MULTISYSTEMIC THERAPY: COMMUNITY-BASEDTREATMENT FOR HIGH RISK YOUNG OFFENDERS
Rationale and Overview from the Randomized Clinical
Trials in Canada
Alan W. Leschied, Ph.D. C. Psych.*
ACKNOWLEDGEMENTThe M ST clinical trials in Canada
represent the effo rts of manyorganizations and individuals. Foremost I
want to acknowledge Alison Cunningham
who served as the research director for
the f our yea rs. The N ation al C rim ePrevention Centre supported ther e s e a r c h e f f o r t, w h i l e t h e O n t a r i o
M i ni st r y o f C o m m un i ty a nd S o ci a l
S e r v ic e s f u n d e d th e t h e r a p i s t a n d
supervisor training. MST teams workedo u t o f th e f o l lo w in g o r g a n iz a ti o ns :Craigwood Y outh S ervices (London);
Associated Youth Services (Mississauga);
Eastern Ontario Young Offender Services(Ottawa); Kinark Youth Services and
New Path (Orillia and Barrie). Scott
Henggeler and his collea gues at the
Family Services Research Centre as wella s the consultants from MS T Inc. ofC harleston, South Carolina werei nv a l ua b le . W e w a n t t o e xt e nd o u rappreciation to the many community
organizations—probation, children’s aid
socie ties, schools, children’s me ntal
health organizations as well as youth
court judges—who supported this workover the past four years. Lastly, we want
to extend our appreciation to the youngpe ople and their families who
participated in these trials. We trust thatthe results of this effort will further theneeds of families like you well into the
future.
* Professor, Faculty of Education, University ofWestern Ontario, London Ontario, CANADA

54

I. THE SYSTEM OF YOUTH JUSTICEIN CANADA
Administration of youth and adultjustice in Canada has followed the path of
most countries in emphasising the use ofinca rc era tio n to an e ver -inc re as in g
extent. Concerns have been expressed not
only for the cost but also the questionableeffectiveness of imprisoning a
proportionately large num ber ofof fend ers. T he C om missio ner o f theCorrectional Services of Canada, in thespring of 1998, convened a worldconf ere nce studying the issu e. T his
followed a meeting of senior Canadiangovernment officials 18 months earlier
w ho, up on review ing the incre asing
reliance of custody in the context of otherservice and demogra phic trends a ndcosts, concluded that the country could
not support these trends either
financially or in the spirit of effective
service delivery. This observation is noless true in the youth justice system
A. Policy Implications of the Trends
in Young Offender Law
The challenge for policy advocates andservice providers has been to achieve abalance between the desirability of thelower costs associated with alternatives
to custody while being mindful of thecommunity’s demand for safety and thehigh profile nature of criminal justiceissues. While these challenges may seem
demanding and complex, criminal justiceprofessionals are fortunate in having an
extensive literature on which to draw in118TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS
providing policy direction for thedevelopm ent of comm unity-base dintermediate sanctions that are mindfulof both goals of cost-effectiveness andcommunity safety. There is som e
indication of the government’s responseto this issue in proposals for reform of theYoung Offenders Act and the associatedprocesses for youth justice (Department
of J ustice, 19 98). This review of theCanadian situation focuses on levels ofcustody use and factors that influence theu se o f c u st o d y i n t he y o ut h j u st ic esystem. Multisystemic Therapy is one
examp le of an evidenced-base dintervention that can guide practice ins e r v i c e s e l e c ti o n b y a p p r o p r i a t e l ytargeting those most likely to be
consumers of the most costly andintrusive services.
1. Juvenile Justice Innovation
The guiding philosophy to designing ayouth justice system is important toconsid er appreciating on-going
dissatisfaction with what is perceived bymany in the public, as a ‘soft’ on crimea pproa ch to young peop le (B ala a nd
Corrado, 1985). Contemporaneous withother Commonwealth jurisdictions andthe United States, Canada created aseparate system of youth justice with theenactment of the Juvenile DelinquentsAct (JDA) in 1908. It took many years for
the JDA to be used outside of a few urban
centres (Hatch and Griffiths, 1991) but it
gradually took hold. The JDA dictatedthat young people should be responded to
not a s crimina l s b ut ra t he r as ‘mi s guided’ children in need of ‘guidance andassistance’ requiring the judge to take therole of a kindly parent in re-directing the
behaviour of errant youth.
(i)

Reform in the 1960s to the 1980s
In the early 1960s, it was recognisedthat reform of the juvenile system
was necessary. Three major

influences can be identified a s
fuelling the debates that spanned two
decades and culminated in the 1984
proclamation of the YOA.
The first was the growing recognition
th a t y o u n g p e o p le n e e d e d t o b e
af ford ed protection unde r law toensure their rights were not being
violated at any stage of the
pro ce ed ings f ro m q ue stio ning a t
arrest through to sentencing (Bala,
1998). This concern grew from theo b s e r v a t io n t h a t t h e f l e x i b il i ty
afforded by the JDA w as being
misused to justify more intrusive
punishments than an adult would
garner for the same behaviour.
Second, there was increasing
scepticism about the effects of social
re-engineering to reduce conditions
that were thought to influence themisbehaviour of some young people( M a r t i ns o n, 1 9 7 4 , L e s c h ie d a n d
Gendreau, 1986). Simply put, there
was essentially no empirical evidence
that the efforts of the juvenile court
had been followed by anything otherthan steady increases in youth crime.
Third, there was recognition that theoffence of ‘delinquency” was too broad,encompassing, as was often observed,
every act from spitting on the
sidewalk to murder. It was felt that
violations of the criminal law requireda different response from actions andsituation that, while ‘disturbing’ tom a ny , w e r e n o t c rim i na l . T h e se
behaviours, called status offences,included (dep ending upo n thepr o vin ce ) in co r rig ibilit y, s e xu al
im m o r a l i ty , r u n n in g a w a y , a n dtruancy.

55

RESOURCE MATERIAL SERIES No. 59(ii) Basic Tenets of Young Offender Law
RevisionsThree prevailing principles can beseen as guiding and finallyinfluencing the YOA. These included:•••

Protection under law for therights of youth in insuring accessto legal counsel;
Makingaccountability
forbehaviour a guiding principal for
decision making, andAttempting to strike a balance
between the need to make young
people acco untable fo r their
behaviour while coincidentallyproviding appropriate guidanceand direction.

Data from the mid-1980s revealed theeffects on incarceration of the reforms
i n t h e Y O A . I n s e v e r a l st u d i e s ,placem ent in custody in O ntario,
Canada’s most populated province,
showed signs of doubling over rates oftraining school committals under theJDA (Leschied and Jaffe, 1986; 1991
Despite reporting of the early effects
o f YO A re f o r m , p u blic atti tud e scontinued to hold that the yo uthjustice system, similar to the adultsystem, was soft on crime and moreemphasis was needed to be make thep unishm ent fit the crime In thiss p i r i t , a t l e a s t f o u r s ig n i f i c a n trevisions we re ma de at different
intervals that reflected publicdemand for a tougher law (see Bala,
1998). Data on trends in sentencing
under the YOA supported the belief
by many justice professionals that theuse of custody had become a ‘runaway
train’ in the justice syste m(Archambault, 1991).

(iii) Lack of Custody Alternatives
Sentencing judges in the youth courts
have few disposition alternatives thatcan be resorted to with confidence
when an offender poses a risk to thecommunity. This, along with the redirected emphasis of much of thehuman and financial resources
comm itted to the young off endersystem toward s custody, has
restricted the development ofintermediate c ommunity -basedalternatives to the court.
The 1996 International Crime
Victimization Survey f ound that
Canada had levels of crime close to
the a vera ge o f ten other westernindustrialized countries, with 25% of
respondents reporting a victimizationin the previous year from among aselected list of crime s (B esse re r,1998). Compared with a larger list of
34 c ountries, C a na da wa s in thebottom third. Other 19 97 figurespertaining to young offenders, those
who were at least 12 but under 18
years of age when the offence wascommitted, are:
•
•

•

•

•

56

15% of all people charged withviolent offences were under 18
20% of young offenders charged
w i t h a c ri m i n a l o f f e n ce w e recharged with a violent crime and
53% were charged with a property
offenceCompared with other forms ofviolent crime, robbery is more
likely to involve young people:
almost 40% of persons charged
with robbery were youths
Over the past decade, the rate offemal e you ths c har ged wit hviolent crimes has increased twice
as fast as for male youths
54 youths were charged withhomicide in 1997, five more than

118TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS
in 1996 and slightly above thedecade average of 49 per year
Such declines are reflected in theworkload of the nation’s youth courts.
The rate at which young people havebeen appearing in court has fallen forfive years, most especially true forproperty offences where the numberof youth court cases now correspondwith slightly more than 2% of the
youth population, a drop of 20.6%
over four years (Statistics Canada,
1998). Declines are mostly confined toproperty offences because rates forviolent crim es were basicallyu n ch a n g e d . O ve r a ll, t h e ra te o fyouths appearing in court per 10,000
youths dropped 8.5% between fiscal
years 1992-93 and 1996-97. Using
rates is important because post-war
demographics are such that the age
distribution of the Canadian
population varies over time, mostrecently with the maturing of the socalled echo boom (born 1980 to 1995),
the children of the enormous ‘baby
boom’ cohort born between 1945 and1960 are entering the crime prone age(C orrectiona l S ervice of C a na da ,1998).
Half of youth court cases involve
cr im es a g a inst p ro pe rt y ( m o stlyminor thefts and burglaries) while
only one in f ive ca ses involve a ninterpersonal offence such as assault
or robbery. A significant proportion ofo ff e nce s in volve what ar e ca lle dadministration of justice charges,
where a youth has not abided by acondition of release or sentence. The
five most common offences (minor
theft, burglary, failure to comply witha court disposition, minor assault,
and other non-compliance offencessuch as failure to appear in court)
together comprise 60% of all cases.

