This presentation is an overview of multisystemic family therapy which is an approach to work with children and families where the system in which families live their lives is the target of intervention. Thus, professionals operate within the various ecologies in which families live their lives. There are multiple evaluations of this approach, and in general when implemented accurately has good outcomes.

1. Multisystemic
Family Therapy
Jane F. Gilgun, PhD, LICSW
Professor
School of Social Work
University of Minnesota, Twin Cities, USA

2. Topics
• Basics
• Theoretical Foundations
• Implementation Procedures
• Principles
• Engagement

3. Basics
• $30,000,000 in funding from NIH
• Home based
• Small caseloads of 4-6 families
• Providers on duty 24/7 for 3-4 months
• Intensive supervision
• Provider engages with family members and others in the
various settings in which clients live their lives
• Used in
• child protection & juvenile offending
• Juvenile sex offender treatment
• Drug abuse treatment
• Ecological systems are the client

4. Basics
• Similar to functional family therapy
• But MST includes engagement in multiple
systems (!)
• As the name blasts out
• Uses many other treatment models
• SFT, medication, cognitive-behavioral,
behavioral therapy
• Strict Protocol/Fidelity to Model a Must
• Individualization a Must

5. Theoretical Foundations
• systems theory
• social-ecological models of behavior
• Specifically
• Brofenbrenner’s ecological model
• Structural family therapy
• Strategic family therapy

6. Ecosystemic
& Developmental
Child
Family
Peer group
Extended Family/Social Networks
School
Parents’Work
Religious/Spiritual Institutions
Community Resources
Historical Forces,
Culture, Values
Social
history

7. Specific Ecologies of Interest
• Families
• Peer Groups
• Schools
• Neighborhood hang outs

8. Reciprocal Interactions
• Like attachment theory
• Like family systems theory
• Young persons influence parents
• Parents influence young persons
• Young persons influence sibs
• Sibs influence young persons
• Young person influences peers
• Peers influence young persons
• Young persons influence teachers
• Teachers influence young persons

9. Relevance of Constructivism
• Schemas, belief systems, and actions
• Mutual interaction among the various systems
• Persons construct meanings and belief systems
from their experiences within these various
systems
• Meanings and belief systems are encoded in
brains
• Interpretations of experiences are individual
• Individual interpretations influence
interpretations of others
• The above are Jane Gilgun’s additions

10. Relevance
of Common Factors Model
• Relationship with treatment providers
rather remote
• “Extratherapeutic” events obviously
most powerful
• The above are Jane Gilgun’s additions

11. Applications to MST
• An ecological treatment model that
• Takes into consideration key systems
• Seeks to engage key people in systems

12. Implementation Procedures
• (1) a set of principles that guide the formulation of clinical
interventions,
• (2) a family-friendly engagement process,
• (3) a structured analytical process that is used to prioritize
interventions,
• (4) evidence-based treatment techniques that are integrated
into the MST conceptual framework,
• (5) a home-based delivery of services that enables the
provision of intensive services,
• (6) a highly supportive supervision process, and
• (7) quality assurance process to promote treatment fidelity.

13. Principle 1
• “The primary purpose of assessment is to understand
the fit between the identified problems and their
broader systemic contexts”
• On-going assessment of key systems
• I (Jane) suggest looking at systems of beliefs
• Not just interactions in various ecologies
• Looks at strengths and needs
• Develop hypotheses about what maintains the
problem

14. Principle 2
• “Therapeutic contacts emphasize the
positive and use systemic strengths as
levers for change.”
• Identify positives in each system
• Ask how they can be used to deal with
the problematic issues

15. Principle 2
• “Therapeutic contacts emphasize the positive
and use systemic strengths as levers for change.”
• Identify positives in each system
• Ask how they can be used to deal with the problematic
issues
• Importance of supervision
• Identify negative views of families and other systems
• Jane: Good place to apply solution focused &
narrative therapy ideas
• Expand practitioners
• Views on solutions—expands visions of possibilities & ways to
get there
• Family stories—bring out stories practitioners may overlook

