Multisystemic Therapy: Treatment Outcome Validity and Predictors of Outcome

Executive Summary Background/Context: • The Child and Adolescent Mental Health Division (CAMHD) has been one of the earliest implementers of Multisystemic Therapy (MST) on a system-wide basis. A considerable research literature exists for MST, which allows CAMHD to benchmark the local implementation to other well-controlled randomized trials. • Given the CAMHD commitment to ongoing data collection and evaluation, there are numerous datasets that allow for an evaluation of MST in CAMHD. The present report focuses on the validity of ideographic MST goal attainment as measured by therapist's ratings of success (" Successful " , " Partially Successful " , and " Unsuccessful ") and changes in CAFAS and CALOCUS scores from initiation to termination of MST services. Purposes: • Examine the validity of the therapist-rated outcome measures (based on goals attained) by comparing these to changes in case manager's ratings of client level of functioning (CAFAS) and level of service needs (CALOCUS) collected around the time of entry and exit from MST. • Examine client and service characteristics that might predict the extent of goal attainment (therapist-rated outcomes). • Compare improvement in child functioning observed in MST in Hawaii to rates reported in the MST efficacy literature. Method: • This report examines outcomes for 254 children who received MST services between January 1, 2004 and December 13, 2005 and had complete therapist-rated outcome data. • A sample of 254 youth with MST outcomes was used to examine potential demographic and clinical data that might predict therapist-rated outcomes. These participants comprised the " full MST " sample. • Of the full MST sample, 122 (48%) had available CAFAS and CALOCUS data near the beginning and ending of MST treatment. These participants made up the " full CAFAS and CALOCUS " sub-sample. Data from this sub-sample was used to validate the MST outcome measures by comparing therapist ratings of success to changes in CAFAS and CALOCUS. • Data from the " full CAFAS and CALOCUS " sub-sample was used to estimate the amount of improvement and to compare this to rates of improvement reported in the scientific literature. What percent of MST cases are rated by their therapists as meeting few, some, or all of their MST goals at the end of MST services? Nearly one half (48%) of all MST cases were rated as " Successful " (all treatment goals met) by therapists at the end of MST services. About 36% …