Local governments can invest in this strategy using State and Local Fiscal Recovery Funds (SLFRF) from the American Rescue Plan Act (ARPA).

  • This strategy can help prevent violence. The U.S. Department of Treasury has indicated that strategies that help achieve this outcome are eligible for the use of Fiscal Recovery Funds.
  • Investments in this strategy are SLFRF-eligible as long as they are made in qualified census tracts or are designed to assist populations or communities disproportionately impacted by COVID-19.

Program overview

  • Reducing justice-involvement and behavioral issues: Multisystemic therapy (MST) is an intensive home- and community-based treatment model for at-risk adolescents. It aims to address behavioral issues (e.g., delinquent activity) while keeping the adolescent in school and at their home, instead of in custody.

  • Designed for at-risk youth: MST is designed for adolescents aged 12 to 17 who are at risk of an out-of-home placement due to antisocial or delinquent behavior. Often, youth with substance use disorders are strong candidates for MST.

  • Addressing risk factors and building skills: MST focuses on addressing risk factors (e.g., alcohol and drug use) in the youth’s personal, family, peer, school, and community environment that contribute to behavioral issues. Additionally, the model emphasizes empowering the adolescent and their caregivers by helping them identify and develop strengths and support systems (e.g., extended family, friends) and remove barriers to behavioral change (e.g., parental stress, youth substance use).

  • Providing intensive and collaborative treatment: MST is typically delivered by licensed therapists working for child welfare, juvenile justice, or behavioral health agencies. The therapist collaborates with the adolescent and their family to set treatment goals and supports them in achieving those goals. The intensity and length of the treatment varies depending on the participants’ needs, but typically, therapists work with adolescents and their families between one and five times per week over a three to five month period.

Cost per Participant
$8,000-$10,000 per participant

Multiple studies with rigorous designs demonstrate that multisystemic therapy is a well-supported strategy for improving outcomes related to recidivism, incarceration, and behavioral issues.

  • A 2021 systematic review identified MST as a well-supported treatment for adolescent substance use and child and adolescent disruptive behavior, as well as a well-supported alternative to long-term residential care.

  • A 2018 systematic review identified MST as a scientifically supported strategy for reducing recidivism and incarceration.

  • A 2011 systematic review identified MST as an effective strategy for reducing recidivism, rearrest, and number of days incarcerated.

  • Create a referral network: In some jurisdictions, communication between child welfare, juvenile justice, and other organizations that work with at-risk youth is fragmented. By convening key these stakeholders, an implementing agency can educate other organizations on MST eligibility requirements, program goals, and referral options. This type of outreach can ensure that youth who do not interact with the implementing agency still have access to MST.

  • Maintain small caseloads: As part of the MST model, therapists work intensively with adolescents and their families (i.e., up to five times per week) and are available to provide support 24 hours a day, 7 days a week. To make this level of care sustainable, therapists typically have small caseloads of four to six families and are part of teams of three to four therapists who can rotate responsibility for being on-call during off-hours.

  • Develop relationships with community organizations: MST emphasizes addressing risk factors and developing a support network in the adolescent’s family, peer, school, neighborhood, and community contexts (e.g., working with a school principal to identify an in-school mentor). To do so, MST programs need to build relationships with leaders in community organizations that regularly interact with at-risk youth (e.g., schools, court systems, religious organizations).

  • Bring treatment to participants: Due to the intensity of the MST model (i.e., sessions up to five times per week), scheduling and transportation can be barriers to adolescent and family participation. Delivering sessions at the family’s home or in the adolescent’s school can help mitigate these concerns.

  • Use quality assurance mechanisms: To maximize effectiveness, MST programs should collect data to validate that they are adhering to the MST model. The nonprofit, MST Services, maintains a database of program data and produces reports to assist individual programs with monitoring their effectiveness.