Multisystemic Therapy-Emerging Adults Trial
Condition: Antisocial Behavior
MeSH terms: Antisocial Personality Disorder
Study type: Interventional

Summary: 
      This study's purpose is to test the effectiveness of a promising intervention for emerging
      adults (EAs) with mental illness (MI) and serious antisocial behavior in achieving the
      ultimate outcome of reduced antisocial behavior, and proximal intermediate outcomes.
      Multisystemic Therapy-Emerging Adults (MST-EA) is an adaptation of MST, a well-established,
      effective intervention for antisocial behavior in adolescents.
    

Detailed description: 
      Serious antisocial behavior, including criminal offending, is extremely costly to society.
      Rates of such behavior are highest during emerging adulthood. Antisocial behavior is
      especially high among emerging adults (EAs) with mental illness (MI); findings suggest the
      majority of EAs with MI will be arrested by age 25, most with multiple arrests, and for
      serious charges. Thus, there is a clear public health need for effective treatments to reduce
      serious antisocial behavior in EAs with MI. Astonishingly, there are no established
      interventions with evidence of efficacy to reduce serious antisocial behavior among EAs, with
      or without MI. Effective antisocial behavior interventions in adolescents address the
      comprehensive causes of that behavior. Similarly, this team has developed and completed
      research on a well-defined age-tailored intervention for EAs with MI and serious antisocial
      behavior that addresses the correlates of EA antisocial behavior, and provides MI treatment.
      The intervention is an adaptation of the well-established effective juvenile antisocial
      behavior intervention, Multisystemic Therapy (MST). MST-EA is a single source that targets
      the EA correlates of antisocial behavior, including gainful activity (school, work, housing,
      and positive relationships) and reduced substance use, in part by targeting the proximal
      mechanism of poor self-regulation. MST-EA also addresses these correlates through reducing MI
      symptoms. The investigative team has already established the safety, feasibility, and
      preliminary efficacy of this type of intervention in a successfully completed community-based
      open trial (R34MH081374-01, PI: Davis). The proposed study will rigorously evaluate the
      effectiveness of MST-EA for reducing serious antisocial behavior. Specifically, 240 EAs with
      MI and recent arrests or release from justice facilities will be randomized to receive MST-EA
      or Enhanced Treatment as Usual (E-TAU). Assessments will be completed at months 0, 2, 4, 6,
      8, 12, and 16, with confirmation of outcome data using system records. The first aim will be
      to evaluate the effect over time of MST-EA for improving the ultimate outcome of treatment:
      reduced serious antisocial behavior. The second aim is to evaluate the effect of MST-EA on
      (a) the key proximal target of treatment (self-regulation) and (b) the proposed intermediate
      outcomes of treatment (gainful activity, substance use, and MI problems). The final aim will
      be to determine whether MST-EA's effect on the ultimate outcome is the result of its effect
      on the proximal target and intermediate outcomes of treatment. There is a current absence of
      any antisocial behavior treatments with demonstrated efficacy in this age group. The ultimate
      effect of the proposed research would be decreased antisocial behavior and other public
      health-related behaviors (MI symptoms, substance use, homelessness, unemployment) among one
      of the highest-risk populations of individuals with MI. With an emphasis on treatment
      mechanisms and the near absence of MI research focused on EAs, this innovative research has
      high potential to advance the field.
    

Intervention name(s): Multisystemic Therapy for Emerging Adults; Enhanced Treatment as Usual
Intervention type(s): Behavioral; Behavioral
Intervention description(s): MST-EA is a home-based therapy in which therapists work closely with each young adult. Therapists often also work with the young person's family, as appropriate. MST-EA is designed to help young people work on their own behavior. This treatment also involves the use of coaches who help young people develop skills for young adulthood.; Standard services that a young person would receive if they have been in trouble with the law and also have a mental illness.
Other intervention name(s): Multisystemic Therapy for Transition-Age Youth (MST-TAY); E-TAU
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Antisocial Behavior; Mental Illness; Emerging Adulthood; Criminal Behavior; Serious Mental Illness