Multisystemic Therapy - Problem Sexual Behavior (MST-PSB)
Blueprints Program Rating: Model
A juvenile sex offender treatment program to reduce criminal and antisocial behavior, especially problem sexual behavior, by providing intensive family therapy services in the youth’s natural environment over a 5-7 month period.
- Academic Performance
- Adult Crime
- Delinquency and Criminal Behavior
- Illicit Drug Use
- Mental Health - Other
- Prosocial with Peers
- Sexual Risk Behaviors
- Sexual Violence
- Family Therapy
- Juvenile Justice, Other
- Correctional Facility
- Mental Health/Treatment Center
Continuum of Intervention
- Indicated Prevention (Early Symptoms of Problem)
- Early Adolescence (12-14) - Middle School
- Late Adolescence (15-18) - High School
- Male and Female
- All Race/Ethnicity
Brief Description of the Program
Multisystemic Therapy (MST) is an intensive family- and community-based treatment that addresses the multiple causes of serious antisocial behavior across key systems within which youth are embedded (family, peers, school, and neighborhood). MST for sexual offenders (MST-PSB) focuses on aspects of a youth's ecology that are functionally related to the problem sexual behavior and includes reduction of parent and youth denial about the sexual offenses and their consequences; promotion of the development of friendships and age-appropriate sexual experiences; and modification of the individual's social perspective-taking skills, belief system, or attitudes that contributed to sexual offending. The intervention is individualized for each family; families are provided family therapy, youth are provided individual therapy and services are delivered over a period of 5-7 months. Therapists have 3-5 families on their caseloads, and rotating members of the team are available to respond to crises 24 hours a day, 7 days a week.
See: Full Description
Borduin et al. (1990) demonstrated that the following outcomes were significantly lower in the MST condition:
- rearrests for sexual crimes (12.5% vs. 75%)
- rearrests for nonsexual crimes (25% vs. 50%)
Borduin et al. (2009) demonstrated that the following outcomes were significantly improved in the MST condition:
- mother, father and youth psychiatric symptoms
- youth behavior problems
- family functioning
- peer relationships
- school grades
- person and property crimes
Additionally, over the 8.9-year follow-up period, compared to the control condition, MST participants had
- 83% fewer arrests for sexual crimes
- 70% fewer arrests for other crimes
- 80% fewer days in detention facilities
Letourneau et al. (2009) found that the MST treatment group improved significantly more than the control group at the 12-month posttest on measures of
- deviant sexual interests and risk
- delinquency (also at 18 and 24 months in Letourneau et al., 2013)
- substance use
- youth-reported externalizing
- out-of-home placement
While no subgroup analysis was conducted, most of the subjects were boys in the three clinical trials (i.e., 100% in Borduin et al., 1990; 95.8% in Borduin et al., 2009; and 97.6% in Letourneau et al., 2009). In two of the clinical trials (i.e., Borduin et al., 1990; Borduin et al., 2009), about two thirds of the subjects were White (63.5% and 72.9%, respectively) and the remainder were Black; in contrast, more than half (54%) of the subjects in Letourneau et al., (2009) were Black and the remainder were White. Among all subjects, 2.1% in Bourduin et al., (2009) and 31% in Letourneau et al. (2009) indicated Hispanic ethnicity.
Risk and Protective Factors
- Individual: Antisocial/aggressive behavior*, Early initiation of antisocial behavior, Early initiation of drug use, Favorable attitudes towards antisocial behavior, Favorable attitudes towards drug use, Physical violence*, Rebelliousness, Substance use*
- Peer: Interaction with antisocial peers*, Peer substance use, Romantic partner violence
- Family: Family conflict/violence, Family history of problem behavior, Household adults involved in antisocial behavior, Neglectful parenting, Parent history of mental health difficulties*, Parent stress, Parental attitudes favorable to antisocial behavior, Parental attitudes favorable to drug use, Poor family management, Psychological aggression/discipline, Violent discipline
- School: Low school commitment and attachment, Poor academic performance*
- Neighborhood/Community: Community disorganization, Laws and norms favorable to drug use/crime, Low neighborhood attachment
- Individual: Clear standards for behavior, Problem solving skills, Prosocial behavior, Prosocial involvement, Rewards for prosocial involvement, Skills for social interaction*
- Peer: Interaction with prosocial peers*
- Family: Attachment to parents*, Non-violent discipline, Opportunities for prosocial involvement with parents, Parent social support, Parental involvement in education
- School: Opportunities for prosocial involvement in education, Rewards for prosocial involvement in school
- Neighborhood/Community: Opportunities for prosocial involvement, Rewards for prosocial involvement
*Risk/Protective Factor was significantly impacted by the program.
