Welcome to "In the Loop"

In this issue

• MST Services Announces Contract Updates
• MST Institute Updates
• News from Family Services Research Center
• New Publications and Resources
• New Mexico's Use of MST for Juvenile Offenders within the Medicaid Managed Care Environment
• MST Ohio Receives Certificate of Merit
• MST Community Updates and Announcements

MST Services Announces Contract Updates

• The new MST Program Support and Training contracts are now ready for use.
• To ensure accuracy, please review the list of licensed MST programs on www.mstservices.com and provide any updates

MST Institute Updates

The MST Institute continues to add enhancements to its Web site to meet specific needs identified by MST providers.

A couple of features have been added for our Court Support Services Division (Judicial Branch, State of CT) partners and will be piloted over the next year to determine their usefulness for the wider MST community. These include the CAM and the ability to report the data aggregated at the network level.

Major updates were also made to the Program Implementation Data Report (PIDR) that are available to all Web site users. A number of formulas were changed to more accurately estimate key program indicators. The PIDR will now only summarize information on those cases that had a date of first visit. A new line was added to show how many cases were seen that did not have a date of first visit. Finally, a section was added to display instrumental outcomes and ultimate outcomes for those cases that were most likely to have the opportunity to complete a full course of treatment. The intent of these changes was to provide more information to consultants and system supervisors that will assist them in analyzing a MST program's adherence. If anyone has questions about the website or these changes they can contact the Help Desk at msti@mstinstitute.org.

News from Family Services Research Center

NIH State-of-the-Science Conference statement draft (pdf)

Transportability project update
FSRC recently provided In The Loop with an update on the Transportability Project. The project is currently analyzing one year post treatment arrest data. Additionally, therapist and client predictors of adherence, therapist and client predictors of youth behavioral outcomes, and organizational predictors of staff retention were all identified.

A new grant from NIDA will extend follow-up on arrest data to two years post-treatment, and examine therapist, organization, and client effects on adherence and outcome for drug using and non-using youth.

The predictors of adherence for therapists and clients (currently under review by Schoenwald, Letourneau, & Halliday-Boykins) included that when therapists perceive flexible hours to be difficult (i.e. 24/7 availability), adherence scores are lower. Ethnic similarity between caregiver and therapists predicts higher adherence scores.

Predictors of youth behavior problem reductions included the similarity of caregiver and therapist ethnicity, and better adherence among ethnically similar pairs accounts for some of the effect of ethnic similarity on some outcomes (Halliday-Boykins, Schoenwald, & Letourneau, in press, Journal of Consulting & Clinical Psychology).

Staff retention appears lower when the organizational climate is characterized by high emotional demand, and when salaries are lower.

For additional information on the transportability study, e-mail Sonja Schoenwald at schoensk@musc.edu.

Additional Study Updates:
An Independent Effectiveness Trial of MST with Juvenile Justice Youth

• (Timmons-Mitchell, et al - under revision)
• 93 juvenile offenders randomized to MST or usual services
• 50% reduction in offenses at 18 months
• Significantly improved functioning on CAFAS

Authors: Jane Timmons-Mitchell, Monica M. Bender, Maureen A. Kishna and Clare C. Mitchell.
Contact: Jane Timmons-Mitchell

Long-Term Follow-up to Missouri Delinquency Study

• Long-Term (13.7 Year) follow-up to Missouri Delinquency Study
  (Schaffer and Borduin - in press, Journal of Consulting and Clinical Psychology)
  Key Findings (N=176)
  • Recidivism rates: MST 50%; Individual Therapy 81%
  • MST participants 54% fewer arrests (1.8 vs. 4.0 offenses)
  • MST participants 57% fewer days confined (582 vs. 1356 days)

Contact: Chuck Borduin

MST Network Pilot Projects:

• Problem Sexual Behavior (JSO) pilot started in Connecticut
• Child Abuse and Neglect pilot project planned for early 2005 (to start in Connecticut)

Contact: Dan Edwards

New Publications

The following publications have been recently published. To request a copy, or for more information, click here

Swenson, C.C., Henggeler, S.W., Taylor, I.S., & Addison, O. (2005). Multisystemic Therapy and Neighborhood Partnerships: Reducing Adolescent Violence and Substance Abuse. New York: Guilford Press.

Henggeler, S.W. & Lee, T. (2003). Multisystemic treatment of serious clinical problems. In A.E. Kazdin and J.R. Weisz. (Eds), Evidence-based psychotherapies for children and adolescents (301-322). New York: Guilford Press.

Halliday-Boykins, C.A., Schoenwald, S.K., Letourneau, E.J. (in press). Caregiver-therapist ethnic similarity predicts youth outcomes from an empirically based treatment. Journal of Consulting & Clinical Psychology.

