Study raises doubts about Multisystemic Therapy as gold-standard treatment for delinquents

Multisystemic Therapy (MST) has been promoted as an important advancement in the treatment of conduct problems. Compared to cognitive-behavioural or family therapies, MST is more intensive and involves multiple levels of intervention (individual, family, school, and neighbourhood). This type of treatment was subjected to a number of clinical trials; findings were generally positive. In recent studies however, concerns were raised about whether MST works as well in all countries, and whether it is more effective than standard treatment.

In this randomized control trial, the effectiveness of MST in reducing the conduct problems of Swedish adolescents was compared to treatment as usual. While the MST youth and their families did improve over time, so did the youth receiving the standard treatment. According to youth and caregiver reports, lower levels of psychiatric symptoms and delinquency were noted in the youth, and both youth and parents reported the enhanced social skills over time. The improvements in the MST group were not significantly different from those of the treatment as usual group.

A number of explanations for the lack of difference were forwarded. Firstly, the treatment of young offenders in Sweden is based on a child welfare model; most cased are referred to social services. In the US where the most promising MST evaluations took place, treatment as usual likely involved a referral to the juvenile justice system and a court-mandated punishment. Given this discrepancy, the authors suggested that the control group in their study might have received a more effective "treatment" than the control groups in previous studies. Secondly, it is possible that the Swedish youth possessed fewer risk factors and thus might not have required an intense intervention. Finally, methodological problems were reported that might have influenced the findings.

In light of these findings and a recent meta-analysis (Littell et al., 2005), cross-national studies on MST are needed to ensure that it truly represents the next generation of conduct disorder treatment. MST is a costly intervention. Before transporting this model to other countries, the sound policy decision is to ensure that MST represents a superior treatment, given the available alternatives. These findings also raise an important research issue: Not all control groups are the same. Future program evaluations that involve a "treatment as usual" research design should specify exactly what intervention the control group receives.