Author: Pam Buckley

 

Program Description: Multisystemic Therapy® (MST®) is an intensive family- and community-based treatment that addresses the multiple causes of serious antisocial behavior across key settings, or systems within which youth are embedded (family, peers, school, and neighborhood). Because MST emphasizes promoting behavior change in the youth’s natural environment, the program aims to empower parents with the skills and resources needed to independently address the inevitable difficulties that arise in raising teenagers, and to empower youth to cope with the family, peer, school, and neighborhood problems they encounter.

A Master’s-level therapist works with the family to identify strengths and weaknesses in the adolescent, the family, and their transactions with other systems (e.g., peers, friends, school, parental workplace). Identified problems are targeted for change by using the strengths within each system to facilitate change. Intervention approaches are derived from well-validated strategies such as strategic family therapy, structural family therapy, behavioral parent training, and cognitive behavioral therapy.

Typically, MST uses several types of interventions during the course of the 3- to 5-month program. Individual-level interventions generally involve using cognitive behavior therapy to modify the adolescent’s social perspective-taking skills, belief or motivational system, and ability to deal assertively with negative peer pressure. Family-level interventions aim to remove barriers to effective parenting, enhance parenting competencies, and promote affection and communication among family members. Interventions might include introducing systematic monitoring, reward, and discipline systems; prompting parents to communicate effectively with each other about adolescent problems; problem solving day-to-day conflicts; and developing social support networks. Peer-level interventions frequently aim to decrease affiliation with delinquent and drug-using peers and to increase affiliation with prosocial peers. Interventions in the school domain may focus on establishing positive lines of communication between parents and teachers, parental monitoring of adolescent’s school performance, and restructuring after-school hours to support academic efforts.

Results: Blueprints has certified five studies evaluating Multisystemic Therapy. A summary of the study demographics is as follows (see Table 1):

• The samples included youths with serious behavior problems.
• Study 1 was done by the developer; Studies 2-5 were conducted by independent researchers.
• Most youth were male (reported in binary male/female categories).
• Two studies were conducted in the U.S. (Missouri, and SE states); 3 were in Northern Europe.
• Race, ethnicity, and income were mixed. In terms of race, for the two U.S. studies, one sample was 30% Black or African American and 70% White, and the other sample was 60% Black or African American and 40% White.

Study 1: Borduin et al. (1995) randomly assigned 176 adolescents referred through the State of Missouri juvenile courts to the intervention group (n=92) or an individual therapy control group (n=84). Adolescents and parents completed pretest and posttest assessments that included self-reports and observational tasks. Additionally, arrest data was obtained approximately four years after program completion from police and court records. Compared with the control group at posttest, MST youth experienced significantly decreased parent-reported problem behaviors and improved family relations per the youth, parents and observations. By four years post intervention, the intervention group had fewer arrests (including violent arrests).

Study 2: Ogden and Halliday-Boykins (2004) randomly assigned 100 Norwegian youths with serious antisocial behavior to an intervention group (n=62) or a control group receiving child welfare services (n=38). Assessments at posttest and two-year follow-up measured problem behavior, delinquency, and out-of-home placement. The intervention group, relative to the usual-services control group, showed significantly decreased youth internalizing symptoms at posttest.

Study 3: Weiss et al. (2013) conducted a study in the southeastern U.S. in which they randomly assigned 164 youths enrolled in behavior intervention classrooms to MST (n=84) or to a treatment-as-usual control group (n=80). Assessments from posttest to a one-year follow-up measured conduct problems, externalizing, and criminal offending. Youth in the intervention group showed significantly lower parent- and youth-reported externalizing and fewer absences in school compared with youth in the control group.

Study 4: Deković et al. (2012) and Asscher et al. (2013) randomly assigned 256 Dutch adolescents with antisocial behavior to an MST intervention group (n=147) or a treatment-as-usual control group (n=109). Assessments at pretest and posttest measured a variety of outcomes relating to antisocial behavior and family relations. Relative to the control group, the intervention group showed significant reductions in externalizing, oppositional defiant disorder, conduct disorder and property offenses as well as improved parent-child relationship quality.

Study 5: Butler et al. (2011) randomly assigned 108 adolescents referred by youth offending services in London, England, to an MST intervention group (n=56) or a treatment-as-usual control group (n=52). Assessments from posttest to 12 months post intervention measured reoffending and problem behavior. Relative to the control group, the MST youth showed a significant decrease in non-violent offending, aggression, delinquency, and psychopathic traits.

