Scott Henggeler Molly Brunk Lisa Reiter

Scott Henggeler Molly Brunk Lisa Reiter

Transporting the MST Family of Interventions into the World

Tena Koutou Welcome! G Day! Welkom! E komo mai! Velkommen! Hola Bienvenido aqui! Välkommen! Velkomin

MST Around the World Outcomes for 2011 MST: Key Component of Social and Systems Change Awards Status of MST Adaptations Change Still Needed

MST Presence Around the World 34 states in the US Australia Belgium Canada Chile Denmark England Iceland Netherlands New Zealand Northern Ireland Norway Scotland Sweden Switzerland

Why do we do this work? What does it mean to be a part of the MST community? Why do we each do it? Why does what we do matter? How are we doing it well?

Progress in the past year across current MST teams: MSTI Annual Report Data

Data for Jan 1-Dec 31, 2011 At Home 88% In School/Working 85% No Arrests 85% These results are based on the comprehensive review of the 12,771 cases (88% of 14,500 cases referred for treatment) that were closed for clinical reasons (i.e., completed treatment, low engagement, or placed)

Five Years of Continued Progress Since 2005 when data reporting started, the MST community has shown progress in the percentage of youth at discharge who are: living at home in school or working had no arrests during treatment

Percent of Youth 90% 88% 86% 84% 82% 80% 78% 76% 2006 2008 2009 2010 2011 74% 72% At Home In School/working No arrests Youth Outcome

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Number served Youth in MST 14000 12000 10000 8000 6000 4000 Total U.S. Int'l 2000 0 2006 2007 2008 2009 2010 2011

MST: Key Component of Social and Large Systems Change

MST: Key Component of Social and Large Systems Change Chile UK/Essex Social impact bonds Pennsylvania New Mexico New York City Norway

MST - Part of Crime Reduction Initiative Driven by the President Chile Presenter: Cecilia Tijmes, Ministry of the Interior and Public Security

General Background Goals of the 2010-2014 Plan Chile Seguro Reduce the percentage of households victims of crime by 15% Reduce the amount of crimes in public areas by 25%

Elements of Plan Chile Seguro Program of Integrated Security, 24-hour program Carabineros (Police) de Chile, coordinating with municipalities, send the program data on children and adolescents who are admitted to any police station in the country If they re a victim of crime or, If they ve committed a criminal offense Vida Nueva, ministry program created to address the lack of psychosocial services for children and adolescents identified by the PIS 24 hour program Subsecretary of Crime Prevention expanded the Vida Nueva program to 6 new comunas

Operational definition of the 24-hour program o System of evaluation and management of children and adolescents who reside in comunas presenting high admission of minors to police stations in the country. o The objective is to contribute to the interruption of criminal paths of children and adolescents that have committed a criminal offense for the first time or repeated behavior that violate the norms

Municipality: 24 Hour Program Family Court MST (High Risk) Child with Offending Behavior Risk Assessment Team Assessment of Risk Factors for Offending Specialized Intervention Program and Similar (Moderate Risk) Other Programs of Municipalities and Private Organizations (Low Risk) Municipality Programs Spontaneity Demand Juvenile Justice Programs (Probation, Community Services)

Process to Implement MST in Chile 2012-2013 Phase 0: MST Services Representatives visit Chile to familiarize with the realities of Chile and assess the feasibility of the implementation in 2011 Multisystemic Therapy Conference in Santiago open to professionals of related institutions Agreement between the Subsecretary of Crime Prevention and MST Services to implement MST starting 2012

Process to Implement MST in Chile 2012-2013 Phase 1: La Pintana, Pudahuel, La Florida and Puente Alto Translation of documents and protocols Process of selection of therapists and supervisors Site Assessment 5 day training for MST teams. Ends with the start of services starting August 2012.

