Swenson, C.C., Schaeffer, C.M., Henggeler, S.W., Faldowski, R., & Mayhew, A.M. (2010). Multisystemic Therapy for Child Abuse and Neglect: a randomized effectiveness trial. Journal of Family Psychology, 24(4), 497-507.
Relying on a broadly accepted social-ecological conceptual framework, the authors assume child physical abuse to be multi-determined. Therefore, the authors suggest a multisystemic treatment approach as an appropriate intervention for children who have experienced physical abuse. The adaptation of multisystemic therapy (MST) for child abuse and neglect expands the application and extensive research of MST in fields such as serious emotional disturbance in adolescents or juvenile sexual offenders. MST is tailored on the individual family needs and on a home-based model of service delivery to overcome barriers to service access.
The study sample was based on newly opened Child Protective Services (CPS) reports of physically abused adolescents in a South Carolina county. It included 86 youth (10-17 years) and the custodial parent. The participants were randomly assigned to either MST or enhanced outpatient treatment, the standard service provided at the local public sector mental health centre. Outcome data were gathered at follow up 16 months post-baseline, including youth functioning, parent functioning and behaviour, social support, service utilization, out-of-home placement and reabuse. Compared with the control group, MST was significantly associated with reduced youth mental health symptoms, parent psychiatric distress, and parenting behaviour associated with maltreatment. MST was also significantly associated with fewer out-of-home placements and placement changes.
The post-baseline of 16 months represents the longest period measuring mental health functioning and placement outcome of any physical abuse treatment to date. Further strengths of the study were the high recruitment and the low attrition rate: From the 92 adolescents eligible for inclusion, only 2 refused and 86 could be followed up until the final post-baseline. The application of the treatment approach in a community setting enhances the external validity of the study.
The generalizability of the results is somewhat limited by type of abuse and race, as the sample was restricted to physically abused adolescents and included a high percentage of black families (69%) who are overrepresented in the CPS system. As a result of the small sample size, some of the outcome measures’ cell sizes became very small, unfortunately including the outcome measure of re-abuse, thereby limiting the statistical power of the analyses. Furthermore, the co-supervisor of the project is also the lead developer of MST, which implies that the objectivity of interpretation and the generalizability of outcomes could be limited.