Multisystemic Therapy® (MST®)
Blueprints Program Rating: Model Plus
A juvenile crime prevention program to enhance parenting skills and provide intensive family therapy to troubled teens and delinquent teens that empower youth to cope with the family, peer, school, and neighborhood problems they encounter - in ways that promote prosocial behavior while decreasing youth violence and other antisocial behaviors.
The strong track record of MST in helping states and localities achieve savings on costly out-of-home placements has led to the leverage of significant state and local funds for MST, most typically in the budgets of juvenile justice and child welfare agencies. Medicaid is also an important source of support for MST, and many states have included MST in their Medicaid State Plans as a mental health therapy. Foundation support and public-private partnerships can play an important role in helping states and localities get MST programs up and running so that they can begin to divert youth from costly placements and reinvest the savings on those placements in the continued operation and expansion of the program.
Improving the Use of Existing Public Funds
Redirection: Many states and communities have redirected state and local funding from detention and residential placements to MST. The reasons for redirecting funds include: an interest in keeping youth with their families and in their communities; poor results with current strategies and the strong track record of results for MST; and the potential for cost savings by implementing MST and keeping young people out of costly out-of-home placements.
Reinvestment: Reinvestment is a strategy that can help to bring MST to scale by seeking a commitment from public agencies that they will reinvest the savings generated by implementing MST and reducing the use of out-of-home placements into sustaining and replicating the program. It may be helpful to pair this strategy with a public-private partnership in which a private funder helps to facilitate and support the development of commitments from public agencies to reinvest savings. See the Opportunity Compact example below.
Allocating State or Local General Funds
Many states have chosen to fund MST with general funds as part of a commitment to evidence-based practices and in an effort to achieve better outcomes for youth. Some counties and cities have made additional contributions to funding the program.
Maximizing Federal Funds
Entitlements: Medicaid is an option for funding MST as a family therapy. Also, there is now a billing code assigned directly to MST (HCPCS code H2033). Some states also bill MST as a psychosocial rehabilitative service. Any Medicaid approach requires the state to provide state matching funds, with the state share percentage set by the federal government. This option is limited to the Medicaid eligible portion of the population to be served.
- Juvenile Accountability Block Grant (JABG) Funds are focused on reducing juvenile offending through efforts that promote accountability, including providing effective early intervention through mental health screening and treatment.
- Office of Juvenile Justice and Delinquency Prevention (OJJDP) Formula Funds support a variety of improvements to delinquency prevention programs and juvenile justice programs in states. Evidence-based programs are an explicit priority for these funds, which are typically administered on a competitive basis from the state administering agency to community-based programs.
- The Mental Health Services Block Grant (MHSBG) can fund a variety of mental health promotion and intervention activities and is a potential source of support for functional family therapy programs.
- Title IV-B, Parts 1 & 2 provides fairly flexible funding to state child welfare agencies for child welfare services, including prevention and family preservation activities.
Discretionary Federal Grants: Such grants have mostly been used for start-up expenses. Federal agencies including SAMSHA and OJJDP administer relevant discretionary grant programs.
Foundation Grants and Public-Private Partnerships
A number of states have used foundation grants to provide start-up funding for MST programs. Foundations are not as good a source of ongoing implementation funding. An Opportunity Compact is an example of a relevant public/private partnership, where private funding initiates an intervention such as MST, with the potential of saving money from the avoidance of a costly alternative. Savings are then used to sustain the intervention.
Program-related investment, social impact bonds or government bonds can all be used for start-up and initial implementation funding for programs such as MST, which target cost avoidance for youth who would otherwise need an expensive alternative such as out-of-home placement. Savings from avoided costs would repay the investment as well as sustain the intervention.
Generating New Revenue
While presenting a challenge in securing needed public support, new revenue should be considered in the form of taxpayer referenda, new taxes and fees or dedicated revenue streams such as tax form check-offs.
All information except unit cost comes from the responses to a questionnaire submitted by the purveyor, MST Services, Inc., to the Annie E. Casey Foundation. The unit cost is from Drake, Elizabeth K., et.al. (2009). Evidence-Based Public Policy Options to Reduce Crime and Criminal Justice Costs: Implications in Washington State, Victims and Offenders, 4:170-196.