Table 1: Summary of Sample Demographic Characteristics

References:

Study 1:
Borduin, C. M., Mann, B. J., Cone, L. T., Henggeler, S. W., Fucci, B. R., Blaske, D. M. & Williams, R. A. (1995). Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence. Journal of Consulting and Clinical Psychology, 63, 569-578.

Study 2:
Ogden, T., & Halliday-Boykins, C. A. (2004). Multisystemic treatment of antisocial adolescents in Norway: Replication of clinical outcomes outside of the US. Child and Adolescent Mental Health, 9(2), 77-83.

Study 3:
Butler, S., Baruch, G., Hickey, N., & Fonagy, P. (2011). A randomized controlled trial of Multisystemic Therapy and a statutory therapeutic intervention for young offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 50(12), 1220-1235.

Study 4:
Asscher, J. J., Deković, M., Manders, W. A., van der Laan, P. H., Prins, P. J. M., & the Dutch MST Cost-Effectiveness Study Group 4. (2013). A randomized controlled trial of the effectiveness of Multisystemic Therapy in the Netherlands: Post-treatment changes and moderator effects. Journal of Experimental Criminology, 9, 169-187.

Deković, M., Asscher, J. J., Manders, W. A., Prins, P. J. M., & van der Laan, P. (2012). Within-intervention change: Mediators of intervention effects during Multisystemic Therapy. Journal of Consulting and Clinical Psychology, 80(4), 574-587.

Study 5:
Weiss, B., Han, S., Harris, V., Catron, T., Ngo, V. K., Caron, A., . . . Guth, C. (2013). An independent randomized clinical trial of Multisystemic Therapy with non-court-referred adolescents with serious conduct problems. Journal of Consulting and Clinical Psychology, 81(6), 1027-1039.

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Program Description: The Blues Program actively engages high school students exhibiting depressive symptoms or who are at risk of onset of major depression in six weekly, one-hour group (4-8 participants) sessions and home practice assignments. Sessions focus on building group rapport, increasing participant involvement in pleasant activities, learning and practicing cognitive restructuring techniques, and developing response plans to future life stressors. Motivational enhancement exercises are used to maximize willingness to use new skills, strategic self-presentation is used to facilitate internalization of key principles, behavioral techniques function to reinforce the use of new skills, and group activities foster feelings of social support and group cohesion. In-session exercises require teens to apply skills taught in the program, while home assignments reinforce these skills and help participants to apply the skills to their daily life.

Results: Blueprints has certified two studies evaluating the Blues Program. Both studies included students experiencing depressive symptoms and excluded students with a major depression diagnosis.

Study 1: The first study included 378 students from five high schools who were randomly assigned to the intervention group (n=126), or one of two control groups – cognitive-behavioral bibliotherapy (n=128) or educational brochure (n=124). Described in the certified article (Rohde, Stice, Shaw, & Brière, 2014), participants completed a survey and diagnostic interview at pretest, posttest and six-month follow-up. At posttest, intervention participants experienced significantly lower depressive symptom severity than the brochure control group and moderately lower (p=.06) symptom severity compared to the cognitive-behavioral bibliotherapy group. At six-month follow-up, the onset of major depressive disorder was significantly greater for both control groups compared with the intervention group.

Characteristics of Study 1 Sample as Reported by Study Authors:

Study 2: Stice et al. (2008, 2010) examined 341 students from six high schools who were randomly assigned to four conditions: the intervention group (n=89), supportive-expressive group (n=88), bibliotherapy group (n=80), or educational brochure group (n=84). Students completed self-report surveys and diagnostic interviews at pretest, posttest, 6-month follow-up, and one- and two-year follow-ups.