National Mental Health Association: Compendium of promising practices
Download the pdf (1.2MB)

New Mexico's Use of MST for Juvenile Offenders within the Medicaid Managed Care Environment

Medicaid Managed Care (SALUD! - meaning "to health")

• Implemented in 1997
• "Integrated Model"
• Multiple Layers
• Inefficient - high administrative costs
• Redesigned in 2001

Current

• Three MCO's administer system
• Physical & Behavioral Health
• Capitates risk bearing financing

Target Population

• All eligible recipients that meet MST criteria
• Juvenile Justice only
• Medicaid only

Admission Criteria

• To be eligible for MST, the child must:
  • Be age 12 to 17
  • Meet the criteria for Conduct Disorder diagnosis
  • Live with the immediate family, extended family, or other person(s) committed to long-term parenting of the child, and willing to participate in treatment-no temporary placements (e.g., Treatment Foster Care).
  • Have already received multiple service intervention attempts (such as probation, outpatient treatment, school-based treatment, RTC, etc.).
  • Have Salud! Medicaid
  
  
• And must fall into one or more of the following categories:
  • At risk for out-of-home placement due to delinquent behavior.
  • Adjudicated youth returning from out-of-home placement.
  • Chronic or violent juvenile offender.
  • SED (seriously emotionally disturbed) or substance abusing youth involved in the juvenile justice system.
  
  
• And must NOT:
  • Be actively suicidal, homicidal, or psychotic around the time of referral.
  • Have an IQ below 70
  • Have a diagnosis with the Autistic Spectrum.
  • Have sex-offending behavior as a primary problem (e.g., a pattern of such behavior, or such behavior in the absence of other delinquent of antisocial behavior).

Current Status

• Seven teams (four providers)
• Ten teams (five providers) Feb.05
• Training contract with Colorado MST Support Services Office
• Collecting data - major challenge
• Implementing version of Colorado MST Outcome Tracking Project

Why MST Within Managed Care?

• RTC's are the largest driver of cost in Medicaid
• RTC cost for Presbyterian approximately $25,000,000 per year
• State culture supports long term out-of-community placement for troubled youth
• Exemplified by attitudes of parents, juvenile justice social workers and parole officers
• Juvenile justice reform is moving adolescents out of detention/incarceration

Financial

• Total Medicaid cost of each treatment team was $328,000
• Each MCO had five members served at each site at any given time
• Cost of treating each family is $7,288
• RTC cost for four months is approximately $36,000

Outcomes

• Number of days out of home 1-year prior to MST = 1,545 days
• Number of days out of home 1-year post MST = 955 days (38%+ reduction)

MST Ohio Receives Certificate of Merit

SAMHSA Administrator's Award was created this year in response to the President's New Freedom Commission on Mental Health recommendations to improve and expand mental health services to students in schools. The MST Program at Junction Psychological Services was nominated for the award by Elizabeth Tracy, PhD at Case Western Reserve University. The MST Program received a Certificate of Merit for advancing mental health programs in schools and promoting mental health for students. The program for which they were recognized, Safe Schools, includes several initiatives aimed at promoting mental health, including two other evidence-based approaches. Additionally, preliminary research information on the MST program is contained in the first year program evaluation report prepared by the Kent State Center for the Prevention of Violence.

Contact Jane Timmons-Mitchell at jtm07@aol.com for more information.

MST Community Updates & Announcements

Golf on the Wild Side
Many of you have had the pleasure of witnessing a Djole performance. It's a performance that any MST professional can take personal pride in. Djole, a West African dance and drumming company, was created as a result of an MST project five years ago to get children off the street, encourage them toward a more positive path in life, and improve their health status.

On June 14 - 29, Djole will embark on an ambassadorial trip to West Africa for the purpose of interacting with West African dancers and drummers, cultural exchange, and teaching youth in Africa about AIDS.

To make this journey, they must raise enough money to pay for the trip. NONE of the children in Djole have family money to support this trip. Indeed, their parents are working as hard as they can to put food on their tables. They will fundraise to earn the entire amount needed. This will further instill discipline and a work ethic that is currently being taught to the children.

For more information about Djole and to download the registration form, visit www.djoledancecompany.org. If you are unable to golf, perhaps you will consider being a hole sponsor.

When: Sat. Jan. 22, 2005
Where: Oak Point Golf Course (just outside the gates to Kiawah Island, SC)
Time: 8:30 a.m. registration
Prizes: Brand New Car for a hole-in-one! Silent Auction immediately following the tournament (items include a drumming lesson, airline tickets to anywhere in the continental US, sports memorabilia, gift baskets, handcrafted jewelry, Spoleto tickets and much more)

New MST Teams
In the fourth quarter of 2004, the following teams were added to the MST Community:

Name	State	# of teams
Psychological Centers	Rhode Island	1
Ruth Dykeman Center	Washington	1
Department of Justice	Western Australia	1
Summit Pointe	Michigan	1
Kinark Family Services	Canada	1
Su Vida	New Mexico	1
Methodist Home	North Carolina	1
Omni Visions	North Carolina	1
YDCA	North Carolina	1
Haven House	North Carolina	1
Families and Youth Inc	North Carolina	1
Options	Oregon	1
Lynchburg	Virginia	1
Department of Mental Health	South Carolina	1
Children's Village	New York	1

Call for Proposals
The Colorado MST Support Services Office, working with Functional Family Therapy and Multidimensional Treatment Foster Care, has issued a call for proposals to communities and agencies throughout Colorado. The initiative, which has resulted in significant interest, will offset a portion of the startup costs for 3-4 sites implementing their choice of one of the three evidence-based program models. Awards will be made in early February. For additional information contact:

David Bernstein, MSW
Director, Colorado MST Support Services Office
900 Auraria Parkway, Suite 129
Denver, CO 80204
303-352-4203 ph
303-352-4201 fax
bernstei@mscd.edu