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MST for Child Abuse and Neglect: What Do We Know And Where Are We Headed?

MST for Child Abuse and Neglect: What Do We Know And Where Are We Headed?. Cynthia Cupit Swenson, Ph.D. Medical University of South Carolina. MST for Child Abuse and Neglect The Evidence: Study #1-- Standard MST. Brunk, Henggeler, & Whelan, 1987 First Randomized Trial (N = 43)

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MST for Child Abuse and Neglect: What Do We Know And Where Are We Headed?

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  1. MST for Child Abuse and Neglect:What Do We Know And Where Are We Headed? Cynthia Cupit Swenson, Ph.D. Medical University of South Carolina

  2. MST for Child Abuse and Neglect The Evidence: Study #1-- Standard MST • Brunk, Henggeler, & Whelan, 1987 • First Randomized Trial (N = 43) • Multisystemic Therapy vs. Parent Training • Children were abused or neglected • Mean age 9.8 for youth in MST Condition 6.8 for youth in the Parent Training Condition MST Greater Alleviation of Family Difficulties Greater Control of Child Neglectful Parents More Responsive PT Greater decrease in parent social problems

  3. Community-Based Treatment for Child Physical Abuse: Costs and Outcomes Study #2—Standard MST with Adaptations NIMH-Funded R01 (2000-Present) Principal Investigator: Cynthia Cupit Swenson,Ph.D. Co-Investigators: Scott W. Henggeler, Ph.D. Richard Faldowski, Ph.D. David Ward, Ph.D. Project Coordinator: Lisa Saldana, Ph.D.

  4. Community-Based Treatment for Child Physical Abuse: Costs and Outcomes PEACE, Betta Fuh Fambly(Project Empowering Adults, Children, & Their Ecology) • Funded by National Institute on Mental Health • 5 Year Project • Adolescents 10-17 • Physical Abuse Referrals from Charleston County CPS

  5. PEACE, Betta Fuh Fambly(Project Empowering Adults, Children, & Their Ecology) • Effectiveness Study • Site-Charleston/Dorchester Mental Health Services For Children, Adolescents, and Their Families • N = 86 Families • Random Assignment • 2 groups-MST with Adaptations versus Parent Training Group Plus Standard Community Services

  6. PEACE, Betta Fuh Fambly(Project Empowering Adults, Children, & Their Ecology) • 5 Assessments -Intake, 2 month, 4 month, 10 month, 16 month • Outcomes • Child Level • Parent Level • Family Level • Service Utilization (Monthly Interview) • Cost

  7. Demographics Average Age (years) 13.8 Gender Female = 56% Ethnicity: Black 59 White 19 Hispanic 6 Native American 1 Arab American 1

  8. Short-Term Outcomes Recruitment & Retention Study Recruitment Rate: 97% Treatment Retention Rates: MST: 98% Parent Group: 86% Research Retention Rates: 4 Month: 100% 16 Month: 95%

  9. Short-Term Outcomes Both Groups Showed Dramatic Reductions in: Parent to Child Physical Violence Parent to Child Psychological Aggression

  10. Child Report of Discipline Use of Non-Physical Discipline MST > PG, p < .01

  11. TSCC: Sexual Concerns(p = .05)

  12. Children’s Depression Inventory: Total Score (p < .05)

  13. CDI: Negative Mood(p < .05)

  14. CDI: Anhedonia(p < .01)

  15. Satisfaction with Services • MST Parents Reported Greater Satisfaction with Services: • Services Were Worthwhile to the Family p < .01 • Services Helped the Family p < .05 • Services Changed the Way the Family Behaves p < .01 • Skills Learned Became a Part of Daily Life p < .01 • Treatment Matched the Individual Needs of the Family p < .01

  16. Out-of-Home Placement-16 Months(MST n = 6; PG n = 12)

  17. Summary Though Youth and Parents in Both Groups Got Better In the Short Term MST Youth Were More Likely to: • Be Home with the Family • Feel Safe • Experience less Depression & Anhedonia • Report that their Parent was Using more Non Physical Discipline Strategies MST Parents Were More Likely to: • Have Their Child Home with the Family • Have Their Child Report that the Parent was using more Non Physical Discipline • Be Happy with Treatment and Feel it is Helping The Family Change and That Skills Learned are Becoming Part of Daily Life • Report that their child’s symptoms of anxiety and distractibility are reduced

  18. MST for Child Abuse and Neglect How is it Different From Standard MST?

  19. MST-CAN Population Abused and Neglected Children Ages 6-17 Caseload Maximum 4 Families Greater Focus on Adult Treatment Treat Entire Family Treatment Length 6-8 Months

  20. Risk Factors Related to Child Maltreatment PARENT Depression Substance Abuse Low Empathy Poor Impulse/Anger Control Antisocial Behavior Poor Knowledge of Child Development Negative Perception of Child History of Maltreatment as a Child Age and Gender CHILD Aggression Noncompliance Difficult Temperament Age Delayed Development Gender Chronic Medical Prob. History of Abuse Child Abuse & Neglect Community Economic Disadvantage Instability Neighborhood Burden Low Community Activities FAMILY Marital Status-Single Limited Resources Family Stress/Poverty Family Violence

  21. MST-CAN Key Systems Involved Child Protective Services Family Court MST Adaptations An Addition of Empirically-Supported Components to What is Considered Standard MST to Address Problems Commonly Found in CAN Families

  22. MST-CAN Adaptations • Family Safety Plan • Functional Analysis of the Use of Force or Physical Discipline • Treatment for Anger Management • Treatment for PTSD • Treatment for Substance Abuse • Family Communication Training • Clarification of the Abuse • Inclusion of a Psychiatrist • Involving CPS in Treatment

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