16. Principle 3
• “Interventions are designed to
promote responsible behavior and
decrease irresponsible behavior
among family members.”
• Promote competence
• Child
• Parental

17. Principle 3
• “Interventions are designed to promote responsible
behavior and decrease irresponsible behavior among
family members.”
• How?
• Child
• Positive relationships with parents, sibs, peers, teachers
• Engagement in positive activities
• Supportive services such as tutoring, art lessons, sports clinics
• Parents
• Positive relations within families, work, communities
• Increase interest in child’s activities
• Increase supervision of child

18. Principle 4
• “Interventions are present-focused and action-oriented,
targeting specific and well-defined.”
• Based on behavior therapy
• Define target behavior clearly
• How to measure behavior
• How to measure change in the behavior
• Use clearly-defined interventions

19. Principle 5
• “Interventions target sequences of behavior
within and between multiple systems that
maintain the identified problems.”
• Principles of SFT
• Extended to patterns of interactions in systems
other than families
• in schools
• Courts
• Recreation centers
• Public spaces in general
• Etc.

20. Principle 6
• “Interventions are developmentally appropriate
and fit the developmental needs of the youth.”
• Examples
• young person doesn’t know how to use the bus
• Parents don’t know how to find housing
• Jane:
• Challenge and provide supports, both
• This is a basic developmental principle

21. Principle 7
• “Interventions are designed to require
daily or weekly effort by family.”
• Daily tasks that build upon successes of
previous tasks
• Practice in sessions
• Homework during the week

22. Principle 8
• “Intervention effectiveness is evaluated continuously
from multiple perspectives, with providers assuming
accountability for overcoming barriers to successful
outcomes.”
• Me: Sounds like solution-focused therapy
• Interact with others in ways that represent a desired change
• Show all participants how to evaluate the changed
interactions
• When new interactions don’t seem to work, provider has the
task of identifying barriers—but must work with participants
• Also important to work out new solutions/interactions

23. Principle 9
• “Interventions are designed to promote
treatment generalization and long-term
maintenance of therapeutic change by
empowering caregivers to address family
members' needs across multiple systemic
contexts.”
• Parents supervise/monitor children in all
systems in which children participate
• Parent-child relationship more important than
provider relationships with participants

24. Engagement
• Engage family members and significant others in
the ecologies of interest
• Engagement can be difficult for very good
reasons
• Identify barriers and work with them
• Families may be comfortable in their own homes
• An on-going process

25. Assessment
• standard intake assessment
• presenting problem,
• a history of prior services (inpatient and
outpatient),
• the child's developmental history (language,
social development, motor skills)
• Me (Jane): should do sexual development, history
of friendships

26. Assessment
• a medical history (accidents, injuries, allergies,
health problems),
• a school history (grade, special services,
expulsions/suspensions, behavioral problems),
and
• a trauma history (abuse or neglect, accidents,
community or family violence).
• mental status examination is conducted with the
child to gain an understanding of possible
psychiatric symptoms, and
• A genogram

27. A Structured Analytic Process
• Operationalizes the 9 treatment principles
• Assess the referral behaviors from multiple points of
view
• Including court and school records
• Interview all persons who are relevant
• Recruit relevant persons for participation in treatment
• Interview each of them
• Ask them to identify strengths
• What changes are necessary to bring about success

28. A Structured Analytic Process
• Next: Prioritize
• “Prioritize those interactions and
relationship changes that are necessary
by identifying the "fit" of the problem
behaviors within the context of the
youth's natural ecologies.”
• Hypothesize about how the “problem” fits
with the relevant ecologies
• This is systems analysis—very important to
understand and do