(iv) Exploring the Range of Dispositions
For youths, the sentencing options(called dispositions) are listed in the
Young Off ende rs Act . O p tions inessence include custody (open, closed,or b oth), com munity sup ervision(probation, community service order)
or measures w ith no correctiona lintervention (fine , discharge,
compensation orders). Orders forcommunity services and restitution
are often em b edd ed in pro ba tionorders. Non- com pliance would
therefore comprise the new offence of
breach of probation making themmore easily enforced than if theystood alone as dispositions.
While a key intention of the YOA wasto extend due process protections toyouths as they were processed by the
courts, vestiges of the former welfarebased juvenile system remain in fourareas:••••

Caps on maximum sentences significantly lower than for adults;
Key emphasis on probation as acorrectional measure;
Limitations on the publication of
the names of offenders; Record
destruction requirements, andSentencing judges are clearlyencouraged to consider individualized sanctions rather than attend
p u re ly t o t h e s e v e r it y o f th e
offence.

Nationally, probation is the mostserious disposition in 51% of casesa nd cu s t o d y i n 3 4 % , f o l l o w e d i nfrequency by community service (6%),
fine (5%), and absolute discharge(2%). Since these data were collected,
conditional discharge has also becomea sentencing option. Other options,which comprise 2% of the mostserious dispositions, include

57

RESOURCE MATERIAL SERIES No. 59
co mp ensatio n to victim, seizur e,
f orf eiture, essays, a polo gie s a ndc o u n s e ll in g p r o g r a m m e s . T h e s e
f i gu r e s r e p r e se n t o n ly th e m o stserious measure ordered even though,in many cases, dispositional options
are combined. For example, ap ro b a t i on t e rm ma y f ol l o w a ft e r
release from custody or victim
compensation may be a condition ofprobation. There is some variation inthese figures depending on the mostserious offence at conviction, as can beseen in Table 1.
Community-based, or non-custodial,dispositions comprise two thirds ofthose handed down by youth courts,
with probation being the mostfrequently imposed. Terms ofp robatio n ca n also be or de red tofollow release from custody.
P r o b a t i o n e r s a r e su p e r v i se d b yprovincial probation officers for terms
that can be as long as two years, as
determined by the judge. In 1996-97,
o nl y 2 2 % w e re fo r m o re t ha n 1 2
months (Statistics Canada, 1998).
Probation as a stand-alone disposition
was most common in cases involving
minor assault, motor vehicle theft,
and trafficking in drugs. Standard
c o n d i t io n s o f p r o b a ti o n in c lu d ekeeping the peace and being of good
behaviour. Optional conditions can
include attending school, seeking andmaintaining employment, or living at
ho m e or with an adult the co urt
deems appropriate.
B. Utilizing Custody in Youth
Justice
Custodial dispositions have resulted in
34% of cases that ended in conviction(Statistics Canada, 1998). A custody
disposition is most likely to be orderedwhen a young offender has violated ano rd e r o f th e c o u r t , s uc h a s w h e n a

58

co ndition o f a probation order isbreached. Custody was the most common
disposition for being unlawfully at large(89%), escape fr om custody (88%),
manslaughter (87%), aggravated assault(79%) and robbery (57%).
The maximum len gth of a you th
custody sentence is typically two years
but, after some public outcry,
amendments to the Young Offenders Act
have permitted longer sentences in somecases such as murder. However, custodysentences are typically short. In 1996/97,
29% were for one month or less and 46%
from one to three months. Moreover,there is some evidence to indicate thatt h e le n g t h o f c u s t o d y s e n te n c e s i sshortening (Statistics Canada, 1998).
Cases with sentence lengths of threemonths or less now comprise 75% of all
custodial sentences, up from 71% in 1992/
9 3 . S u c h f ig u re s a re m a t c he d w it hdecreases in the longer sentences. This
trend is observed for both open and closed
custody sentences. It is important to note,however, that youth custody sentences
are not subje ct to rem ission, either
statutory or earned. Early release from acustody term is possible under somecircumstances by applying to a judge for areview of the sentence.
Young offenders sentenced to custody
will generally serve their terms in a standalone facility for youths, although there
are a few places where adults and youth
are co-located with strict separation
betw een the two. All young offenderfacilities a re opera ted by provincia lgovernments. The Young Offenders Act
differentiates between open and closed
custod y but ea ch province is free tooperationalize those concepts. At thediscretion of the sentencing judge, theterm can be served in a closed custodyfacility, an open custody facility, or a
specified combination of both. About half

118TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERSo f y o ut hs se n te n c e d to c us to d y a r e
sentenced to begin the term in a closed
facility. An unknown proportion of themwill graduate to an open facility at a set
p o in t i n th e s e n te nc e , t o f a c il it a t e
reintegration into the community. The
other half serve their entire sentences inan open facility.

•

1. General Explanations in the Rise in
Custody/Imprisonment Rates
Maur (1998) of the Sentencing Projectin Wa shington, D.C., has linked theincreased use of imprisonment in North
America to four distinct trends:

Linking many of these factors has also
been the shift in the fundamental
premise in managing youth that are in
conflict with their communities.

•
•
•
•

The shift from offender-based tooffence-based sentencing;
Decreased emphasis on rehabilitation;
Shift of resources to institutions; and,
Limited consideration for non-custodial sentencing options.

O ther explanations for the rate ofincrease include the proliferation of highmand atory minimum sentences(particularly for drug offences), threestrikes laws, and ‘truth in sentencing’laws, that typically require an offender toserve at least 85% of a sentence before
conditional release (Maur, 1998). Indeed,
the number of violent offenders in thefederal system is small and dropping,
being supplanted by those convicted ofdrug, weapons and immigration offences(Gilliard and Beck, 1998).
2. Specific Factors Influencing Custody
Rates for Youth in Canada
A combination of factors can provide
understanding of the rapid increase in
the rate of increased use of custody in
Canadian youth justice. These would
include:•Public attitudes toward community
safety•••(i)Federal-provincial
costsharingarrangements
Rise in the importance of accountability
Shift in the mandate for the probation
service, andThe lack of alternatives made available to the courts.

Public Attitudes Toward Community
SafetyRecent evidence reported by Baronand Hartnagel (1996) suggests thatthe public’s fear of crime, conservativevalues and victimization experience
are useful predictors of attitudes in
sup port of the use of custod y foryoung
o ffenders.
Canadian
respondents, along with those fromthe United Kingdom and the UnitedStates, overwhelmingly choose
imprisonm ent as the mostappropriate sentence for a burglar
convicted for the second time when
asked as part of the International
Crime Victimiz ation Survey(Besserer, 1 998 ). Legisla tors areclearly aware of these public attitudes(Department of Justice, 1998;
National Crime Prevention Centre,
1998).

(ii) Shifts in the Importance of
Accountability
Yo u th j us tic e a d m i nis tr a ti o n in
Ca nad a dra ma t ica l ly cha nged inorientation with the proclamation of
the Young Offenders Act (YOA) in
1984.
While
changes
in
implementation over the years hadvaried the administration of youth
justice, the original legislation of
1908, named the Juvenile Delinquents59

RESOURCE MATERIAL SERIES No. 59
Act, governed justice for young people
without major fundamental change
for almost three-quarters of a century.
Critics of the YOA suggested that thisnew legislation heralded anincreasing emphasis on incarcerationof youth (Leschied and Gendreau,
19 86). Growing concern b y policy
makers for the ‘drain’ on financial andh um a n r e so ur ce s to sup p o rt th e
expanding use of custody is but one
major contributor to the re-newed
emp hasis on comm unity-based
interventions.
C. Responses to the Over-relianceon Youth Custody
The irony of the emphasis placed on
custody is this: these ‘deep-end’ services
are the most costly, but nowhere in therelatively meagre research on the effects
of institutionalisation is there empiricalsupport that custody is an effective way
to reduce youth crime and increase public
safety (Henggeler, Schoenwald, Borduin,
Rowland and Cunningham, 1998).
Canada is not experiencing the rapid
construction of prisons evident in her
close neighbour the United States, but
the rate at which incarceration is used ishigher than many other Western nations(Maur, 19 98; Correctional Service ofCanada, 1997).
While the general public seems to
support more of the ‘get-tough’ approach,both levels of government in Canada(federal and provincial) appear to beinterested in reducing the use of custody,
in part because of the enormous cost andthe drain it makes on funds available forcomm unity-based resources. The
Standing Committee on Justice and Legal
Affairs(1997),agroupofParliamentarians charged with reviewing
the implementation of the YOA, held
hearings in 23 sites across the country.
One of their conclusions was that:60“C a na da use s i m p ri son me nt i n
response to youth crime more thanmany other countries. The bulk offinancial resources devoted to youth
i n co nf li ct w it h t he la w i n t his
country have gone to b ui ld a nd
operate custodial facilities... This
over reliance on the formal justicesystem a nd im prisonment is a nenormous drain on public dollars,
introduces minor offenders to more
serious, persistent offenders,stigmatizes offenders and reinforces
criminal identity in a deviant
subculture. Moreover it fails to deter
youth crime”. (p. 35)
There is little doubt that community
safety in the short term is enhanced bycustody as it is used. Nationally, moreyouthsareincarcerated
for
administration of justice offences (themost serious offences in 36% of cases
where custody is a disposition) than forin te r p e rs o na l o f f en c e s ( 1 7 %) . S u c hoffences include failure to comply with adisposition (mostly breaching conditionsof probation), failure to appear in court,
escaping custody and being unlawfully atlarge (Statistics Canada, 1998).
Numerous approaches are currently
underway to bring youth justiceadministration in Canada m ore intobalance. These attempts draw o n
rest orativ e j ust ice prin cipals a ndcommunity driven responses addressing
the causes of youth crime a s well a s
victim involvement in providing more‘satisfying justice’ experiences for allconcerned parties.
1. Attempts at Providing Alternative
Measures, Intermediate Sanctions
and Custody Alternatives
The Y OA also reflects the need toprovide the least intrusive intervention
possible at various stages in the

118TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS
proceedings. This recognition is reflected
i n t he m a nd a t ed us e o f a l t e rn a t i v emeasures and community service orders.
Reflected in these measures are services
targeting offenders who commit acts of aminor nature; the imposition of probation
for community monitoring of compliancewith the terms spelled out by a judge; andbail supervision for youths who would
otherwise be held in a detention centre
for the duration of the court proceedings.
Y e t , a s B a l a ( 1 9 9 8 ) ha s s u gg e st e d ,legislation alone is not a solution incurtailing the use of custody. Probation
continues to be the disposition of choicewith judges making orders to a greater
extent than competing choices. However,
it is in the proportion of custody orders
relative to the overall number of youths
being pro cessed through the justicesystem that is both driving the high costof ‘deep end’ services and restricting thedevelopment of suitable alternatives. For
example, the cost of a single custody bed
is two and a half times the average yearlysalary of a probation officer.
2. Increasing the use of Community
Alternatives
Currently in Canada, there is interestin developing alternatives to the formal
justice system and to increase the rangeof choices for high-risk young offenders at
the disposition stage when custody would
be the obvious next step in legal
processing. Borrowing primarily fromdevelopments in Australia, New Zealand,and practices known to Canada’s First
Nations People, alternatives to formal
court processing have been given impetus
in recent proposals for juvenile justicereform (see, for example, Department ofJustice, 1998). Examples of such court
diversion programmes include; police
cautioning, family group conferencing
and circle sentencing. Proposals such asthese are targeting youth with minor
offences to capitalise on the naturally

occurring strengths in a community ofcommitted volunteers. Additionally, these
proposals support police discretion in
avoiding the use of court for youth thatare generally considered as low risk forsubsequent offending. In many cases
where such diversion programmes areapplied, no formal charge is laid.
•••

SECTION SUMMARY
Rates of custody in nine of ten
provinces approximate 34% of youth
court dispositions
75% of federal to provincial young
offender cost sharing funds custodyfacilities
Recent amendments to the YOA havefocused on incre asing severity ofsa nctions fo r yo uth with seriou s
offences while encouraging the use ofcommunity-based alternatives
II. EMPIRICAL SUPPORT FOR
IMPROVING YOUNG OFFENDEROUTCOMES

A. Revisions to the Young Offender’sAct
In the winter of 2001, Canada once
aga in ha s re view ed le gisla tio n tha t
governs the implementation of youngo f f e n d e r p r o gr a m m e s a n d p o l ic ie s.
Following at least three years of on-going
consultation, the revised policy may
further the schizophrenic nature of thislaw in combining toughness withtreatment. Several commentators havealready echoed the feelings of then Judge
George Thomson in 1982 who noted thatthe original YOA was attempting to be allthings to all people. In the revised Act,now called The Youth Criminal Justice
Act (YCJA), there is a lowering of theminimum age of the reverse onus
pro vision to fourteen for youth withserious offenses, and a broadening of thebasis on which youths can be transferred

61

RESOURCE MATERIAL SERIES No. 59
to adult court. Coinciding with the “gettough” aspects of the new Act, is thecontinuing expression of support forrehabilitation as a principal that should
guide much of the Act’s implementation.
For example, there is an emphasis given
to restorative justice principals that seekt o su p p o r t c o m m u n i ti e s i n f in d in galternatives to the traditional forum of
the court. Additionally, the revisions also
support the development of community
alternatives for moderate and certain
h ig he r r isk y o ut h in a n a tt e m p t t od e c r e a s e t h is c o u n t r y ’ s in c r e a si n greliance on custody. During the years
1986-96, 27 per cent more youths werecharged following police apprehension
when compared to the years 1980-83.
T here is little d oub t, tha t a s pub lic
opinion continues to demand a tougher
Act, and as increasing numbers of youths
find themselves in the court system,
increasing creativity w ill need to b eb r o ug h t t o a d d r e s s t h e d il e m m a o fbalancingaccountability
witheffectiveness in youth justice.
1. Treatment Directions from Policy
Revisions
Legal revisions to the YOA, as this isbeing written, are now entering firstr e a d in g in t he H o us e o f C o m m o ns .
C h a n g e s m a y c o n t i n u e to b e m a d ethrough to passage of the Bill. Major
emphasis from this renewal includes (formore detail see Youth Justice Renewal
Initiative—www.Canada.justice.gc.ca/
en/news/nr/2001/doc):
•

•

62

Increase in the use of measuresoutside the formal court process thatcan often be m ore effective in
addressing some types of youth crime
Establishment of a more targeted
approach to the use of custody foryoung people••

Improvement in the system’s ability
to rehabilitate and reintegrate young
offenders
Increases in the use of communitybased alternatives

What seems clear how ever, is thatemphasis on residential custod yprogramm es will continue to beemphasised as sentences are lengthened
but the use of custody will be targeted atth e more u ppe r end of v iolent an dpersistent young offenders. Community
alternatives will be sought, not onlyc o n si st e n t w it h r e st o r a t iv e j u st ic e
principals, but as a true alternative forthe use of custody for certain moderate
and high risk youth. In addition, andw h a t c o u ld t u r n o u t to b e n o t o n l ycontroversial but also a true test forassessors in youth justice, is thediscretion given to non-judicial justiceprofessionals in making judgem ents
regarding placement decisions—use andlevel of custody—as well as an increasing
reliance on early release decisions fromc u s t o d y t o c o m m u n it y s u p e r v is i o nthrough probation.
2. Accumulating Evidence forAssessment and Treatment in Youth
JusticeT h e r e is a go o d d e a l o f r e s e a r c hsupport for som e of these federal
initiatives in Canadian youth justicer e f o r m . F o r e xa m p l e , in a r e c e n tl ypublished summary of the accumulationof evidence on assessment and treatment
with yo ung of fe nde rs, Le sch ie d a nd
Cunningham (1 999) noted that more
articles have been published regarding
young offender assessment andtreatment in the past ten years (198819 98 ) than w ere documented on the
major literature data bases than during
all of the years prior to 1988. What thisp oints to , is not o nly an incr ea sin g
em pirica l ba sis f or d ecision ma king

118TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS
regarding place ment and trea tment
targets, but as well an indication of thevast knowledge base which practitioners
can draw, in designing assessment andtreatment strategies.
B. General Principals from theYoung Offender Treatment andAssessment Literature
There
is
now
considerable
d isse minatio n o f th e m eta-a nalyses
regarding the prediction, assessment andtreatment literature in youth corrections(see for example Andrews, Leschied and
Hoge, 1994; Loeber and Farrington, 1998;
Lipsey and Wilson, 1998; Losel, 1997).
Some of the maj or prin ciples that
continue to be reinforced in the reportingof the literature suggest the following:
•

•
•
•
•

•

Delivery of a human service within
the court sanction contrib ute thegreatest in explaining reductions in
re-convictions
Sanctions or punishments alone aren o t a s s o c ia te d w i th m e a n i n gf u l
reductions in recidivism
High risk offenders benefit most fromgreater intensity of service
Certain interventions are associatedwith greater reductions in offending
Clinically relevant targeting ofinte rventions is essential toincreasing the likelihood of effective
outcomes
Community-based interventions aresuperior in their ability to reduce
offending that residentially-based
interventions

literature in addressing the challenge ofproviding an effective intervention forhigh risk youth within the youth justicesystem.
C. Developing Intensive
Community-Based Services forHigher Risk YouthWhi le con s idera ble emph as is i s
c u r r e n t ly b e in g g i v e n t o f r o n t e n dservices targeting lower risk offenders(e.g. diversion, community/family groupconferencing), there is also support fordeveloping services addressing the needsof higher risk cases who would otherwise
be heading towards a custody disposition.
J u s t if ic a ti o n f o r c o m m u n i ty - b a s e dservices must first have, as its yardstick,
the ability to deliver cost-effective service
that does not compromise thecommunity’s safety. A key intention of
the Department of Justice (1998) with its
proposed framework for youth justicereform is to lower the rates of custodyordered in Canadian youth courts. Thiscannot be a ccomplished through law
reform alone. Members of the public ingeneral, and sentencing judges
specifically, must be convinced of several
things.
•••There is now a body of literature that isstrong enough to suggest that evidencebased interventions should provide theba sis for deciding on programm es ofchoice for child and family interventions.
The following section regarding
Multisystemic Therapy provides just sucha context in drawing on the research

Incapacitation through custody may
protect the public in the short term
but not in the long term.
There are viable community-basedalternatives to custody that can bothprotect the public in the short term
and reduce recidivism in the longterm.
The expensive option of custody will
not ‘purchase’ as much reduction in
offending as these other non-custodial
sentencing options.

Providing empirical evidence of thesethree factors was one of the principle
in t e n t s o f s e le c t in g M u l t is y s t e m ic
Therapy (MST). The following review of63

RESOURCE MATERIAL SERIES No. 59
effective service outlines the choice of
MST as a viable alternative to custody forh i g h - r i sk y o u n g o f f e n d e r s a n d t h eimplementation of the clinical trial of
MST in four Ontario communities.

•••

D. Systemic and Programmatic
Requirements for the Choice of a
Community-Based Option forHigh Risk YouthLesson s learned from the met aanalysis on systemic variables in effective
p r o gr a m m ing f or yo ut h co r re c tio ns
suggest that:•••

Lower risk cases can be safely
assigned to less intensive services
Higher risk cases are more effectively
dealt with in more intensive services
The differential assignment of youth
according to risk is critical in thea p pro p riate d eliver y o f ef fe ctive
service

Accordingly, a spectrum of services toaddress youths at all levels of risk andneed would be a desirable characteristicof any youth correctional system.

