Multisystemic Therapy-Building Stronger Families (MST-BSF): Substance misuse, child neglect, and parenting outcomes from an 18-month randomized effectiveness trial

Parental substance misuse is a risk factor for children entering the child welfare system, especially in terms of foster care admissions. Considering that parents with child welfare involvement often have low attendance and treatment completion, services offered to families in their homes might offer some promise to this population.  MST-BSF integrates Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) and Reinforcement Based Treatment (RBT) for adult substance misuse. MST-BSF utilizes a low threshold intervention model whereby service provision occurs in a client’s home. A master-level therapist is the primary service provider with support from a supervisor, a family resource specialist, and if needed, a model-trained psychiatrist can deliver evidence-based psychiatric care to parents and children. Therapists carry a relatively small caseload (4 families); however, the intervention is intense with a minimum of three visits a week, along with the availability 24/7 of an on-call therapist.  While treatment is tailored to each family, all families are provided with three core intervention strategies: comprehensive safety protocols, RBT for parental substance misuse, and an abuse clarification/healing process. Should a caregiver/parent relapse, they agree in advance that they will remain out of the home while using and not return until the MST-BSF team confirms a negative test for drugs or alcohol. In the event of this happening, the wider system surrounding the child fulfills the caregiving needs in the family home.

This study reported on the first time that RBT was utilized as a home-based intervention. Participants were parents (n=98) and children (n= 86) referred to CPS in two area offices in Connecticut due to concerns of physical abuse and neglect and who also met the criteria for serious substance abuse disorder. Families were randomly assigned to either MST-BSF or to the standard comprehensive community treatment (CCT).  Parent and child self-report data were collected at baseline, and at 3, 6, 12, and 18 months.. Measures included a demographic questionnaire at baseline, Addiction Severity Index, Parent self-report of days of substance use in previous 30 days (all time points), breathalyzer test and urine sample (each home assessment visit), Conflict Tactics Scale (CTS) and Alabama parenting questionnaire (completed at each time point by both parent and child). Department of Children and Families (DCF) records were accessed to gather information relating to placements, child maltreatment reports, and substantiated re-abuse occurrences. 
 

Outcomes were encouraging, especially given that the comparison intervention (CCT) was federally recognized as an exceptional service provision model for addressing child maltreatment. The intent-to-treat analysis highlighted that MST-BSF was more effective in the following areas 1) children who received this intervention had significant declines in parental neglect over the 18-month period 2) Parents reported significant declines in the number of days of using alcohol and opiates. However, the likelihood of receiving a new substantiated incident of Child Maltreatment was not mitigated by being part of the MST-BSF Group.