Process to Implement MST in Chile 2012-2013 Phase 2: Peñalolén, Recoleta, La Granja and Lo Espejo Start of cases at the beginning of September 2012 Phase 3: San Bernardo, Maipú and Valparaíso* Start of cases on February 2013 *first comuna outside of the Santiago metropolitan area

Process to Implement MST in Chile 2012-2013 Phase 4: Puerto Montt, Temuco and Los Ángeles In process of selecting the therapists and supervisors Site Assessment scheduled for the 26th, 27th and 28th of March 5 Day scheduled for week of 15 th of April

MST - Part of Innovative Approach Using Social Investment to Increase Funding for Effective Services Essex County, UK Presenter: Cathy James, Department of Health

UK/Essex social impact bonds A fixed-rate loan to Places for People Homes (a provider of affordable housing) A social impact bond to provide services to troubled families whose children are considered to be at risk of being placed in care Low risk loan combined with high risk investment = greater appeal to civic-minded investors

Essex faces formidable challenges Predominance of high cost residential placements Higher proportion of older adolescents with behavioral issues in care Poor parenting support in particular around managing behavior Underdeveloped early intervention and family support services Lack of higher level intensive interventions and limited resources to establish them Vicious circle: wrong service offer, young people in care unnecessarily, pressure on budgets, reducing available investment Steven H. Goldberg, February 4, 2013

The possibility of making a modest profit on the investment Features that make the Bond an attractive social investment: The possibility of making effective social services much more widely available to kids who really need them

What Private Investment in Future for Children Bonds Could Mean for the Growth of MST Possible expansion in ways that government spending and philanthropy can t provide Attractiveness of well-evidenced programs to investors Problems are only increasing over time Impact investment might work a lot better Working with new kinds of partners

If we want civic-minded affluent people to make a lot more money available for social purposes, they need to know they ll eventually get it back. Philanthropy is disposable; social investment is recyclable. Return Impact Steven H. Goldberg, February 4, 2013

SIBs and other social investments don t make money more important than helping people The only way they make any money for investors at all is if they do help people Future for Children Bonds provide a small financial incentive for investors to pay for more MST Could reduce the number of children taken from their homes and save government a lot of money Monetization creates an entirely new source of funding that doesn t compete with limited government budgets or donations Steven H. Goldberg, February 4, 2013

Costs in time and money of set up To ensure that investors and social finance organisations are realistic about targets for savings Challenges? To communicate the need for programme fidelity and quality assurance to a new audience To keep positive outcomes for families top of the agenda

Social investing has the potential to significantly change how we fund social programs

MST: Part of Movement to Offer Evidence-Based Interventions, Resulted in Decreased Placement Rates Pennsylvania, USA Presenter: Susan Pribyson, Community Solutions, Inc.

Pennsylvania (County Comparison) 8 counties that did not have any EBI from 2006-2010 were compared to 11 counties that began the implementation of their first EBI between 2007 and 2009. Placement rates were totaled across the counties in each group. Group 1, Counties without an EBI 2006-2010: Bedford, Carbon, Franklin, Fulton, Lebanon, Schuylkill, Somerset, and Susquehanna Group 2, Counties beginning implementation 2007-2009: Allegheny, Berks, Cameron, Clarion, Elk, Forest, Lackawanna, McKean, Monroe, Pike, and Potter

Placements as a percent o dispositions Pennsylvania (County Comparison) Juvenile Court Placement Rates: A comparison of counties with and without an EBI 11 10.5 10 9.5 9 8.5 8 7.5 7 2005 2006 2007 2008 2009 2010 No EBI during 6- year period Adopted EBI in '07,' 08, or '09

Pennsylvania (County Comparison) The Juvenile Justice placement rate for the two groups was comparable prior to adopting an EBI. The placement rate for counties that did not adopt an EBI dropped temporarily, but then returned to its 2005 level. There was virtually no change in placement rate from 2005 to 2010. Counties who began an EBI during the intervening years saw a 28% decrease in the rate of placements, from 10.84% in 2005 to 7.78% in 2010. There was a steady decrease over the 6-year period.

Placements of Youth In Care, Ages10-17, In a Restrictive Placement as of March 31 Pennsylvania (County Comparison) Children & Youth Placements: A comparison of counties with and without an EBI 39 37 35 33 31 29 No EBI during 6- year period Adopted EBI in '07, '08, or '09 27 25 2006 2007 2008 2009 2010 2011

Pennsylvania (County Comparison) At baseline, counties that went on to adopt an EBI had a higher rate of Children & Youth placements than the counties that did not go on to adopt an EBI From 2007 to 2008, restrictive placements decreased significantly for counties that adopted at least one EBI, then remained fairly steady. This group saw an overall decrease of 9% in restrictive placement rates, from 35.3% of youth in 2006 to 31.98% of youth in 2010. Counties choosing not to adopt an EBI saw a steady increase in the percentage of youth in restrictive placements. Over six years the placement rate increased 22%, from 30.88% to 37.90%.