A review of literature for effective
service in youth justice served as the
beginning point in developing the MST
clinical trial in Ontario. The search for analternative to custody for high-risk youth
began with the understanding that any
service model considered had to matchthe eight integrity issues summarized byAndrews et al. (1990). According to theseauthors, a coherent and em pirica lly
defensible model:••••

1. Effective Programmatic
Requirements
Researchers have also addressed theprogrammatic components of correctional
interventions for youth by identifying thecontent and quality of e ffective
programmes. The components of effective
programmes are assessed in relation to
the ir ability to mea ningfully reduce
recidivism within the targeted group.
Programmes assessed as effective wereconsidered as those that:
•
•
•

64

systematically assess risk in clients,
use the risk principle of caseclassification,
adopt programme orientations known
to be effective,

employ well educated and welltrained staff,
monitor programme integrity andadherence to the intervention model
used,
and rigorously evaluate the extent towhich programme goals are met

•
•

•

•

empirically links interventions withdesired outcomes;
assesses risk and need levels ofclients and targets them forintervention;
has a detailed programme manualoutlining the discreet steps involvedin the intervention;
ensuresthat
therapists
havestructured and formal training in
relevant theory and practice;ensuresthat
therapists
aresupervised in a meaningful manner;
assesses the therapeutic process asdelivered to monitor the adherence to
key principles and the employment oftechniques claimed to be employed;
conducts assessments of intermediatechanges in values, skills or
circumstances of clients tha t arepresumed to relate to de sired
outcome(s); andassociates level and intensity ofintervention to risk, need andresponsivity.

T he M S T a pp ro ac h r ep re sente d acommunity-based option that parallels

118TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS
many of these characteristics and forthese reasons was chosen for the current
clinic al trial. The f o llo w ing sec tio nprovides a detailed overview of MST.
III. The Multisystemic Therapy
Approach
M ST w as developed by the Family
Services Research Centre at the Medical
University of South Carolina. It had been
become apparent to these researchers,
that mental health services for serious
young offenders were minimally effectiveat best, extremely expensive and notaccountable for outcomes. They reviewed
the research literature and looked forinterventions with documented success inshaping good outcomes for anti-social
youth. They also noted whichinterventions, some quite popular, had noe m p ir i c a l su p p o r t . T h i s p r o c e s s o f
discarding ineffective techniques while
gleaning those most effective means that
MST is more an amalgam of bestpractices than a brand new method.
A. A Social Ecological
Understanding of Behaviour
MST adopts a social-ecologicalapproach to understanding anti-social
behaviour. The underlying premise of
MST is that criminal conduct is multicausal; therefore, effective interventions
should recognize this fact and address themultiple sources of criminogenic
influence. These sources are found not
only in the youth (values and attitudes,social skills, organic factors, etc.) but inthe youth’s social ecology: the family,
school, peer group and neighbourhood.
The needs of youths are understood byassessing the ‘fit’ between them and their
immediate social context, a relationshipwhich is seen as adaptive or functional aswell as bidirectional. Treating youths in
isolation of these other systems meansthat any gains are quickly eroded upon

return to the family, school orneighbourhood. In fact, it is a key premiseof MST that community-based treatment
inf o r m e d by a n un d e rs tan d in g o f ayouth’s ecology will be more effective thancostlier residential treatment. This iseven true when selection of MST
candidates is made who are bound forr e s i d e n t i a l tr e a t m e n t o r c u s to d i a lplacements because of the seriousness of
their conduct or emotional problems.
1. Assessing the “Fit” of Targeted
Behaviours
The M S T p roce ss be gins with theidentification of the problem behaviours,a task, which involves the whole family.
I n o th e r w o r d s , p a r e nt s a re k e y in
identifying treatment targets. Examplesof these behaviours include noncompliance with family rules, failure toattend school, failu re to complete
schoolwork, substance use, disrespect toauthority figures, and assaultive
behaviour. W hile the focus ofintervention is on the elimination ofproblem behaviours, this is accomplishedin great m easure by building onstrengths. So the assessment process also
involves identifying the strengths in the
youth and his or her family, which canin c lu d e at h le t ic ab ili ty , a t r us ti ng
relationship with an extended family
member or teacher, warmth and love
among family members, or a hobby.
The next step is an assessment of thefactors in the youth’s ecology, w hichsupport the continuation of the problem
behaviours and the factors that operate
as obstacles to their elimination. These
factors may be found in any sphere of the
youth’s ecology or the linkages among
them. Hence, therapists go to the school,spend time with the peer group, or speakwith members of the extended family.
Examples of these contributing factors
might include; poor discipline skills on

65

RESOURCE MATERIAL SERIES No. 59
the pa rt of the pa rents or tea chers,
marital discord, parental substance use,lack of supervision, peer reinforcement ofp rob lem b ehaviours, neighb ourhoo dc ultu re w hic h co nd o ne s vio le nc e o r
e n c o u r a g e s a n t i- s o c ia l v a l u e s , l o w
commitment to education, chaotic schoole nvir onm e nt, p oo r p ar en t-to - scho olcommunication, or financial stresses
experienced by the family.
By identifying the fit betw een thep r ob le m s a nd the b ro a d e r syste m ic
context, MST workers are defining bothth e tar ge ts of inte rv en tion an d th e
ind ica tor s of w he the r the m ea suresu n d e r t a k e n h a ve b e e n e f f e c ti v e . A
therapeutic strategy should produce
observable results in the problem
behaviour or else the strategy is revised.
In other words, positive changes in the
behaviour (e.g., school attendance) isused as indication that the intervention(e.g., parent contacting the school daily)
is on the right track. Failure to achieve
positive changes requires a reassessmentof the fit and plainly indicates the need totry a new approach. The MST service
providers are ultimately accountable forovercoming barriers to change. Blaming
language such as sabotage, resistance,
an d intractable problems, are n ot
permitted. In fact, diagnostic labels of
any type are discouraged in favour of aperspective that focuses on challenges
and strengths.
2. The Nature of Intervention
MST is designed to be an intense but
short-term involvement that can result in
the generalization of treatment gains
over the long-term. The frequency andduration of contacts will decrease overtime, being intense in the beginning but
lessening as improvements are observed.
No social service intervention can lastforever, s o the ultimate goal is toempower the family or extended social

66

support system to continue w ith thestrategies and interventions which weresuccessful. An important goal in thisprocess is to foster in the parents oranother caregiver the ability to be good
advocates for their children andthemselves with social service agencies
and to seek out supportive services andnetworks when they are required. In
other words, parents are encouraged todevelop the requisite skills to solve theirow n problems rather than rely on
professionals.
MST is a highly individualized, flexible
intervention ta ilored to ea ch uniq ue
situation. In other words, there is no one
recipe for success. Instead, there are nine
principles that guide intervention:
THE NINE MST PRINCIPLES
1. Theprimary
purposeof
assessment is to understand the‘fit’ between the identified
pro blems an d th eir bro ader
context
2. Therapeutic
contacts
shouldemphasize the positive andshould use systemic strengths aslevers for change.
3. Interventions should be designed
to promote responsible behaviourand decrease irresponsible
behaviour
am ongfamilymembers.
4. Interventions should be presentfocussed and action-oriented, targeting specific and well-definedproblems.
5. Interventions
shouldtargetsequences of behaviour within or
between multiple systems thatmaintain the identified problems.
6. Interventions should be developmentally appropriate and fit thedeve lo pmenta l needs of the
youth.

118TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS
7. Interventions should be designed
to require daily or weekly effort
by family members.
8. Intervention efficacy is evaluatedcontinuously from multiple
perspectives with prov iders
assuming a ccountability forovercoming barriers to successful
outcomes.
9. Interventions should be designed
topromotetreatmentge ne raliza tion and long- te rm
maintenance of therapeuticchange by empowering caregivers to address family members
needs across multiple systemic
contexts.
The MST-specific training augments
the education and experience therapists
bring from their chosen fields (usuallysocial work or psychology).
3. Research Evidence
Several randomized and quasiexperimental studies of MST have beenco nducted in the U nite d S ta te s a ndothers are now under way (See Borduin,
1995; Henggeler et al., 1996; Henggeler,
1997; Henggeler et al., 1998). MST has
been demonstrated to reduce rates ofcriminal activity (officially recorded andself-reported), institutionalization, anddrug abuse. MST intervention is also
successful at engaging and retaining
families in treatment and encouraging
completion of substance abuseprogramming. It can result in
improvements in family functioning andcohesion. These results are notable in afield where successes are few and far
b e t w e e n b u t e sp e cia l l y r em a rk a b l e
because MST has been effective in innercity urba n area s, a mong youth withserious criminal records, youth identified
a s high risk to reo ffend, a nd a mong
economically marginal families and thosew ith l on g h isto r ie s o f u ns uc ce s sf ulinterventions.

