Research to Practice: Multisystemic Therapy (MST) for Elementary School Students with Behavior Disorders Center for At-Risk Children’s Services University of Nebraska-Lincoln Jacquelyn A. Buckley, PhD & Michael H. Epstein, EdD The Child Guidance Center Tricia Monzon, MA
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Research to Practice: Multisystemic Therapy (MST) for Elementary School Students with Behavior Disorders Center for At-Risk Children’s Services University.
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Research to Practice: Multisystemic Therapy (MST) for Elementary School Students with
Behavior DisordersCenter for At-Risk Children’s Services University of Nebraska-Lincoln
Jacquelyn A. Buckley, PhD & Michael H. Epstein, EdD
The Child Guidance Center Tricia Monzon, MA
Mental Health Status of School ChildrenThree types of children in school settings
Exhibit intense problem behavior
Not at risk
At risk for problem behavior
1-7%
5-15%
80-90%
Three-Tiered Prevention Program
Primary Program: Behavior and Academic Support
& Enhancement (BASE)
Secondary Program: First Step to Success
Tertiary Program: Multisystemic Therapy (MST)
BASE
Primary Schoolwide Discipline Program
Ecological arrangements: traffic patterns, arrival and dismissal, student supervision Behavior: consistent expectations, continuum of disciplinary responses, Think Time, behavior intervention plans
Academic: focus on achieving outcomes, early identification, evidence-based academic skill support
First Step to SuccessSecondary Program (Grades K-1)
Contingencies for Learning Academic and Social Skills (CLASS)
Teaching and role-playing appropriate behavior
Continuous feedback with visual and verbal prompts
Whole class reinforcement for meeting goals
homeBase
Six weekly lessons: communication, cooperation, limit setting, problem solving, making friends, developing confidence
MST
Family- and home-based treatment that strives to change how youth function in their natural settings – home, school, and neighborhood.
Clinical trial of MST adapted for younger children
Social-ecological framework
Family preservation mode of service delivery
Tertiary Program (Grades K-3)
Who is eligible for MST?
School Referred (Principal as main contact) K-3rd grade student BD label Currently experiencing significant
behavior problems
Additional ways to qualify: Lack of success in 1st Step Program Fall screening of K-1 students
Interventions should be designed to promote responsibility and decrease irresponsible behavior among family members.
4. Present-focused, Action-oriented & Well-definedInterventions should be present-focused and action-oriented, targeting specific and well-defined problems.
MST Treatment Principles5. Targeting Sequences
Interventions should target sequences of behavior within and between multiple systems that maintain identified problems.
6. Developmentally AppropriateInterventions should be developmentally appropriate and fit the developmental needs of the youth.
MST Treatment Principles7. Continuous Effort
Interventions should be designed to require daily or weekly effort by family members.
8. Evaluation and AccountabilityInterventions efficacy is evaluated continuously from multiple perspectives, with providers assuming accountability for overcoming barriers to successful outcomes.
MST Treatment Principles
9. GeneralizationInterventions should be designed to promote treatment generalization and long-term maintenance of therapeutic change by empowering care givers to address family members’ needs across multiple systemic contexts.
Intervention Strategies Use of research-based treatment options
Behavior Therapy including Parent Management Training (PMT)
Cognitive behavior therapy Pragmatic family therapies: Structural Family
Therapy and Strategic Family Therapy Pharmacological interventions (e.g., for ADHD)
For K-3 project only: Components of Parent-Child Interaction
Therapy (PCIT; Eyeberg) Components of The Incredible Years (Webster-
Stratton) Adapted from MST Services (www.mstservices.com)
Intervention Philosophy
Services are comprehensive, individualized, and address all identified drivers of the problem behaviors
Therapists are accountable for all outcomes Families and communities are central and
essential partners in MST treatment Barriers to services are removed (e.g., 24/7
availability of team; scheduling meeting times that are convenient to families)
Adapted from MST Services (www.mstservices.com)
Wait-List Control Group Design
Child Outcome Measures Social
Child Behavior Checklist (CBCL); Behavioral and Emotional Rating Scale
(BERS); Social Skills Rating System (SSRS)
AcademicWoodcock-Johnson Tests of Academic Achievement, Third Edition (WJ-III);
Woodcock Reading Mastery Test – Revised (WRMT-R); Dynamic Indicators of
Basic Early Literacy Skills (DIBELS); Comprehensive Test of Phonological
Processing (CTOPP); Academic engaged time (AET)
Family Outcome Measures Family Adaptability and Cohesion Scale – III (FACES-III); Parenting Stress
Index (PSI); Beck Depression Inventory (BDI-III)
Characteristics of Participating Schools
School
Total
Enrollment
% Free/Reduced
Lunch
% Minority
Status
% Student Mobility
1
433
26.1
10.9
14.5
2
574
69.9
55.3
30.8
3
443
39.3
13.4
16.2
4
424
80.7
48.4
41.8
5
499
39.0
13.4
19.4
6
418
56.0
16.4
27.4
7
427
53.9
20.4
27.9
Child and Family Characteristics 1st Year Cohort
Data collected on 30 students referred for MST Data presented is intake data only 12 month availability of program - outcome data still being collected