licensed MST teams by organization and by location are available as links on the MST home page directly under the "Licensed MST Programs" link.

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MST Institute's Enhanced Web site, www.mstinstitute.org, has a significant change in its look and the password assignment process. If you have not logged in since January 1, you will be asked to update your password the next time you log in. Please take a minute to go to the Enhanced Web site, log in and update your information. If you need assistance in this process, please contact the Help Desk, msti@mstinstitute.org. Users who have not been updated by June 1, 2007 will be deactivated.

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Web site training is available via "webinars" on several topics. Registration is limited to 15 connections and is offered on a first-come, first-serve basis. Go to mstinstitute.org to sign up. Click on Services, and then on Training and Education. Access to the Internet and a telephone connection are required to participate.

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News Briefs from Family Services Research Center at MUSC: New Research

MST CRAFT
Project site: Hartford, CT
Abstract: The study aims to test a promising strategy for improving vocational and employment outcomes for adolescents with identified substance abuse problems or at high risk for such. The 6-month employment program, Project CRAFT (Community Restitution Apprenticeship-Focused Training), is designed to train and place high-risk youths in employment within the residential building industry. Importantly, CRAFT is operated by the Home Builders Institute, which is the educational arm of the National Association of Home Builders and has formal linkages with virtually all local building associations across the nation. CRAFT participants are connected with local employers throughout the course of training. This initial test of CRAFT uses existing MST programs in Connecticut as the platform for the evaluation.

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MST-HIV adaptation efficacy pilot
Project site: Columbia and Charleston, SC
Abstract: A 3-year research project has been funded by the National Institute of Mental Health to adapt an empirically validated intervention, MST to address sexual risk behaviors by HIV+ adolescents. The first aim of this project is to complete the adaptation, which in addition to targeting risky sexual behaviors will also incorporate prior successful adaptations of MST for use with substance abusing/dependent youth and medication non-adherent youth. The second aim of this project is to conduct a pilot study with 50 HIV+ youths ages 11-17 years who receive clinical care at either the University of South Carolina's Palmetto Health Children's Hospital-based outpatient pediatric clinic or the outpatient pediatric AIDS clinic at the Medical University of South Carolina Children's Hospital.

New Publications

The following MST-related publications are available:

• 264 Ogden, T., & Hagen, K.A. (In press). Multisystemic therapy of serious behavior problems in youth: Sustainability of therapy effectiveness two years after intake. Journal for Child and Adolescent Mental Health.
• 267 Ellis, D.A., Frey, M.A., Naar-King, S., Templin, T., Cunningham, P.B., Cakan, N. (in press). The effects of multisystemic therapy on diabetes stress in adolescents with chronically poorly controlled type II diabetes: Findings from a randomized controlled trial. Pediatrics.
• 270 Henggeler, S.W., Halliday-Boykins, C.A., Cunningham, P.B., Randall, J., Shapiro, S.B., Chapman, J.E. (In press). Juvenile drug court: enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology, 34(4), 658-670.
• 271 Cunningham, P.B., Narr-King, S., Ellis, D.A., Pejuan, S., Secord, E. (in press). Achieving adherence to antiretroviral medications for pediatric HIV disease using empirically supported treatment: A case report. Journal of Developmental and Behavioral Pediatrics.
• 272 Ellis, D.A., Narr-King, S., Cunningham, P.B., Secord, E. (in press). Use of multisystemic therapy to improve antiretroviral adherence and health outcomes in HIV-infected pediatric patients: Evaluation of a pilot program. AIDS, Patient Care, and STD's.
• 280 Henggeler, S. W., Sheidow, A. J., & Lee, T. (in press). Multisystemic treatment (MST) of serious clinical problems in youths and their families. In A. R. Roberts & D. W. Springer (Eds.), Forensic social work in juvenile and criminal justice settings: An evidence-based handbook (3rd ed.). Springfield, IL: Charles C. Thomas.
• 281 Sheidow, A. J., & Henggeler, S. W. (in press). Multisystemic Therapy with Substance Using Adolescents: A Synthesis of the Research. In N. Jainchill (Ed.), Understanding and Treating Adolescent Substance Use Disorders. Kingston, NJ: Civic Research Institute.
• 293 Sheidow, A.J., Schoenwald, S.K., Wagner, H.R., Allred, C. A., & Burns, B.J. (2006). Predictors of workforce turnover in a transported treatment program. Administration and Policy in Mental Health and Mental Health Services Research. 1, 1-12.
• 295 Mattejat, Fritz (2006). Innovative behandlungskonzepte jenseits der dyade patie nt-therapeut. Verhaltenstherapie & Verhaltensmedizin, 27 (4), 489-490.
• 296 Swenson, C.C., Saldana, L., Joyner, C.D., & Henggeler, S.W. (2006). Ecological treatment for parent to child violence. In A.F. Lieberman & R. DeMartino (Eds.), Interventions for children exposed to violence (pp. 155-185). New Brunswick, New Jersey: Johnson & Johnson Pediatric Institute.
• 297 Ellis, D.A., Templin, T., Naar-King, S., Frey, M.A., Cunningham, P.B., Podolski, C., Cakan, N. (2007). Multisystemic therapy for adolescents with poorly controlled type 1 diabetes: Stability of treatment effects in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 75, 168-174.
• 298 Henggeler, S.W., Chapman, J.E., Rowland, M.D., Halliday-Boykins, C.A., Randall, J., Shackelford, J., Schoenwald, S.K. (2007). If you build it, they will come: Statewide practitioner interest in contingency management for youths. Journal of Substance Abuse Treatment, 32(2), 121-131.
• 299 Ellis, D.A., Yopp, J., Templin, T., Naar-King, S., Frey, M.A., Cunningham, P.B., Idalski, A., Niec, L.N. (2007). Family mediators and moderators of treatment outcomes among youths with poorly controlled type 1 diabetes: Results from a randomized controlled trial. Journal of Pediatric Psychology, 32(2), 194-205.

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MST Community Updates & Announcements

Welcome New MST Teams
The following MST teams were implemented during the first quarter of 2007:

Community Solutions (2 teams)	Florida
Family Counseling	Maine
Bluesky Adaptation team	New York
Youth Services of Tulsa	Oklahoma
NAFI - BSF Adaptation team	Connecticut
Olympia/Thurston/Mason	Washington
Gulf Coast Teaching	Louisiana
North Range Behavioral Health	Colorado
Alexander Youth Network	North Carolina
DHS CAN Adaptation team	Colorado

Highlight Your Organization in In the Loop

Something exciting happening with your MST team? Has someone recently joined your team or been promoted? If so, share your news with the MST community. Send your news to intheloop@mstservices.com.