Pennsylvania - Conclusion The number of EBI programs and the number of Pennsylvania counties implementing an EBI have grown steadily over the past 7 years. Across all placement types (Juvenile Justice, C&Y, M.A.- funded) there have been decreases in the numbers and rates of placement. As a whole, counties implementing EBIs have shown substantial decreases in placement rates while counties without EBIs have shown no change or even increases.

For more information including materials from this presentation: EPISCenter 206 Towers Building University Park, PA 16802 Phone: (814) 863-2568 Fax: (814) 865-3936 Email: EPISCenter@psu.edu Web: www.episcenter.psu.edu The EPISCenter is a project of the Prevention Research Center, College of Health and Human Development, Penn State University, and is supported by funding from the Pennsylvania Commission on Crime and Delinquency and the Pennsylvania Department of Public Welfare as a component of the Resource Center for Evidence-Based Programs and Practices.

MST: Funded by Medicaid State-Wide, Resulted in Decreased Recidivism, Decreased Placement Rates and Cost Savings New Mexico, USA Presenter: David Bernstein, Center for Effective Interventions

New Mexico New Mexico MST Outcomes Tracking Project Description In July 2001, New Mexico s Medicaid Behavioral Health system started program to fund MST NM Children, Youth and Families Department provided funding for evaluation; conducted by Anita Saranga Coen, LCSW, Focus Research & Evaluation NM Outcomes Tracking Project began collaboration with Colorado s Center for Effective Interventions and the MST Institute Developed outcome tracking system using a specialized menu on the MSTI Enhanced Website

New Mexico New Mexico MST Outcomes Tracking Project Findings Tracked data from 2005-2011 2386 youth were served across 10 MST providers and across 23 counties The following indicators improved from admission to discharge Legal, mental health and substance abuse problems Out of home living situations Instrumental indicators of youth and family functioning

New Mexico New Mexico MST Outcomes Tracking Project Findings 641 youth completed MST treatment, and caregivers reported 6 and 12 month follow-up data Six- and twelve-month post discharge data demonstrated maintenance of the initial gains

New Mexico Substantial Cost Reductions Outcome evaluation showed substantial reductions in out of home placement and its associated costs compared to costs pre- and during MST treatment Reports from clinicians and caregivers showed over $2 million in estimated Net Benefits for the six months after discharge due to reduced use of: residential psychiatric inpatient services detention services

New Mexico Substantial Cost Reductions, continued New Mexico s Medicaid managed care entity reported an $8.5 million (64%) decrease in paid claims for the six months after discharge compared to the six months prior to admission to MST for: residential/group mental health psychiatric inpatient therapeutic foster care services Report is in the process of being updated through 2012 and will include all paid Medicaid claims for the period 12 months before admission to MST, during MST treatment, and for the 12 months after discharge.

MST: Part of Huge Initiative to Increase Use of EBP s New York City, USA Presenter: Tina Schleicher, Children s Village

Initiative to Increase Use of EBP s Two sides of system change

Phases and Initiatives through ACS (Administration for Children s Services) Initiatives have been driven by the Mayor s office in NYC ACS absorbed juvenile justice system 2006 2008 ACS brought EBPs into their juvenile justice system: JJI and FAP initiatives

Phases and Initiatives through ACS Fall 2011, ACS participated in OCFS (Office of Children and Family Services) move to bring kids close to home For residents of NYC who would normally be sent to upstate correctional facilities, some out-of-state Now these youth will be sent to residential facilities in NYC, then aftercare, SIB Funded EBPs for this aftercare post placement - still in process of being set-up Currently ACS is bringing EBPs into general prevention work within child protection

Unique Opportunity for Collaboration Around EBP s Collaboration between many participants: ACS and OCFS MST providers and Network Partners (Children s Village, Evidence-Based Services, University of Washington, and MST Services) in NYC New York City Implementation Support Center hosted by New York Foundling, funded by EBP developers and providers MST Services

Current State of MST in New York City 26 MST teams currently in operation in New York City 20 MST-SA 2 MST-Psych 2 MST-FIT 2 Blue Sky

ACS Massive Investment Voluntary conversion of existing contracts to EBPs (called the Expression of Interest funding) $ value unknown Teens Services RFP - $22+ million for city-wide implementation of EBPs and promising models Will include 8 MST-SA teams and 8 MST-CAN teams Largest consolidated roll out of EBPs under one initiative EVER!