An American study by the Washington
State Institute for Public Policy (1998)
rated MST as the most effective and cost
efficient of the 16 programmes analysed.
Each programme followed youths until
the age of 25. None eliminated offending
but 15 of the 16 documented lower rates
of recidivism am ong programme
pa rticip a nts c om p a red w ith co ntro l
youth. After subtracting the cost of the
MS T interve ntion itself , MS T saved
taxpayers on average $7,881 (U.S.) pery o u t h f o r s e r vi c e s a s s o c ia t e d w i thcrim inal
behaviour,suchasincarceration. The cost of theintervention was recouped after two
years. In addition, the reduction in crime
was associated with $13,982 in savings topotential victims of crime. Five of the
programmes reviewed did not reduce
crime enough to pay for themselves andnone generated the level of savings linked
to the MST intervention.
•

•

•
•

•

SECTION SUMMARY
A considerable body of empirically
based support now exists to identify
programmes that can influence young
offender outcomes
Effective
programmesarecharacterized by clearly articulated
components, assessment strategies,
and service delivery options
Community-based services reflecting
ecological integrity promote mostimproved outcomes
Multisystemic Therapy has shown
itself through randomized trials to be
an e f fe ctive me a ns o f d elive ring
service to high risk youth
There now exists a training method totest multisystemic therapy inrelatively large scale clinical trials

B. The Ontario Implementation of
MST
MST has been implemented in fourcommunities in Ontario, with the co-

67

RESOURCE MATERIAL SERIES No. 59
operation of nine community agencies.
The London Family Court Clinic
coordinated the research in association
with MST Services Inc. of Charleston,South Carolina. The study began in Aprilof 1997 and concluded in January of 2001.
MST Services Inc. has provided initialand on-going training to MST workers
and clinical supervisors.
The review by the Washington State
Institute for Public Policy (1998)
concluded with the observation that mostprogrammes designed to reduce crime arenever evaluated. As the Institute (1998:
2) stated: “Some interventions may be
w orking and we don’t know it, whileothers may not be effective yet absorb
scarce tax dollars that could better be
directed toward effective programmes”.
In
contrast,theOntario
implementation of MST followed not only
the programm e integrity issues a nd
knowledge transfer challenges of
implementing a complex and rigorous setof programme goals, but also invested
heavily in evaluation. An experimental
de sign was used , with rando massignment of qualifying cases to either
the MST condition or to other services
available in the local area. To qualify for
the MST trial, referred youth must haveb een rated as ha ving at least a highmoderate to very high chance to offend in
the future, a designation made in part on
the basis of outcome from the Risk/Need
A s ses sm en t pr ot oc ol, p a s t c rim ina lconduct and in consultation with thefamily and community service providers.
A battery of psychological tests wasadministered at intake before the random
assignment was conducted. Parents andteachers completed standardized forms.
T ho se fam ilies not a ssigned to M S T
carried on with the treatment plan thatwould have been devised were there no
MST. Many of the youths in both groups

68

were on probation a t the time of thereferral.
The psychological tests were
readministered at discharge from MST
or, in the case of the control group, after
five months. Intermediate target areas(i.e ., a rea s k now n e mp irica lly to b e
related to offending rates among youth)w e re a sse sse d a lo ng w ith o utco m e s
related to re-offending rates (number andseverity), service utilization rates andcost effectiveness. The youths in both
tr ea tm e nt an d co nt ro l gr o up s w e retracked until 2001. Adherence to the MST
model was also measured (see Henggeler
et al., 1997). The overall goal was todetermine if MST can be an effective
alternative to custody by controlling risk
to the community in the short-term as
effectively as other penal sentences,
reducing the recidivism of high-risk youth
up to three years after discharge from
MST, and reduce that rate at which MST
recipients are placed outside the home inpenal, child protection and therapeutic
settings. Among the hypotheses were:
•

•
•
•
•

Recipients of MST will be less likely
to commit criminal offences during
th e f o ll o w - u p p e r io d t h a n a re acontrol group of youths who did notreceive MST
Those who drop out of MST will be
more likely to offend than those whocomplete MST
Recipients of MST who offend will doso after a longer offence-free period
than youths from the control group
Recipients of MST who offend willcommit less serious offences thanthose who did not receive MST
Recipients of MST who do offend will
spend less time in custody than those
who did not receive MST

The study has high ecological validity
in that the youths were identified by

118TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS
referral sources as being those youths in
the local area that presented the greatest
challenge to current services. Unlike
many programmes, MST does not screenout treatment-resistant youth or thosewith serious criminal histories, with the
exception of sex offenses.
The
metho dology
employe daccommo dates
threedifferent
information needs. First, the evaluation
charts outcom es. Put simply, anevaluation should be able to document
the degree of success in achieving statedgoals. The benefits of outcome evaluationi n c lu d e a c c o u n ta b i l i t y t o f u n d e r s ,consumers and the public. Thisin fo rm atio n also c on tribute s to th eknowledge base in the area of prevention.
Outcomes need to be comprehensive andlong lasting. That is, the benefits of the
programme should not only be observedin the short term but also sustainable
over time. Another goal of MST is todecrease the services utilized by suchy o u t h s . I t is h e r e t h a t p r o g r a m m eoutcomes can be related to costeffectiveness and service utilization rates.
S eco nd, the e valuation mo nitore dprogramme delivery to ensure treatment
fidelity, a process evaluation. Integrity is
crucial to any test of a programme; to beable to unambiguously relate outcomes tothe programme as defined. It is also
important to be attentive to thep o s si b i lit y o f p ro g r a m m e d r if t a n dintervene when it is observed. Especiallywith a best practice model compiled fromthe literature, as with MST, drifting fromthat practice may dilute the success of the
programme overall.

use with any defined group. Comparative
inform ation is be st gathered by
implementing the same programme inseveral areas. All programmes, eventh ose wi th d em ons trated pos iti ve
outcomes, do not work equally well in allcommunities. The four participating sites
vary in terms of population size a nd
density, urbanism, ethno-cultural profile,proxim ity to m ajor centres, andsophistication of social service
infrastructure.
SUMMARY
In the context of Canadian juvenile
justice reform, co mmunity-basedalternatives for high-risk young offenders
using MST would be most consistent withthe goals of cost-efficient and effectives e r v ic e a n d i s c o n s i s t e n t w i t h t h e
principles of the administration of justice
to youth. These are policy and legislative
goals spelled out by both the provincial
and federal governments. The major
challenge for service providers and policy
advocates is to view the use ofintermediate sanctions in youth justiceprocessing as being more concerned withcom munity- safety than vested inpunishment, consistent with theun de r lyin g p ri nci p les of th e Y o ung
Offenders Act. With these goals in mind,t h e m o m e n t u m o f d e b a t e in y o u n g
offender services indicates three major
conclusions:•••Third, the design accommodated then e e d f o r c o m p a r a t i v e i n f o r m a t io n ,specifically the portability ortransferability of the programm ecomponents to any community and for

Positive outcomes are best achievedby targeting the needs of high-riskyouth,
Community safety is promoted byaddressing the problems of youth intheir natural environments, andEffectiveness is best achieved using
services with clear track records ofpositive outcomes as identified in
rigorous outcome evaluations.

69

RESOURCE MATERIAL SERIES No. 59
Hence, it follows that the MST
implementation project in Ontario could
herald a revised look at the mission toeffectively service youths at risk andcommunities in need while stemming thetrend tow ards continued relia nce on
custody.
••••

SECTION SUMARY
Ontario’s randomized clinical trial
included four geograp hic sites
involving nine separate agencies
MST Inc. trained and licensed each of
the four sites during the course of
implementation
Evaluation
includedvariablesreflecting both process and outcome
evaluation
Cost
effectivenessandserviceu tilization rat es w ere factored
separately to evaluate outcomes fromintervention
BIBLIOGRAPHY

Andrews, D.A., A.W. Leschied and R.D.
Hoge. A review of the profile, prediction
and treatment literature with young
off enders: A social psychologicalapproach, Toronto: Ministry ofCommunity and Social Services, 1992.
Andrews, D.A., I. Zinger, R.D. Hoge, J.
Bonta, P. Gendreau, and F. Cullen. Does
correctional treatment work? A clinically
relevant and psychologically informed
meta-analysis. Criminology, 28, pp. 369404, 1990.
A r ch a m b a ul t , O . Pr o log ue . I n A .W .
Leschied, P.G. Jaffe, and W. Willis (Eds.),
The Young Offenders Act: A Revolution in
Canadian Juvenile Justice, Toronto: The
University of Toronto Press, pp. ix-xii,
1991.
Bala, N. Young Offenders Law, Concord,
Ontario: Irwin Law, 1998.

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Baron, S.W. and T.F. Hartnagel. Lock ’em
up: Attitudes toward punishing juvenile
offenders. Canadian Journal of
Criminology, 38, pp. 191-212, 1998.
Besserer, S. Criminal Victimization: An
International Perspective, Results of theI n te r na ti o n a l C ri m e V i ct im iz a t io n
Survey. Juristat: Canadian Centre for
Justice Statistics, 6, 1998.
Borduin, C.M., B.J. Mann, L.T. Cone,
S.W. Henggeler, B.R. Fucci, D.M. Blaske
and R.A. W illiams. Multisy stemictreatment of serious juvenile offenders:Long-term prevention of criminality andviole nce. Journal of Co nsulting andClinical Psychology, 63, pp. 569-578,
1995.
C a r ri e r e , D . A d u lt C r i m i na l C o u r t
Statistics, 1996-97. Juristat: CanadianCentre for Justice Statistics, 7, 1998.
Corre ctional Service of C anada.
Dominant Environmental Issues, Ottawa:
Correctional Service of Canada. 1998.
Correctional Service of Canada. Basic
Facts About Corrections in Canada, 1997
Edition, Ottawa: Correctional Service ofCanada, 1997.
Department of Justice Canada. A
Strategy for the Renewal of Youth Justice,
Ottawa: Department of Justice Canada,
1998.
Doob, A. Review of Dispositions for YOA
Review. Ottawa: Department of Justice
Canada, 1997.
Gilliard, D.K. and A.J. Beck. Bulletin:
Prisoners i n 19 97, Washington, D C:
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Hatch, A.J. and C.T. Griffiths. Child
Saving Postponed: The Impact of theJuvenile De linquents Act on theProcessing of Young Offend ers inVancouver. In R. Smandych, G. Dodds
and A. Esau (eds.), Dimens ions ofC hildhood: Essay s on the History o f
C hildren a nd Youth in Canada.
Winnipeg: Legal Resea rch Institute,
University of Manitiba, pp. 233-266,
1991.

