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International Research

MST Services

MST was originally developed in the USA building on the best evidence of what worked for keeping young people at home with their families and tackling problems with offending and anti-social behaviour. Over the last 30 years a number of research trials across the world have shown MST to be effective in reducing offending and improving family relationships and also to be cost effective.
Results from international research shows MST leads to:
  • long-term re-arrest rates reduced by median of 42%;
  • out-of-home placements, across all studies, reduced by a median of 54%;
  • improved families functioning;
  • decreased substance use;
  • fewer mental-health problems
  • higher levels of client satisfaction;
  • considerable cost savings.
MST’s positive results are long lasting
A 14-year and 22-year follow-up study by the Missouri Delinquency Project showed young people who received MST were still significantly less likely to be rearrested or placed away from home in care or custody than their comparison group.
For more information about MST's evidence base, please download the MST Research At A Glance document or visit the MST Services website.
MST has proven the importance of treatment adherence
A large, 45-site study on the transport of MST involving almost 2,000 families, and more than 450 therapists and 80 supervisors, concluded:
  • High therapist adherence can reduce the number of young people with criminal charges by 36 percent at 2.3 years after treatment;
  • high supervisor adherence can reduce the number of young people with criminal charges by 53 percent at 2.3 years after treatment;
  • MST has been effectively transported to community practice settings;
  • MST currently has more than 500 active programmes;
  • adherence measures demonstrate that MST is being delivered with high levels of fidelity;
  • outcomes in community practice settings are similar to those of university-based trials.


Click here for information about MST for Child Abuse and Neglect (MST CAN) research


European studies

The Association of Child and Adolescent Mental Health (ACAMH) - Child & Adolescent Mental Health Journal

Alliance and Adherence in a Systemic Therapy (2016)

Background: The client–therapist working alliance is a key contributor to effective adult psychotherapy. However, little is known about its role in family and systemic therapy. Moreover, few studies have assessed alliance longitudinally or have investigated how it interrelates with other process variables, such as therapist adherence (i.e. the extent to which the therapist adheres to the treatment protocol or manual). We hypothesised that alliance and adherence interrelate over the course of the therapy. Method: This study investigated the bidirectional associations between alliance and therapist adherence using cross-lagged panel analyses for a sample of 1970 adolescents and their families participating in Multisystemic Therapy (MST). A number of client characteristics were included as moderators, namely demographic characteristics, type and severity of adolescent problem behaviour, and whether or not the MST treatment was court ordered. Alliance and adherence were scored by the primary caregiver through telephone interviews at monthly intervals during treatment.

Results: Alliance in 1 month predicted therapist adherence in a subsequent month. Adherence only predicted subsequent alliance during the middle part of the treatment process. The results were not moderated by any of the client factors. Conclusions: The results suggest that alliance and therapist adherence may reinforce one another during therapy. Although alliance may facilitate the development of therapist adherence, adherence may subsequently deepen and consolidate the client–therapist alliance. These results are independent of client characteristics.

Journal of Clinical Child & Adolescent Psychology
Treatment effects may not be observed if an empirically supported intervention is not administered with treatment adherence. This retrospective study investigated how therapists’ adherence to Multisystemic therapy (MST) varied during a 6-year period in Sweden. Adherence was measured using the Therapist Adherence Measure, which was provided by caregivers. The associations between treatment adherence and therapist-reported posttreatment youth outcomes were also assessed. Retrospective adherence data were obtained for 973 families with youths between 12 and 17 years old who received MST from 68 therapists divided into 10 teams. Implementation of MST occurred in 2 waves between March 2003 and August 2009. Multilevel structural equation modelling was used to evaluate family- and cohort-level predictors and outcomes of treatment adherence.
The results confirm previous research: Treatment adherence predicts MST treatment outcomes. With respect to the relationship between MST treatment experience and MST treatment adherence, the analysis showed mixed results. An increase in years that a team had been active predicted an increase in therapist adherence to MST. Therapists from the 2nd implementation wave had higher therapist adherence rates than therapists from the 1st implementation wave. Nevertheless, a therapists’ experience with MST did not predict MST treatment adherence. The results suggest that the found links among treatment experience, treatment adherence, and treatment outcomes provide support for the hypothesis that the collective experience
of the team members promotes treatment adherence. However, results are mixed and further research is needed.