Relative to participants in one or more comparison groups, students in the intervention group had:

♦ greater reductions in interviewer-rated depressive symptoms at posttest, and one- and two-year follow-ups

♦ greater reductions in self-reported depressive symptoms at posttest, six-month follow-up, and two-year follow-up

♦ lower rates of major depression onset at six-month follow-up and two-year follow-up

♦ greater reductions in self-reported substance use at posttest and six-month follow-up

Characteristics of Study 2 Sample as Reported by Study Authors:

References:

Study 1:

Rohde, P., Stice, E., Shaw, H., & Brière, F. N. (2014). Indicated cognitive behavioral group depression prevention compared to bibliotherapy and brochure control: Acute effects of an effectiveness trial with adolescents. Journal of Consulting and Clinical Psychology, 82(1), 65-74. doi:10.1037/a0034640

Study 2:

Stice, E., Rohde, P., Seeley, J. R., & Gau, J. M. (2008). Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: A randomized efficacy trial. Journal of Consulting and Clinical Psychology, 76(4), 595-606. doi:10.1037/a0012645

Stice, E., Rohde, P., Gau, J. M., & Wade, E. (2010). Efficacy trial of a brief cognitive-behavioral depression prevention program for high-risk adolescents: Effects at 1- and 2-year follow-up. Journal of Consulting and Clinical Psychology, 78(6), 856-867. doi:10.1037/a0020544

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Program Description: The RealTeen internet-based program is designed to improve adolescent girls’ general personal and social skills and skills specific to drug use. The program operates through a secure website, which offers a homepage with a variety of content, including feeds from the latest entertainment sites, online polls, horoscopes, beauty tips, and a quote of the day. Participants in the program also use the RealTeen website to complete 9 intervention sessions, requiring approximately 20 minutes each to complete. Sessions cover goal setting, decision making and problem solving, puberty, self-esteem and body image, coping, drug knowledge, norms and social influences, refusal skills, and a review. In these sessions, participants are guided through content and asked to respond to questions and complete practice exercises.

Results: Blueprints has certified one study evaluating RealTeen. In a randomized controlled trial, Schwinn et al. (2017, 2019) recruited 13-14 year old girls from ads on Facebook and then randomly assigned them to the intervention (n=396) or control (n=392) groups. Study participants completed online assessments at pretest, posttest, 1-year follow-up, 2-year follow-up, and 3-year follow-up. Compared to the control group, girls in the intervention group reported significantly lower rates of:

♦ cigarette use at posttest and 1-, 2-, and 3-year follow-up

♦ marijuana use at 2-year follow-up

♦ other drug use (e.g., cocaine, club drugs) at 2-year follow-up

♦ e-cigarette use at 3-year follow-up

Characteristics of Study Sample as Reported by Study Authors:

References: 

Schwinn, T. M., Schinke, S. P., Hopkins, J., Keller, B., & Liu, X. (2017). An online drug abuse prevention program for adolescent girls: Posttest and 1-year outcomes. Journal of Youth and Adolescence, 47(3), 490-500. doi:10.1007/s10964-017-0714-4

Schwinn, T. M., Schinke, S. P., Keller, B., & Hopkins, J. (2019). Two- and three-year follow-up from a gender-specific, web-based drug abuse prevention program for adolescent girls. Addictive Behaviors, 93, 86-92. https://doi.org/10.1016/j.addbeh.2019.01.010

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Program Description: Family Foundations was developed in collaboration with childbirth educators to enhance coparenting quality among couples who are expecting their first child. The program consists of four prenatal and four postnatal sessions, run once a week, with each two-hour session administered to groups of 6-10 couples. A trained male-female team leads the sessions and follows the Family Foundations curriculum. The female leader is a childbirth educator, and the male leader is experienced at working with families and leading groups. Ongoing observation of sessions facilitates regular supervision discussions.

The program focuses on coparenting and the coparenting relationship, rather than other romantic relationship or parenting qualities. In assisting parents to work together supportively, the program content covers emotional self-management, conflict management, problem solving, communication, and mutual support strategies. The program organizes material into three major domains: Feelings, Thoughts, and Communication. These domains help participants remember and utilize program tools. Parenting strategies include an understanding of temperament, fostering children’s self-regulation, and promoting attachment security. However, as the focus is on coparenting, these topics are examined in terms of whole-family dynamics. The prenatal classes introduce the couple to themes and skills, and the postnatal classes revisit the themes once the couple has experienced life as parents and coparents. The delivery is psychoeducational and skills-based, with didactic presentations, couple communication exercises, written worksheets, videotaped vignettes of other families, and group discussion. Skilled facilitators are able to maintain fidelity to the content while engaging parents in an interactive, supportive group learning context.

Results: Blueprints has certified two studies evaluating Family Foundations.