Washington State Social Policy Centre.
Cost-effective
young
of fenderinterventions. Seattle WA.

Lipsey, M.W. and Wilson, D.B. (1998).
E f f e c t iv e in t e r ve nt io n s f o r s e r io u s
juv enile offen ders: A syntheses ofresearch. In R . Loeber and D.P.
Farrington (eds.) Serious and violent
offenders: Risk factors and successfulinterventions. Thousand Oaks, CA. Sage
Publ. pps. 313-366.
R. Loeber and D.P. Farrington (Eds.)
Serious and violent offenders: Risk factors
and successful interventions. Thousand
Oaks, CA. Sage Publ.
Losel, F. (19 98) . Trea tment a ndmana gement of psychopaths. In D.J.
C o o ke , A . Fo rt h & R . B . Ha re ( e d s. )P sy cho pa t hy: T heo ry , Res ea rch a nd
Implications for Society. The Hague:
Kluwer Academic Publishers, pps. 303354.
M a r ti n s o n , R . ( 1 9 7 9 ) . W h a t w o r ks :Q uestions and answ ers about prison
reform. The Public Interest, 35, 22-54.
Maur, M. (1998). The sentencing project.
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Appendix A
CLINICAL TRIALS OF MULTISYSTEMIC THERAPY WITH
HIGH RISK YOUNG OFFENDERS, 1997 TO 2001
FREQUENTLY ASKED QUESTIONS
Coordinated by:• Centre for Children and Families in
the Justice System of the London
family Court Clinic
In Partnership With:• Associated Youth Services of Peel(Mississauga)• Craigwood Youth Services (London)• Crossroads
Children’sCentre(Nepean)• Eastern Ontario Young OffenderServices (Ottawa)• Kinark Child & Family Services(Barrie)• Madame Vanier Children’s Services(London)
• New
Path
Youth
&
FamilyC o u n se l li n g S e r v i c e s o f S im c o eCounty• William E. Hay Centre (Ottawa)
In Association with:• http://www.mstservices.com/,Charleston, South Carolina
Funded by:• Ministry of Community and Social
Services (Ontario)• Ministry of Correctional Services(Ontario)• National Crime Prevention Centre(Ottawa)
This document describes a four-year
study of the effectiveness ofMultisystemic Therapy (MST) in four
Ontario communities: Simcoe County,
London/ Middlesex, the Mississauga area72

(including Peel, Dufferin and Halton),a nd O t t a w a . M S T i s a h o m e- b a s e d,family-based,
present-oriented
therapeutic intervention using family
strengths to attenuate risk factors andimprove family relations, peer relations,and school performance among serious
young offenders. MST aims to reduce
crim inal o ff en ding by targ eting themultiple causes of anti-social behaviour
and empowering parents to maintain thegains made in treatment.
Follow-up studies of MST graduates in
the United States—over $10 million ofresearch—have documented re-arrest
rate s 2 5% to 70 % low er than am ong
co n t ro l y o u th s. T hi s i s f o ll o w e d b ysignificant cost savings in policing, court
and correctional budgets. For example,
American research has shown that MST
can reduce days in out-of-homeplacements by 47% to 64%. The U.S.
Office of Juve nile Justice andDelinquency Prevention asked the Centerfor the Study and Prevention of Violenceat the University of Colorado to identify
ten exemplary programmes to promote asmodels for communities to implement.
MST was one of the ten Blueprints forViolence Prevention.
MST is also useful in the treatment of
substance abusive youth. The National
Institute of Drug Abuse identified MST
as one of 12 scientifically based
approaches to drug addiction treatment
in a 1999 publication called Principles of118TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS
Drug Addiction Treatment: A ResearchBased Guide.
As evidence mounted that the MST
approach is a cost-effective way to keep
serious young offenders out of custody
without putting the community at risk,
we asked: Will it work in Ontario? That is
the question behind this evaluation.
T he study bega n in April o f 19 97 ,following several months of site selection
and accr ed itation by M ultisystem ic
Therapy Services from South Carolina.
Four clinical supervisors and 13 workers
joined the MST project. The Ministry of
C omm unity and So cia l S ervices has
supported the implementation of MST for
four years to permit its evaluation foryouths aged 10 to 15. Beginning in Aprilof 2000, Phase II young offenders (aged
16 and 17) are also eligible for the clinical
trial, through the cooperation of the
Ministry of Correctional Services.

To answer the se questions, theresearch d esign involves random
assignment of referred cases so that halfof them receive MST and half of themcontinue on with their individual casemanagement plans. There will be somepre- and post-testing of the members ofboth gro ups. The se instruments areadministered at intake and a gain a tdischarge (or after five months in the caseof the control group). The youths in bothgroups will be tracked for up to three
years, to gauge their subsequent
offending and levels of service utilization.
Over the four years, we involved over
400 youths, 200 of who will receive MST.
The evaluation component is funded by
the Ministry of Community and Social
Services (Year 1) and Department ofJustice Canada (Years 2 to 4) through the
National Crime Prevention Centre in
Ottawa.
•The long-term goal of MST is to reduce
the future offending of those youths
judged by their probation officers or othercase managers as highly likely to reoffend. This in turn should be followed bylower rates of custody and incarceration.
No intervention has a 100% success rate.
I t is not realistic to e xpe ct all M S T
recipients to remain offence free. But wewant to answer these questions:

•
•
•
•
•
•
•
•

•

•
•
•

Are recipients of MST less likely tocommit future criminal offences thana similar group youth who do notreceive MST?
Do those who re-offend do so after alonger period than if they had notreceived MST?
Will the offences they do commit beless serious?
Will they spend less time in custodya s a gr o u p t h a n if th e y h a d n o t
received MST?

•
•
•
•
•
•

This document provides answers tothese frequently asked questions:
What is MST?
What do MST therapists do?
How do we know that MST works?
Isn’t MST too expensive a service?
Does MST work with older teens?
Where can I find more information
about MST?
Who can qualify for MST in the
Ontario clinical trials?
Are some youths not appropriate
referrals to MST?
How do I make a referral to MST?
Is MST available in other areas of
Ontario?
Why do you need a control group?
Isn’t random assignment of referrals
unethical?
How is “effectiveness” being measured?
When will the research findings beavailable?

73

RESOURCE MATERIAL SERIES No. 59•

Where can I get more information on
the research?

What Is MST?
MST was developed by the Family
Services Research Center at the Medical
University of South Carolina. It wasapparent that mental health services forserious young offenders were minimallyeffective at best, extremely expensive andno t a cco unta b le f o r o utcom es. T hey
reviewed the research literature andlooked for interventions with documented
success in shaping good outcomes foranti-social youth. They also noted whichinterventions, some quite popular, haveno empirical support. This process of
discarding ineffective techniques while
gleaning those most effective means that
MST is really more an amalgam of bestpractices than a brand new method.
MST ad opts a social-ecologicalapproach to under-standing anti-social
behaviour. The underlying premise of
MST is that criminal conduct is multicausal; therefore, effective interventions
would recognize this fact and address them ultiple sources of criminogenic
influence. These sources are found not
only in the youth (values and attitudes,social skills, biology, etc.) but in the
youth’s social ecology: the family, school,
peer group and neighbourhood.
It is a key premise of MST that
community-based treatment informed byan understanding of the youth’s ecology
w ill be mo r e e ff e ctive than co stlie r
residential treatment. This is true evenwhen you select as candidates for MST
those youths that are bound forr e s id e n t i a l t r e a t m e n t o r c u st o d i a lplacements because of the seriousness of
their conduct or emotional problems.
Research has shown that treating theyouth in isolation of the family, school,74

peer and neighbourhood systems meansthat any gains are quickly eroded upon
re turn to the family, school orneighbourhood. Custody stays could alsocounte r-p rod uctive b eca use a lrea d ytroubled youth are immersed in a peer
culture where anti-social values
predominate.
M ST uses the fa mily preserva tionmodel of service delivery in that it ishome-based, goal-oriented a nd timelimited. It is present-focused and seeks to
identify and extinguish behaviours thatare of concern not only to referring agents
but also to the family itself. In fact, theentire family is involved with MST, in
contrast to many intervention which
define the youth as the “identified client.”
M S T i n vo lv e m e nt w il l t y p ic a ll y b e
between four to six months.
Collaboration with comm unity
agencies is a crucial part of MST. The
school is a key player and workers may be
i n d a i l y c o n ta c t w i t h t e a c h e r s a n dadministrators. MST therapists also workin clo se p artne rship w ith p rob a tio no ff ic e rs tha t in m a ny c a se s a re thereferral source. There may be a need to
involve the youth in substance abuse
treatment or seek a psychiatricconsultation about a parent, for example.
While the initial MST involvement may
be intensive, perhaps daily, the ultimate
goal is to empower the family to takere sponsibility for making andmaintaining gains. An important part ofthis process is to foster in the parents theability to be good advocates for theirchildren and themselves with socia lservice agencies and to seek out their own
supports. In other words, parents areencouraged to develop the requisite skills
to solve their own problems rather thanrely on professionals. MST is a flexible
intervention ta ilored to ea ch uniq ue

118TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS
situation. There is no one recipe forsuccess.
The MST-specific training augments
the education and experience therapists
bring from their chosen fields (usuallysocial work or psychology).
What Do MST Therapists Do?
MST therapists do the work in thefamily home rather than in the office andare available 24 hours a day if needed.
T he a v er a ge ca s e l o a d i s fo u r t o s i xfamilies. Especially in the beginning, theworker may be in the home every day. As
needed, they will spend time at school
and meet with the youth’s peer group andextended family. A key part of the processb e g ins w ith e n ga g ing the f a m ily , asignificant challenge in so me cases.
W orke rs a re clo sely supe rvised an dmonitored for adherence to the MS T
principles and receive weekly guidance
and feedback about their interventions
with the families on their caseloads.
T he M S T pro cess b egins w ith th e
identification of the problem behaviours,
a process that involves the whole family.
I n o t he r w o rd s, p a r e n ts a r e k e y in
identifying treatment targets. Examplesof these behaviours include noncompliance with family rules, failure toattend sch ool, failure to complete
schoolwork, substance use, disrespect toauthority figures, and assaultive
behaviour. While the focus is on
elimination of problem behaviours, this isaccomplished in gr eat measure bybuilding on strengths. The assessment
process a lso involves identifying thestrengths in the youth and his family,
which ca n include a hob b y, a thletic
ability, a trusting relationship with anextended family member or teacher,warmth and love among family members.

