Transcript Multisystemic Treatment of Juvenile Sexual Offenders

FSRC Update & Publications
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Transport Findings Update and Summary
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Sonja Schoenwald, Ph.D.
January 14, 2009
MST Transport &
Implementation Research
Thanks to:
Office of Juvenile Justice and Delinquency Prevention
National Institute of Mental Health
National Institute of Drug Abuse
Family Services Research Center
Charles Glisson
Don Hedeker
David Mackinnon
Service systems, organizations, clinicians, and families
Transporting New Treatments:
MST as Test Case
Funded by
National Institute of Mental Health
MH59138
1999 – 2004
National Institute of Drug Abuse
DA018107
2005 – 2007
Schoenwald, PI
MST Transportability Study Aims
To Examine Relations Between:
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
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MST therapist adherence and outcomes
Organizational climate and structure, adherence, &
outcomes
Supervision, adherence, & outcomes
Impact of clinician training & experience on
adherence
A mediation model of transport
Social Ecological Model of
Treatment Transportability
Extra-Organizational Context
(Referral, Reimbursement, Disposition)
Organization
(Structure,Climate,)
MST Supervision
Clinician
Adherence
Child
Outcomes
(Behavior, functioning,
criminal activity)
Clinician Variables
Professional Training & Experience
Design
 Prospective, uncontrolled study
 Children nested within therapists nested within
organizations within service systems
 Repeated measures
 Youth: Pre, post, 6 & 12 months post-treatment; lifetime
pre through 1-year post criminal charges
 Clinicians: TAM monthly; SAM bimonthly
 Organizations: biannually
 Service system: biannually, & per case
Participants
 45 MST programs in 12 states and Canada
 452 therapists: 73% female, 73% Caucasian,
15% African American, 6% Asian/PI, 2% Hispanic
 64% masters (social work, counseling, psychology)
 1979 youths and their caregivers
 Youths were: 15.5 years old, 65% male,
58% Caucasian, 19% African American, 6% Asian,
4% Hispanic, 13% Biracial
MST Transportability Study
Published Findings Redux
Predictors of Post-Treatment
Change
 Therapist Adherence
(Schoenwald, Sheidow,
Letourneau, & Liao, 2003; FSRC Pub. # 235)
 Select Organizational Climate &
Structure Scales (Schoenwald et al., 2003; same as above)
 Consultant Adherence
Letourneau, 2004; FSRC Pub. # 242)
(Schoenwald, Sheidow, &
Organizational Factors
Assessed
Climate
 Psychological impact of work environment
 Validated measure, OCQ, has 10 scales
Structure
 Formal features of organization
 Hierarchy of Authority
 Procedural & Rule Specification
 Participation in Decision-making
 “Fit” of work with structure is more important than
structure per se
Organizational Predictors
 Select climate and structure factors predicted
short-term outcomes, some in unexpected
directions.
 Climate & structure did not predict adherence.
 Adherence moderated relations between climate
and structure and outcomes.
Findings at Long-Term Follow-Up
Youth Change Over Time
 Significant reductions in behavior and
functioning problems through 1-year post-
treatment
 Significant reductions in criminal charges
through 4-year post-treatment
Did Adherence Predict LongerTerm Post-Treatment Change?
 Reductions in behavior problems one-year posttreatment differed significantly as function of
therapist adherence ratings
Schoenwald, S. K., Carter, R. E., Chapman, J. E., & Sheidow, A. J. (2008).
Therapist adherence and organizational effects on change in youth behavior
problems one year after Multisystemic Therapy. Administration and Policy in
Mental Health and Mental Health Services Research, 35, 379-394; FSRC Pub
#326)
Adherence – Criminal Outcomes
 At the highest level of adherence, the annualized
rate of post-treatment charges for youth was 47%
lower than at the lowest level of adherence.
 When therapist adherence scores were one SD above
the mean, annualized rate of post-treatment charges
was 29% lower than when therapist adherence scores
were one SD below the mean.
Schoenwald, S.K., Chapman, J.E., Sheidow, A.J., & Carter, R.E. (in press). Longterm youth criminal outcomes in MST transport: The impact of therapist adherence
and organizational climate and structure. Journal of Clinical Child and Adolescent
Psychology.
Structure & Climate Findings
Higher Therapist Adherence Was Predicted By
 Greater organizational average levels of Growth &
Advancement
 Therapist perception of greater Growth &
Advancement and Job Satisfaction
Lower Therapist Adherence Predicted By
 Therapist perception of greater Emotional
Exhaustion
Structure & Climate Findings
(2)
Greater reductions in youth Externalizing
behavior were predicted by:
 Higher organizational average levels of Growth &
Advancement
 Lower organizational average levels of Hierarchy of
Authority
 Therapist perceptions of greater Participatory
Decision making
Structure & Climate Findings
(3)
However,
 When therapist adherence was added to the
statistical models, the effects of these
organizational climate and structure factors on
youth outcomes weakened.
Structure & Climate Findings
(4)
Youth Criminal Charges (on average 4 years
post-treatment) Were Predicted By
 Therapist perceptions of greater Job Satisfaction,
Growth & Advancement
 Higher organizational average Participatory Decision
making
But,
These effects washed out when therapist
adherence was included in the model
What Does This Mean
For Your Work?
 When adherence is good, but youth long-term
outcomes are not, it may be that select aspects of
organizational climate or structure are affecting
the outcomes.
 BUT: Depending on the outcome in question, those
organizational effects are either weak or wash out
compared to the effects of adherence
 SO: Keep focusing on adherence
Supervisor Adherence
 Supervisor Adherence Measure (SAM)
 Subscales
 Supervision structure & process (SP)
 Promotion of MST principles (AP)
 Promotion of MST analytic process (ANP)
 Supervisor development of clinician’s skills and
competencies (CD)
*
Supervisor Adherence Findings
 Greater supervisor average focus on Adherence to
Principles predicted therapist adherence.
 Greater supervisor adherence to the Structure and Process
(SP) of supervision during a youth’s treatment episode
predicted greater reductions in youth behavior and
functioning problems.
 Greater average focus on Clinician Development predicted
a lesser decrease in youth functioning problems.
Schoenwald, S.K., Sheidow, A.J., & Chapman, J.E. (in press). Clinical supervision in treatment
transport: Effects on adherence and outcomes. Journal of Consulting and Clinical Psychology.
Empirically – Supported
Fidelity Links
Organization*
Consultant
Supervisor
Therapist
CAM
SAM
TAM
Therapist
Report
Therapist
Report
Parent
Report
Outcomes
Behaviors
Function
Criminal
Activity*