ACS Now in Huge Re-Organization Bound to have a big impact on ACS MST Services providing input into re-writing processes and standards Bottom Line: Huge investment, and huge number of kids/families impacted

MST: Part of Large-Scale, Nation-Wide Social Change Effort to Enhance Family- Focused Treatments Norway Presenter: Bernadette Christensen, The Norwegian Center for Child Behavioral Development

Norway: Nation-Wide Implementation First nation-wide implementation of MST MST implementation in Norway started in 1999 First 4 teams were part of an RCT to evaluate MST in the Norwegian context Decision to implement MST across the country was made before RCT was finished, as part of a social change effort driven by the Ministry of Children and Family Affairs By 2003, there were 25 MST teams across the country

Norway -Other Interventions Parent Management Training Oregon Model (PMTO) provides family management training for parents of children with conduct problems Early initiatives for children at risk (TIBIR) is a lowthreshold prevention service that is implemented in different municipalities all over the country 1037 active practitioners of the TIBIR interventions PALS is a school-wide model aimed at strengthening children s academic and social competence 200 schools in 73 municipalities are participating in the PALS program

Norway: Evidence-Based Family Services and Treatment 800 families received MST 4600 families received PMTO training In 2011 142 families received FFT One MTFC team was established

Norway The Norwegian Center for Child Behavioral Development Objective for the Center: strengthen knowledge and competence in the work with conduct problems among children and youth Center conducts research, developmental work, training and supervision Has a particular responsibility to work with implementation and research-based evaluation of methods used in the work with conduct problems among children and youth Funded by 3 different ministries in Norway

Results MST Norway 1999-2011 100% 80% 60% 40% 20% 0% Admission Discharge 6 mths 12 mths 18 mths

MST IS making a difference in the world

Adaptations of MST: Expanding the Family of MST Interventions Scott Henggeler

Usual Adaptation Process 1) Idea Targets costly and multidetermined problem of youth for which effective and efficient interventions are not available. 2) Pilot/feasibility study Includes specification of model adaptations and assesses whether they are feasible. 3) Efficacy trial Determines whether desired outcomes can be achieved under favorable implementation conditions. 4) Effectiveness trial Determines whether desired outcomes can be achieved under real world implementation conditions. 5) Transportability pilots Involves transport to multiple settings under close adaptation developer oversight to work out bugs. 6) Mature transport MST Services and Network Partners take the lead in transport efforts. 7) Proactive dissemination e.g., marketing, lobbying

MST-PSB MST-CAN MST-SA MST-Psychiatric MST-FIT MST-HC Status of MST Adaptations Problem Sexual Behavior Child Abuse and Neglect Substance Abuse Serious Emotional Disturbance Family Integrated Transition (incarcerated juvenile offenders) Chronic Health Care Conditions (diabetes, obesity, HIV, asthma) MST-BSF Building Stronger Families (adult substance abuse + child maltreatment) MST-EA BlueSky MST-ASD MST-MID Emerging Adults (17-20 year olds with criminal justice and mental health problems) FFT/MST/MTFC continuum of care Autism Spectrum Disorders Mild Intellectual Disability

MST-PSB (Problem Sexual Behavior) Nature of Adaptations Strong emphasis on assuring community safety, addressing caregiver denial, analyzing grooming of victims Promoting age-appropriate social experiences with peers Research 3 RCTs (2 efficacy, 1 effectiveness), mediational study, cost-benefit analysis, long-term follow-up Mature Transport Led by MST Associates (Borduin) 28 sites in US, 2 in England, 2 in Netherlands

MST-CAN (Child Abuse and Neglect) Nature of Adaptations Strong emphasis on family safety planning and clarification of the abuse CBT used for anger management and trauma; adult substance abuse treatment and family communication training provided Research 2 RCTs (1 efficacy, 1 effectiveness), cost-benefit study in progress Ongoing research in Netherlands and Switzerland Mature Transport Led by MST Services (Swenson) Sites in Switzerland, Netherlands, UK (additional UK and NYC sites forthcoming)