The next step is an assessment of thefactors in the youth’s ecology, w hichsupport the continuation of the problem
behaviours and the factors which operate
as obstacles to their elimination. These
factors may be found in any sphere of the
youth’s ecology: family, peers, school,
neighbourhood or the linkages among
them. Therefore, therapists are called
upon to find information from all of thesesources, by going to the school, spendingtime with the peer group, or speaking
with extended family mem bers.
Examples of these factors might include
poor discipline skills on the part of theparents or teachers, marital discord,parental substance use, poor supervision,
peer reinforcement of problem
behaviours, neighbourhood culture which
condones violence or encourages
antisocial values, low commitment toeducation, chaotic school environment,poor parent-to-school communication, or
financial stresses experienced by thefamily.
By identifying the “fit” between thepr o b lem s a n d th e b ro a d e r sys tem ic
context, MST workers are defining boththe t a rge ts o f inte r ve ntio n a nd theind ica to rs o f w he ther the m ea sure s
u n d e r t a k e n h a v e b e e n e f f e c t iv e . A
therapeutic stra tegy should produce
obs ervable resu lts in the problem
behaviour or else the strategy is revised.
In other words, positive changes in the
behaviour (e.g., school attendance) isused as indication that the intervention(e.g., parent contacting the school daily)
is on the right track. Failure to achieve
positive changes requires a reassessmentof the “fit” and plainly indicates the needto try a new approach. The MST service
providers are ultimately accountable forovercoming barriers to change. Blaming
language such as “sabotage,” “resistance,”
a nd “ i ntr a c ta b l e p r o b l e m s ” a r e n o tpermitted. In fact, diagnostic labels of75

RESOURCE MATERIAL SERIES No. 59
any type are discouraged in favour of aperspective that focuses on challenges
and strengths.
MST is designed to be an intense but
short-term involvement that can result in
the generalization of treatment gains
over the long-term. Ideally, the frequency
and duration of contacts will decreaseover time, being intense in the beginningb u t l e s s e n ing a s i m p r o ve m en t s a r eobserved. No social service intervention
can last forever, so the ultimate goal is toempower the family or other caregiver tocontinue with the strategies andinterventions that were successful. The
clearly articulated definition of successpermits objective definition of when thecase can be closed.
How Do We Know That MST Works?
Several randomized and quasiexperimental studies of MST have beenc o n d u ct e d in th e U n it e d S t a te s , inMissouri, South Carolina, and Texas, andothers are now under way. MST has been
demonstrated to reduce rates of criminal
activity (officially recorded and selfreported) and institutionalization. The
M S T ap pr oa c h is also succ es sfu l at
e n ga g in g a n d r e ta i nin g f a m il ie s intreatment and encouraging completion ofsubstance abuse programming. It can
result in im provements in fam ilyfunctioning and cohesion. These results
are notable in a field where successes aref e w a n d f a r b e t w e e n b ut e s pe c ia l l y
r e m a rk a b le b e c a u se M S T h a s b e e neffective in inner-city urban areas, among
youth w ith serious criminal records,
youth identified as high risk to re-offend,
a n d a m o n g e c o n o m i c a ll y m a r g in a lfamilies and those with long histories of
unsuccessful interventions. However, wecannot simply assume that the success in
the U.S. will automatically be replicatedin Ontario. That is why we areconducting a clinical trial, to determine if

76th e u se o f M S T w it h se r io us y o un goffenders will produce better outcomes
tha n the services a nd interventions
already available in this province.
Isn’t MST too Expensive a Service?
Everyone in the social services system
is having to do more with less. With anaverage worker/client ratio of 1:5, MST isindeed a cost-intensive service. A crucial
piece of the evaluation will be todetermin e c os t effec tiven es s: w ill
spending the money now save money
later? A 1998 study by the Washington
State Institute for Public Policy rated
MST as the most cost effective of the 16
programmes analysed. After subtracting
the cost of the MST intervention itself,
there was an average saving of $7,881(U.S.) per youth for services associatedwith criminal behaviour, such as
incarceration. In addition, the reduction
in crime was associated with $13,982 insavings to potential victims. The study iscalled Watching the Bottom Line.
Does MST Work With Older Teens?
With the addition of older adolescentsto the clinical trial in 2000, some haveasked if the MST approach is as effectivewith young offenders over 15. Reference
to the U . S. r e se arc h in d ica te s th at
successful outcomes are achieved andmaintained for youths of all demographic
categories, both males and females, andyouths of all ages.
Where Can I Find More Information
About MST?
The Family Services Research Centerhas published many scholarly articles
about MST research. See the end of thisdocument for a bibliography. Dr. Scott
He ngge le r ha s wr itte n a n e xcelle nt
summary called Treating Serious AntiSocial Behaviour in Youth: The MSTApproach that is available at the web siteof the National C riminal Justice118TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS
Reference S ervice in text and A dob e
formats (see here). There is also a great
deal of information available at the website of MST Services Inc.
Who Can Qualify For MST In The
Ontario Clinical Trials?
MST is designed to fit into acommunity service-delivery spectrum at
the high end , where youths havedem onstrated severe anti-social
behaviour that has proved resistant toother interventions. To qualify for the
MST clinical trial, youths must have ahigh or very high risk of criminal
offending in the future. For the younger
youth, this determination is made with
the Risk/Need Assessment used by the
M in i st r y o f C o m m u n i ty a n d S o c i a l
Services. For youths referred through thePhase II young offender system, the Levelof Service Inventory is used. In mostcases, future risk is indicated by priorserious offending, which may or may nothave resulted in charges. Many youths
will have other presenting problems suchas sch oo l re f usal, subs tance abuse ,parent/child conflict or conduct disorders.
Are Some Youths Not Appropriate
Referrals To MST?
Y es . W e will no t scr ee n c a se s f o r
treatment amenability or exclude thosewith poor prognosis for success. However,there are two categories of exclusionary
criteria:
1. the situation of the youth isinconsistent with a family
preservation modality of treatment
2. the presenting issues of the youth are
not among those for which MST has
been empirically validated
Exclusion of the case means that theyouth does not qualify for MST (at leastat this point but potentially later if thesituation changes).

The first category of exclusionary
criteria requires consideration of thesefour factors:
1. Requisite Level of “Family” Involvement
MST being a family-based
intervention, a youth must have atleast one adult caregiver. This may be
a parent but could also be an older
sibling, grandparent, aunt, uncle orfriend of the family. A Crown ward ina s t a b l e f o s te r p la c e m e n t c o ul dqualify. However, a CAS client in a
new placement may not qualify, as
there is no way to determine if theplacement will break down. Typically,
yo u t hs in g r o u p h o m e s o r o th e r
r e s i d e n t ia l s e t t i n g s w i l l n o t b e
suitable MST candidates unless afamily reunification is imminent or asubstitute caregiver can be identified.
2. Current Family Therapy
If the family were already engaged
with a therapist and making gains,the intervention of a MST worker
would be neither needed nor
appropriate. Should the arrangement
break down, however, a referral could
be made.
3. Safety of Youth and Family
M S T u se s a f a m ily p r e se rva t ion
model but some families cannot bepreserved safely. When assessing theappropriateness of an MST referral,
safety concerns override all others,
whether that involves youths who are
at risk of abuse, at risk of suicide, orat risk of harming other members of
the family. MST is not a substitute for
CAS involvem ent, in-patient
hospitalization, or community safety
through custody/detention.

77

RESOURCE MATERIAL SERIES No. 59
4. Risk of Injury to Worker
C linical sup e rviso rs, p er hap s inc ons ultation with the police orprobation officers, have the discretion
to disqualify a case from the clinical
trial because of a risk of injury or
harm to the MST worker while in thefamily home. This situation is NOT
indicated merely by family violence orassault convictions.
The second category of exclusionary
criteria pertains to the types of caseswith which MST has been
demonstrated effective. It has beentested on youths with many
presenting problems, all of w hom
have one thing in common: criminal
behaviour.
B a se d up o n c le a r d ir ec tion f ro m
S o u th C a r o l in a , t w o g ro up s a r eineligible for MST at this point intime:
1. Sex Offenders
S e x o f f e n d e r s m us t b e e x cl ud e dbecause MST has not yet been
demonstrated as effective with thisgroup (although a project is under
way to adapt MST to this purpose).
2. Acute Psychosis
Youths who are acutely psychotic are
not candidates for the MST clinical
trial. However, a p sychiatricdiagnosis is not a disqualifying factor
in itself.
How Do I Make A Referral To MST?
The MST clinical trials wereconducted in four areas of Ontario
and the referral process is different in
each. Contact the Clinical Supervisor
in your area:
Is MST Available In Other Areas
Of Ontario?