29. A Structured Analytic Process
• Fit Factors with dysregulation showing as anger
outbursts
• (1) The child has low skills for managing frustration;
• (2) the parent and child escalate each other in their
interactions (i.e., coercive interaction sequences);
• (3) parental management of the outbursts exacerbates
the problem; and
• (4) the school is frequently leaving messages for the
parent concerning the child's difficulties at school,
thereby precipitating conflict between the parent and
child that escalate to

30. Identify Drivers & Create
Processes
• Drivers: factors associated with the behaviors
• Identified by all those involved in the treatment
• Example: how is parents’ responses related to anger
outbursts/dysregulations?
• If behaviors stop, may have to little else in other system
• Often, issues persist in other setting such as schools
• All in treatment process evaluate outcomes
• Also identify drivers of successful outcomes
• And drivers of less than optimal outcomes
• Processes repeated
• Drivers, fit, encourage new responses, evaluation, identification
of barriers, implementation, etc.

31. Techniques
• All have been evaluated and have
some indicators of effectiveness
• SFT, behavioral therapies, CBT,
medication for some conditions

32. Service Delivery
• Low caseloads of three to six families per
clinician (2-15 hours per week, titrated to
need).
• 2. Therapists work within a team of three
to four practitioners, though each clinician
has his or her own caseload.
• 3. Treatment occurs daily to several times
a week, with sessions decreasing in
frequency as the family progresses.

33. Service Delivery
• 4. Treatment is time-limited and generally lasts
4-6 months, depending on the seriousness of the
problems and success of the interventions.
• 5. Treatment is delivered in the family's natural
environment: in their home, community, or
other place convenient to the family.
• 6. Treatment is delivered at times convenient to
family; thus, therapists work a flexible schedule.
7. Therapists are available to clients 24 hours per
day, 7 days per week, generally through an on-call
system.

34. Supervision
•Weekly 3-hrs
• Supervisor available 24/7
• Can meet with family or others with
provider
• Supervisor is “responsible for building
the therapists' capacity to be
effective.”

35. Supervision Sessions
• Structured
• Goal directed
• Group format
• Team members do crisis calls night and weekend
• Provider completes a weekly summary sheet for
each family

36. Ian’s Resources:
A Positive “Fit” Model
Resources
Pleasant,
coopertive
personality
Early Secure
Relationship
with Mother
Ian's
Relationship
with Case
Manager
Father's
Relationship
with Case
Manager Services of
ACE
Mutual
Interests with
Father
Good Peer
Relationships

37. A Model of Neighborhood
Collaboration
• Neighborhood Solutions Project, actually
implemented in North Charleston, SC
• Initiated & funded by state
• Money went to MST developers
• Purpose: reduce out of home placements
• By working with persons in settings of interest
• They engaged police
• Medicals services
• MST treatment teams

38. A Model of Neighborhood
Collaboration
• Identify areas of high crime, juvenile
arrests rates, maltreatment reports,
and poverty, and
• design a study to evaluate the effects
of developing and implementing a
collaborative project using evidence-based
interventions to address these
neighborhood problems

39. A Model of Neighborhood
Collaboration
• Four Groups
• Youth at risk for placement because of
delinquency
• Youth at risk for school suspension or
expulsion
• Comparison group from another
community similar to these youth
• “High-functioning youth” from
community

40. A Model of Neighborhood
Collaboration
• Identify Neighborhood Leaders
• Multiple meetings of various
compositions
• Develop trust
• Listen.
• Never promise something you cannot
deliver.
• Don't do too much too soon.
• A Thought: Don't throw money at us:,
instead empower us and give us your time

41. A Model of Neighborhood
Collaboration
• Identify Collaborators
• Police
• Schools
• (Religious Institutions)
• (Youth Workers)
• More on trust
• practiced visibility,
• accessibility,
• persistence, and flexibility,
• always took the time to be with people.

42. Reference
• Cupit Swenson;Scott W. Henggeler;Ida S. Taylor;OliverW.
Addison (2005). Multisystemic Therapy and Neighborhood
Partnerships: Reducing Adolescent Violence and Substance
Abuse. Kindle Edition.