MST-SA (Substance Abuse) Nature of Adaptations Juvenile offenders with substance use problems Integrates contingency management (CM; functional analysis of drug use, drug use testing, youth and family drug management plans) into MST intervention protocol Research Case studies 1 RCT in the context of juvenile drug court Mature Transport Led by Evidence Based Services (Randall), MST Services (Rowland), Children s Village, and Liberty Resources 29 teams in US, 3 in England, 2 in Denmark

MST-Psychiatric Nature of Adaptations Youth with severe mental health problems typically cooccurring with serious antisocial behavior Integrates psychiatric care (psychiatrist, medication management) into team, provides safety crisis training and increased intensity of services Research Case studies 2 RCTs (1 hybrid efficacy/effectiveness, 1 effectiveness) Mature Transport Led by MST Services (Rowland and Aucoin) Current transportability pilots in NYC

MST-FIT (Family Integrated Transition) Nature of Adaptations Incarcerated juvenile offenders treatment starts 2 months prior to release Integrates components of Dialectical Behavioral Therapy (DBT), motivational interviewing, and relapse prevention Research Favorable pilot/feasibility and cost benefit findings RCTs in progress in Chicago and NYC Transport Led by Trupin 9 transportability pilots in US

MST-HC (Chronic Health Care Conditions) Nature of Adaptations Addresses barriers to effective illness management for diabetes, obesity, asthma, and HIV infection Therapist training in disease management and collaboration with medical team Research 4 RCTs (3 with diabetes, 1 with obesity) Case studies, mediational studies, cost effectiveness, pilot studies Seeking funding for HIV efficacy study (Letourneau) Transport Led by Ellis and Naar-King Seeking transportability pilot sites

MST-BSF (Building Stronger Families) Nature of Adaptations Co-occurring parental substance abuse and child maltreatment Integrates MST-CAN with Reinforcement Based Treatment (RBT) for adult substance abuse Research Favorable pilot/feasibility findings Hybrid efficacy/effectiveness RCT in progress in Connecticut Transport If research results are favorable, transportability pilots will be led by Swenson and Schaeffer

MST-EA (Emerging Adults) Nature of Adaptations Young adults (17-20 years) with co-occurring criminal justice and mental health difficulties Provides life coach, psychiatric care, housing and independent living, career goals, adult relationship skill development, parenting curriculum Research Randomized pilot/feasibility study in progress in Connecticut Transport If research results are favorable, effectiveness research will be led by Sheidow

BlueSky Project Nature of Adaptations Provides FFT-MST-MTFC integrated (clinically, administratively, and quality assurance) evidence-based, continuum of care Research Favorable pilot/feasibility findings Hybrid efficacy/effectiveness study in progress in NYC Transport If research results are favorable, transportability pilots will likely be led by provider organization connected with FFT, MST, and MTFC purveyors

MST-ASD (Autism Spectrum Disorders) Nature of Adaptations Focuses on aggression and disruptive behaviors of youth with ASD Addresses cognitive impairments, parental expectations, and communication difficulties Promotes social competencies and appropriate social behavior Research Descriptive pilot study in press and randomized efficacy trial in preparation Transport If efficacy results are favorable, an effectiveness study will be led by Borduin

MST-MID (Mild Intellectual Disability) Nature of adaptations Antisocial youth with IQ between 50-85 Currently identifying adaptations needed and developing a manual, via pilot teams with Stichting Prisma organization in the Netherlands Research Currently in the pilot/feasibility stage Research funding is being sought Project participants: de Vuyst, de Bruijn, Bakker, van Geffen, Moonen, Didden, and Cunningham

Interested in implementing an adaptation that s at the stage of mature transport? Contact Keller Strother, President of MST Services Keller.Stother@mstservices.com

Looking Ahead Our challenge- to more fully address the needs that MST can address successfully How can we leverage the strengths of knowing we can achieve positive outcomes lessons learned from individual families successes the strong ongoing work by dedicated staff and our global reach?

Priority Work Remaining to be Done Stabilize teams funding show stakeholders how MST is worth it Develop a shared sense of urgency and act effectively to utilize full capacity of current teams, increasing referrals and keeping all therapists at full caseloads Build even more MST standard and adaptation teams Keep more youth in mainstream school Develop a shared sense of urgency and act effectively to improve upon poor outcomes

Thank You Tak Tack Ka Kite Ano A hui hou Danke Dank u wel Gracias Merci Takk