Multisystemic Therapy – Problem Sexual Behavior (MST-PSB)

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- to 7-month period.

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). Multisystemic Therapy-Problem Sexual Behavior (MST-PSB) is guided by the same principles and uses many of the same evidence-based techniques as in MST for nonsexual offenders but focuses on aspects of the youth’s ecology that are functionally related to the problem sexual behavior. At the family level, MST interventions often aim to (a) reduce caregiver and youth denial about the sexual offenses, (b) remove barriers to effective parenting, (c) enhance parenting knowledge, and (d) promote affection and communication among family members. Moreover, conjoint work with family members and other appropriate persons in the youth’s social ecology (e.g., teachers, extended family) is essential in the development of plans for risk reduction, relapse prevention, and victim safety. At the peer level, interventions often target youth social skill and problem-solving deficits to promote the development of friendships and age-appropriate sexual experiences. Peer relations interventions are conducted by the youth’s caregivers, with the guidance of the therapist, and often consist of active support and encouragement of relationship skills and associations with non-problem peers, as well as substantive discouragement of associations with deviant peers (e.g., applying significant sanctions). Likewise, under the guidance of the therapist, the caregivers often develop strategies to monitor and promote the youth’s school performance; interventions in this domain typically focus on establishing improved communication between caregivers and teachers and on restructuring after-school hours to promote academic efforts.

MST-PSB is individualized for each family. Families are provided family therapy while 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.

Blueprints has certified three studies evaluating MST-PSB (Borduin et al., 1990, 2009; Letourneau et al., 2009). The first study was a pilot conducted in Columbia, Missouri (Borduin et al., 1990) in which 16 adolescents arrested for sexual offenses were randomized to either MST-PSB or individual therapy control conditions. Recidivism data were collected at an approximately 3-year follow-up. The second Blueprints-certified study was also conducted in Columbia, Missouri (Borduin et al., 2009) and compared the efficacy of MST-PSB versus usual community services (UCS), the latter consisting of cognitive-behavioral group and individual treatment. A total of 48 youth and their families were randomly assigned to MST-PSB (n = 24) and UCS (n = 24). 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. The third Blueprints-certified study was a randomized control trial conducted in Chicago, Illinois (Letourneau et al., 2009) with a sample of 127 participants referred by the Cook County State’s Attorney’s Office after having been charged with a sexual offense. The assessments with each youth and caregiver occurred within 72 hours of recruitment into the study, and at 6, 12, and 18 months post-recruitment.

Results from Borduin et al. (1990) showed that fewer subjects in the MST-PSB condition had been rearrested for sexual crimes (12.5% vs. 75%), as well as nonsexual crimes (25% vs. 50%). The frequency of sexual rearrests was significantly lower in the MST-PSB condition than in the control condition (0.12 vs. 1.62). The number of rearrests was also lower in the MST-PSB group than control group for nonsexual offenses (0.62 vs. 2.25). Significant outcomes were found for 17 of the 18 outcome measures in Borduin et al. (2009), including improved caregiver and youth psychiatric symptoms; family functioning; and youth behavioral problems, peer relations, grades in school, criminal behavior, and sexual reoffending. Letourneau et al. (2009) found that the treatment group improved significantly more than the control group on 8 of 11 outcomes tested: youth-reported deviant sexual interest, youth-reported sexual risk, caregiver-reported deviant sexual interest, caregiver-reported sexual risk, delinquency, substance abuse, youth-reported externalizing, and out-of-home placement.

In terms of cost-benefit analysis, Washington State Institute for Public Policy (December 2018) reports $1.60 in measured benefits per $1 spent in implementing MST-PSB.

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