Study 1: In the first study (Feinberg & Kan, 2008), couples were randomly assigned in two small cities to the intervention (n=89) or to a control group (n=80) that received mailed literature on developmental stages and selecting quality childcare. Blueprints certified the long-term follow-up (6-7 years after program completion) reported in Feinberg et al. (2014), in which:

♦ Teachers reported lower rates of internalizing for the intervention group children (compared to the children in the control group).

♦ Additionally, intervention group boys had lower teacher-rated attention problems, as well as fewer anxious/depressed, aggressive, and internalizing and externalizing behaviors.

Characteristics of Study 1 Sample as Reported by Study Authors:

Study 2: The second Blueprints-certified study included cohabiting heterosexual couples from three mid-Atlantic and one southern state. Couples were randomly assigned to the intervention (n=221) or control condition (n=178) which received materials on childcare and child development. Feinberg and Gedaly (2021) found at the 7-year follow-up assessment that the intervention group, compared to the control group, showed significantly better observer-rated positive affect, negative affect, physical aggression toward objects, and affection toward parents, and significantly lower teacher-rated externalizing behavior.

Characteristics of Study 2 Sample as Reported by Study Authors:

Cost-Benefits: To date, the Washington State Institute for Public Policy has not conducted a cost-benefit analysis of implementing Family Foundations.

References:

Study 1: Feinberg, M. E., Jones, D. E., Roettger, M., Solmeyer, A., & Hostetler, M. L. (2014). Long-term follow-up of a randomized trial of Family Foundations: Effects on children’s emotional, behavioral, and school adjustment. Journal of Family Psychology, 28(6), 821-831.

Study 2: Feinberg, M., & Gedaly, L. (2021). Family Foundations child outcomes at age 7: Teacher ratings and observational outcomes [Unpublished manuscript]. The Pennsylvania State University.

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Program Description: During the 9- to 24-month, full-time YouthBuild program, young adults spend half of their time learning construction trade skills by building or rehabilitating affordable housing, community centers or schools. They spend the other half of their time in a YouthBuild classroom earning a high school diploma or equivalency degree. Personal counseling and training in life skills and financial management are provided. The students are part of a mini community of adults and youth committed to each other’s success and to improving the conditions in their neighborhoods.

Characteristics of Study Sample as Reported by Study Authors:

 

Results: Blueprints has certified one study evaluating YouthBuild. In a randomized controlled trial, Miller et al. (2016, 2018) examined 75 program sites with 3,929 youth randomly assigned within sites to intervention and control groups. The study followed participants for 48 months and found:

♦ At 30 months – 6 months after the maximum length of the program – intervention participants, compared with control participants, reported significantly higher rates of earning high school equivalency credentials, enrollment in college, and participation in vocational training, as well as slightly higher wages.

♦ At the 48-month survey, effects were sustained two years after the end of the program.

♦ Similarly, administrative data indicated higher rates of college attendance, degree attainment, employment in year 2, and earnings in year 1.

♦ Survey reports also indicated significantly higher levels of civic engagement for the intervention group.

Cost-Benefits: To date, the Washington State Institute for Public Policy has not conducted a cost-benefit analysis of implementing YouthBuild. However, Miller et al. (2018) conducted a cost-benefit analysis and found that the program benefits through four years did not outweigh the costs, though the authors suggested that benefits may continue to accrue over the participants’ lifetime.

References:

Miller, C., Cummings, D., Millenky, M., Wiegand, A., & Long, D. (2018). Laying a foundation: Four-year results from the national YouthBuild evaluation. MDRC.

Miller, C., Millensky, M., Schwartz, L., Goble, L., & Stein, J. (2016). Building a future: Interim impact findings from the YouthBuild evaluation. New York: MDRC.

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Cannabis eCHECKUP TO GO is a brief online, personalized feedback intervention designed to motivate college students to reduce cannabis (marijuana) use by correcting misperceived social norms and providing education on cannabis use. After completing a web-based assessment on demographic measures, cannabis consumption, cannabis consequences and perceived social norms, participants receive standard personalized feedback on their cannabis use and information on their perceptions of cannabis use norms versus actual use prevalence at their university and nationally. The goal of this feedback is to highlight the discrepancies between student perceptions and actual prevalence among peers to increase cognitive dissonance related to their own use. Additionally, participants receive a list of protective behavioral strategies and are asked to consider using these change strategies to help reduce their cannabis use. Finally, they receive suggestions on what they could purchase (i.e., cell phone bills, streaming services) if they save the money they would spend on cannabis.

