This study examines the factors associated with the effective transport of a complex family-based mental health treatment, Multisystemic Therapy (MST), to community settings. As such, the study directly addresses major gaps in both clinical (psychotherapy) and mental health services research pertaining to the translation of efficacious treatments to effective mental health services. MST has proven effective in improving child behavior and family functioning in randomized trials with youth experiencing serious clinical problems. In three randomized trials with violent and chronic juvenile offenders, MST reduced long-term rates of rearrest and out-of-home placement and improved child behavior and family functioning. Earlier randomized trials demonstrated the promise of MST in treating child abuse/neglect and juvenile sex offenders, and an ongoing study is evaluating its effectiveness as an alternative to psychiatric hospitalization. In response to demand from policy makers and providers to develop MST programs, 27 programs serving 1500 youth and families annually have been established in 8 states and Canada. Recent research on MST has demonstrated a significant association between clinicians' adherence to the MST treatment protocol and favorable outcomes for youth. Thus, the foremost challenge in transporting the model and its favorable outcomes to usual care settings is determining the organizational and extra- organizational conditions that support the fidelity of MST interventions. Specifically, this study will examine the child and outcomes associated with MST as delivered by clinicians in 26 programs. Participants will be 2550 youth and families referred to MST programs and the clinicians and administrators employed by those programs. A multi-method multi-source measurement battery will be used to examine the organizational and extra-organizational factors thought to support fidelity to MST and concomitant child outcomes.
The aims of this study are to: 1). Document the relationship between clinician adherence to a specific treatment model and child outcomes in usual care settings; 2). Examine the impact of intra-organizational variables on clinician adherence; 3). Examine the extent to which organizational variables relevant to transportability are influenced by selected extra-organizational factors; 4). Examine the influence of clinician variables on adherence; 5). Test a mediation model of treatment effectiveness in which the impact of intra- and extra-organizational factors and individual clinician variables on outcomes is mediated by clinician adherence.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH059138-05
Application #
6639088
Study Section
Services Research Review Committee (SER)
Program Officer
Vitiello, Benedetto
Project Start
1999-09-15
Project End
2005-05-31
Budget Start
2003-06-01
Budget End
2005-05-31
Support Year
5
Fiscal Year
2003
Total Cost
$320,295
Indirect Cost
Name
Medical University of South Carolina
Department
Psychiatry
Type
Schools of Medicine
DUNS #
183710748
City
Charleston
State
SC
Country
United States
Zip Code
29425
Schoenwald, Sonja K; Chapman, Jason E; Henry, David B et al. (2012) Taking Effective Treatments to Scale: Organizational Effects on Outcomes of Multisystemic Therapy for Youth with Co-occurring Substance Use. J Child Adolesc Subst Abuse 21:1-31
Chapman, Jason E; Schoenwald, Sonja K (2011) Ethnic Similarity, Therapist Adherence, and Long-Term Multisystemic Therapy Outcomes. J Emot Behav Disord 19:3-16
Glisson, Charles; Schoenwald, Sonja K; Hemmelgarn, Anthony et al. (2010) Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. J Consult Clin Psychol 78:537-50
Schoenwald, Sonja K; Chapman, Jason E; Sheidow, Ashli J et al. (2009) Long-term youth criminal outcomes in MST transport: the impact of therapist adherence and organizational climate and structure. J Clin Child Adolesc Psychol 38:91-105
Schoenwald, Sonja K; Sheidow, Ashli J; Chapman, Jason E (2009) Clinical supervision in treatment transport: effects on adherence and outcomes. J Consult Clin Psychol 77:410-21
Schoenwald, Sonja K; Carter, Rickey E; Chapman, Jason E et al. (2008) Therapist adherence and organizational effects on change in youth behavior problems one year after multisystemic therapy. Adm Policy Ment Health 35:379-94
Letourneau, Elizabeth J; Chapman, Jason E; Schoenwald, Sonja K (2008) Treatment outcome and criminal offending by youth with sexual behavior problems. Child Maltreat 13:133-44
Glisson, Charles; Schoenwald, Sonja K (2005) The ARC organizational and community intervention strategy for implementing evidence-based children's mental health treatments. Ment Health Serv Res 7:243-59
Halliday-Boykins, Colleen A; Schoenwald, Sonja K; Letourneau, Elizabeth J (2005) Caregiver-therapist ethnic similarity predicts youth outcomes from an empirically based treatment. J Consult Clin Psychol 73:808-18
Schoenwald, Sonja K; Letourneau, Elizabeth J; Halliday-Boykins, Colleen (2005) Predicting therapist adherence to a transported family-based treatment for youth. J Clin Child Adolesc Psychol 34:658-70

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