78

Not at present. The Government of
Ontario is awaiting the results of theclinical trial before making decisions
about expansion.
Why Do You Need A Control Group?
The control group is absolutely crucial
to the study. Without it, we will neverknow if MST is more effective than
the services already available. We
need to determine whether changes
we see in the youths over time would
have occurred anyway or were theresult of other interventions such asprobation or conventional therapy. No
less important is the fact that MST isa relatively expensive intervention.
W i t h t h e c o n tr o l g r o u p , w e c a n
document if spending this money now
will save money that would otherwise
be spent later, on custody and prison
stays. This is how it works. Random
assignment is used to crea te twogroups of equal size that are identical,
especially in terms of thecharacteristics which might impact
future offending (criminal history,etc.). One group continues to receive
the services available to them in their
com munities. The o the r rece ive s
MST. After some time has passed, we
examine the members of these twogroups to see how they have changed
as a group. More importantly, we
examine how the two groups compare
to each other. In the aggregate, they
were the same when we started. The
only differe nce is that one half
received MST. Therefo re, any
dif ferences b etwe en the m ca n belinked unambiguously to the MST
intervention. In short, the control
group helps us rule out other possible
explanations for observed changes(e.g., they grew out of the behaviour,o nl y tr e a t m e n t- a m e n a b le yo u t hreceived MST, etc.). It also allows abasis of understanding what probably

118TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS
would have happened to these youths
if they had not had MST.
Isn’t Random Assignm ent Of
Referrals Unethical?
No.
Most
peoplehave
anunderstandable discomfort with thisprocess. It feels like denial of service to adeserving and probably needy family.
However, no fewer youths are receiving
MST because of the random assignment.
There are a set number of MST
placements and eliminating the control
gr ou p wo uld n ot cha n ge tha t. M or e
importantly, all the families provide
informed con-sent. It is explained tothem, verbally and in writing that they
have a 50/50 chance of being assigned to
MST. The assignment is done using atechnique much like flipping a coin. No
one can control w hich case goes into
which group so the process is completely
fair. Everyone has an equal chance. And
they are free to decline involvement andcontinue to receive the services available
to them in their home community. The
vast ma jority of qualifying fa m ilies
consent to participate. Further, there isno negative consequence for not getting
MST. They are not denied service. In
other words, they do not get a placebo.
The youths and their families continue toreceive the services defined in their casemanagement plans and available in theircommunities. We are not comparing theefficacy of MST to doing nothing, we arecomparing the efficacy of MST to thewhat we do now to see if it helps us shapeb e t t er ou t - co m e s t h a n w h a t w e a r e
already doing.
H ow Is “Effectiveness” Be ing
Measured?
We hypothesize that the MST groupwill show both greater improvements inth e s hort -t er m and lower r ates ofoffending in the long term compared withthe control group. In the short term, pre-and p ost-testing of b oth groups w ill
examine changes in internalizing andexternalizing symptomatology, social
sk ills, an ti- so cial att itud e s, f a m ilyfunctioning and parental supervision. As
noted above, we will examine both preand post changes as well as differences
between the MST and control groups at
the time of post-testing. In the long-term,a g a i n u s i n g t h e c o nt r o l g r o up a s acomparison, we will look for differences inoffending for up to three years after the
MST intervention including issues suchas patterns of offence seriousness andoffence frequency, time until re-arrest,
and time spent in both youth custody,
residential placements and adult penal
institutions.
When Will The Research Findings Be
Available?
This study will conclude in March of
2001 and a final report will be prepared
for the fall of that year. Annual update
reports are prepared for the funding
agencies ea ch yea r in M a rch. These
reports are posted on the web site of theCentre for Children and Families in the
Justice System of the London Family
Court Clinic. An interim report from
September of 1999 is now available.
Where Can I Get More Information
On The Research?
For more information you can contact:
A la n W . L esc hie d, P h. D ., P ri nc ip a l
Investigator
Division of Educational Psychology,
Fa culty of E duc ation, Unive rsity ofWestern Ontario
1137 Western Rd.
LONDON ON N6G 1G7(519) 661-2111 ext. 88628
FAX: (519) 661-3833
leschied@julian.uwo.ca
or79

RESOURCE MATERIAL SERIES No. 59
Alison Cunningham, M.A.(Crim.),
Director of Research & PlanningCentre for Children & Families in the
Justice System
London Family Court Clinic
200–254 Pall Mall St.
LONDON ON N6A 5P6(519) 679-7250 ext. 119
FAX: (519) 675-7772
alison@lfcc.on.ca
MST BIBLIOGRAPHY
Canadian Publications
Leschied, A.W. and Cunningham, A.
(1998). Alternatives to Custody for HighRisk Young Offenders: Application of the
M ultisystem ic A pproa ch in Ca nada .
European Journal on Criminal Policy
and Research, 6: 545-560.
Leschied, A.W. and Cunningham, A.
(1999). Clinical Trials of Multisystemic
T h e ra p y in O n ta r io : R a t io na le a n dCurrent Status of a Community-Based
Alternative for High-Risk Young
Offenders. Forum on C orrections
Research, 11(2): 25-29.
Leschied, A.W. and Cunningham, A. (inpress). A Review of the Use of Custody in
Canada’s Young Offender System and theD evelopment of a Community-Based
Programme for High-Risk Young
Offenders. In A.M. van Kalmthout, H-J.
A lb r e c h t a n d J . J u n g e r - T a s ( e d s . ) ,Community Sanctions, Measures andExecution Modalities in Europe, the USA
and Canada. Kluwer Publishing,Dordrecht, The Netherlands.
Leschied, A.W. and Cunningham, A.
(2001). Empirical and Applied Criminal
Justice Research, 1, 1, 1-24.
American Publications
Borduin, C.M. (1994). Innovative modelsof treatment and service delivery in the80

ju ve n ile ju stic e sys te m . J o ur na l o f
Clinical Child Psychology, 23: 19-25.
Borduin, C.M., Henggeler, S.W., Blaske,
D.M. & Stein, R. (1990). Multisystemictreatment of adolescent sexual offenders.
Inte rnational Jour nal of Offe nder
Therapy and Comparative Criminology,
34: 105-113.
Borduin, C.M., Mann, B.J., Cone, L.T.,
Henggeler, S.W., Fucci, B.R., Blaske,
D.M. & Williams, R.A. (1995).
M ultisyste m ic tr ea tm en t o f se riou s
juvenile offenders: Long-term preventionof criminality and violence. Journal ofConsulting and Clinical Psychology, 63:
569-578.
Brond ino, M.J., Henggeler, S .W.,
Rowland, M.D., Pickrel, S.G. et al. (1997).
Multisystemic therapy and the ethnic
minority client: Culturally responsive
and clinically effective. In D.K. Wilson,
J . R . R o d r ig u e , W . C . T a y lo r ( E d s . ) ,Healt h- prom otin g an d Heal th compromising Behaviors Among Minority
Adolescents: Application and Practice in
Health Psychology, (pp. 229-250).
Washington, DC: American Psychological
Association.
Brunk, M., Henggeler, S.W. & Whelan,
J.P. (1987). A comparison ofm u l t i s y st e m i c t h e r a p y a n d p a r e n t
training in the brief treatment of childabuse and neglect. Journal of Consulting
and Clinical Psychology, 55: 311-318.
Henggeler, S.W. (1997, May). Treating
serious antisocial behavior in youth: The
MST approach. OJJDP Juvenile Justice
Bulletin.
Henggeler, S.W. (1989). Delinquency in
Adolescence. Newbury Park, CA: Sage.

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VISITING EXPERTS’ PAPERS
Henggeler, S.W. & Borduin, C.M. (1995).
M ulti-systemic treatment of serious
juvenile offenders and their families. In
I.M . S chw artz & P. AuC laire (E ds.),
Home-Based Serv ices for Tr oubledChildren. Lincoln, NB: University of
Nebraska Press.
Henggeler, S.W. & Borduin, C.M. (1990).
Fam ily Therapy and Bey ond: A
Multisystemic Approach to Treating theB eh av io r Pro b l em s o f C hi l dren a nd
Adolescents. Pacific Grove, CA: Brooks/
Cole.
Henggeler, S.W., Borduin, C.M., Melton,
G.B., Mann, B.J., Smith, L., Hall, J.A.,
Cone, L. & Fucci, B.R. (1991). Effects ofmultisystemic therapy on drug use andabuse in serious juvenile offenders: A
progress report from two outcome studies.
Family Dynamics of Addiction Quarterly,
1: 40-51.
Henggeler, S.W., Borduin, C.M., & Mann,
B.J. (1993). Advances in family therapy:
E mp irical f ounda tions. A dva nces inClinical Child Psychology, 1, 207-241.
Henggeler, S.W., Cunningham, P.B.,
Pickrel, S.G., Schoenwald, S.K. et al.
( 1 9 9 6 ) . M u l ti sy s t e m i c t he r a p y : A n
effective violence prevention approach forserious juvenile offenders. Journal of
Adolescence, 19: 47-61.
Henggeler, S.W., Melton, G.B., Brondino,
M . J ., S che re r, D .G . & Ha n ley , J .H .
( 1 99 7 ) . M u lti s yst em ic th era p y w i t hviolent and chronic juvenile offenders andtheir families: The role of treatment
fidelity in successful dissemina tion.
Jo ur na l of C ons ul ti ng an d C l i ni ca l
Psychology, 65: 821-833.
Henggeler, S.W., Melton, G.B. & Smith,
L.A. (1992). Family preservation using
m ultisystem ic therapy: A n eff ective

alte rnative to inca rcera ting serio us
juvenile offenders. Journal of Consulting
and Clinical Psychology, 60: 953-961.
Henggeler, S.W., Melton, G.B., Smith,
L.A., Schoenwald, S.K. & Hanley, J.H.
( 1 9 9 3 ) . F a m i l y p r e s e r v a t i o n u s in g
multisystemic treatment: Long-term
followup to a clinical trial with serious
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