Blueprints has certified one study evaluating Cannabis eCHECKUP TO GO.

Riggs et al. (2018) conducted a randomized control trial of college students at a large public university in a western state. Undergraduate students screened for heavy cannabis use were eligible for the study and assigned to the intervention condition (n=146) or healthy stress management control condition (n=155). At six weeks post-intervention, compared to control participants, students in the intervention group showed significantly greater reductions in the number of hours high per week, days high per week, weeks high per month, and periods high per week.

To date, the Washington State Institute for Public Policy has not conducted a cost-benefit analysis of implementing Cannabis eCHECKUP TO GO.

References:

Riggs, N. R., Conner, B. T., Parnes, J. E., Prince, M. A., Shillington, A. M., & George, M. W. (2018). Marijuana eCHECKUPTO GO: Effects of a personalized feedback plus protective behavioral strategies intervention for heavy marijuana-using college students. Drug and Alcohol Dependence, 190, 13-19. https://doi.org/10.1016/j.drugalcdep.2018.05.020

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An Early College High School offers enrolled students an opportunity to earn an associate degree or up to 2 years of college credits toward a bachelor’s degree during high school at no or low cost to the students. Often described as “small schools that blur the line between high school and college,” the model is designed to enable students to take college courses while still receiving support from high school staff. Many early college models target students who are traditionally underrepresented in postsecondary education, including minority students, students from low-income families, and students who are in the first generation of their families to go to college.

The early college is a comprehensive school reform model that focuses explicitly and purposefully on preparing all of its students for college. Core design principles include: 1) partnering with colleges and universities for enrolled high school students to take college courses; 2) providing opportunities to take college-level courses to all students, not only those who are academically advanced – with some models specifically focusing on dropouts or students at-risk of dropping out of high school; 3) giving students a wide variety of academic and social supports, including personalized relationships; academic tutoring; advising; help with study skills, time management, self-advocacy, and other college “life skills;” and college preparation. In addition, early colleges provide students with supports in the formal transition to college, such as assistance in completing college applications and financial aid forms. Some early colleges also have other design principles for adults in the school (for example, professional development focused on a common vision and a collaborative, learning environment for staff).

Blueprints has certified two studies evaluating Early College High School Model.

Haxton et al. (2016) and Song & Zeiser (2019) conducted a multisite randomized controlled trial using lottery assignments. The study recruited from a five-state sample of 17 lotteries across 10 schools and 3 cohorts of students entering high school in 2005-06, 2006-07, and 2007-08, which resulted in a sample size of 2,458 students. Participants were followed to six years after expected high school graduation. Students participating in the intervention were more likely than those in the control group to enroll in any college, enroll in a 2-year college, and earn a college credential within 2 years and within 6 years of expected high school graduation. They were also more likely to earn a certificate, an associate degree, or a bachelor’s degree within 6 years of expected high school graduation.

Edmunds et al. (2017, 2020) conducted another multisite randomized controlled trial with lottery assignments. This single-state study included 20 cohorts of students who applied to one of 19 early colleges and enrolled in ninth grade from the 2005-06 to 2010-11 school years. The sample of 4,054 students was followed to six years after completion of 12^th grade. Compared with the control group, intervention students were more likely to enroll in postsecondary education (2 years after high school graduation), attain a postsecondary degree (within 2 and 6 years after graduation), and attain an associate degree (6 years after the end of grade 12).

References:

Edmunds, J. A., Unlu, F., Furey, J., Glennie, E., & Arshavsky, N. (2020). What happens when you combine high school and college? The impact of the early college model on postsecondary performance and completion. Educational Evaluation and Policy Analysis, 42(2), 257-278.

Edmunds, J. A., Unlu, F., Glennie, E., Bernstein, L., Fesler, L., Furey, J., & Arshavsky, N. (2017). Smoothing the transition to postsecondary education: The impact of the early college model. Journal of Research on Educational Effectiveness, 10(2), 297-325.

Haxton, C., Song, M., Zeiser, K., Berger, A., Turk-Bicakci, L., Garet, M. S., . . . Hoshen, G. (2016). Longitudinal findings from the Early College High School Initiative Impact Study. Educational Evaluation and Policy Analysis, 38(2), 410-430.

Song, M., & Zeiser, K. (2019). Early college, continued success: Longer-term impact of early college high schools. Washington, DC: American Institutes for Research.

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