Training and Technical Assistance
Orientation training in the MST-PSB model lasts for 2 days and follows training in the standard MST model (5 days). MST-PSB orientation training relies on various formats, including slide presentations, video presentations, role plays, and small group exercises. The content covers a range of topics, including:
- an introduction to the MST-PSB model (i.e., costs and correlates of youth problem sexual behaviors, a review of the effectiveness of usual treatments for these behaviors, and a description of the empirical evidence supporting MST-PSB as a family-based alternative to usual treatments);
- safety considerations in the treatment of youth with problem sexual behaviors (including risk reduction, safety planning, and a family clarification process in which responsibility for the offense is accepted and understood);
- strategies for recognizing and handling caregiver and youth denial of problem sexual behaviors;
- a review of what is known about normative sexual behavior, the role of family sexuality in the development of inappropriate sexual behaviors, and prior sexual victimization as a risk factor for sexual offending;
- procedures for reporting sexual abuse; (f) strategic and structural family therapy interventions for youth with problem sexual behaviors;
- assessment and intervention strategies targeting peer relations of problem sexual behavior youth; and
- strategies for assessing and treating behavioral and psychological sequelae of sexual victimization in children and adolescents.
Following the 2-day orientation, training continues through weekly telephone MST-PSB consultation for each team of MST-PSB clinicians aimed at monitoring treatment fidelity and adherence to the MST-PSB treatment model, and through quarterly on-site booster trainings (2 days each). Fully trained MST-PSB Experts teach the on-site MST-PSB supervisor to implement a manualized MST supervisory protocol and collaborate with the supervisor to promote the ongoing clinical development of all team members. The MST-PSB Expert also assists at the organizational level.
The ongoing MST-PSB clinical support is provided to replicate the characteristics of training, clinical supervision, consultation, and monitoring provided in the successful clinical research trials of MST-PSB. This program implementation protocol has been refined through extensive experience with communities and providers in MST-PSB sites in the United States and internationally.
Brief Evaluation Methodology
In a small pilot study conducted in Columbia, Missouri (Borduin et al., 1990), 16 adolescents arrested for sexual offenses were randomized to either MST or individual therapy (IT) conditions. Youth in MST received an average of 37 hours of treatment, and IT youth received an average of 45 hours of treatment. Recidivism data were collected at an approximately 3-year follow-up.
A second study also conducted in Columbia, Missouri (Borduin et al., 2009) used a randomized controlled design to compare the efficacy of MST versus usual community services (UCS), the latter consisting of cognitive-behavioral group and individual treatment. A total of 51 families were referred to the study by the juvenile court system; 3 refused participation in the study, resulting in 48 (94%) youth and their families being randomly assigned to MST (n = 24) and UCS (n = 24). The mean length of treatment/services was 30.8 weeks for the MST participants and 30.1 for the UCS participants. Data were gathered at baseline and posttest, and assessments using police and court records of juvenile and adult criminal activity were conducted an average of 8.9 years after treatment had been completed so that adult arrest data on every youth could be collected.
In a third study conducted in Chicago, Illinois (Henggeler, 2009; Letourneau et al., 2009, 2013), a treatment (MST vs. Treatment as Usual for Juvenile Sexual Offenders TAU-JSO) by time (pretreatment, 6 months, 12 months, 18 months, 24 months) factorial design with random assignment of youth to treatment conditions was used with a sample of 127 participants. The participants were referred by the Cook County State's Attorney's Office after having been charged with a sexual offense. Randomization of the 127 subjects into the treatment group (n = 67) and control group (n = 60) came before the baseline assessment. The assessments with each youth and caregiver occurred at five points in time: within 72 hours of recruitment into the study, 6 months postrecruitment, 12 months postrecruitment, 18 months postrecruitment, and 24 months postrecruitment.
Peer Implementation Sites
Southwest Family Guidance Center
2221 Rio Grande Blvd NW
Albuquerque, NM 87104
Lead Supervisor-Special Programs
Craig Pierce, CEO
91 Northwest Drive
Plainville, CT 06062
Deb Batsie-Hernandez, LMFT
Director of Community Based Services
Family Psychology Mutual
Cambridgeshire MST Services
Scott House, 5 George Street, Huntingdon PE29 3AD.
Tom Jefford , CEO
Brigitte Squire, CEO
Judith Hill, Business Support Manager:
Sarah Reeves, MST-PSB Manager:
Borduin, C. M., Henggeler, S. W., Blaske, D. M., & Stein, R. J. (1990). Multisystemic treatment of adolescent sexual offenders. International Journal of Offender Therapy and Comparative Criminology, 35, 105-114.
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.
Henggeler, S. W., Letourneau, E. J., Chapman, J. E., Borduin, C. M., Schewe, P. A., & McCart, M. R. (2009). Mediators of change for multisystemic therapy with juvenile sexual offenders. Journal of Consulting and Clinical Psychology, 77, 451-462.
Letourneau, E. J., Henggeler, S. W., Borduin, C. M., Schewe, P. A., McCart, M. R., Chapman, J. E., & Saldana, L. (2009). Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial. Journal of Family Psychology, 23, 89-102.
Letourneau, E. J., Henggeler, S. W., McCart, M. R., Borduin, C. M., Schewe, P. A., & Armstrong, K. S. (2013). Two-year follow-up of a randomized effectiveness trial evaluating MST for juveniles who sexually offend. Journal of Family Psychology, 27, 978-985.