MST’s analytical model And a clinical case

1. MST’s analytical model And a clinical case

3. MST Treatment Principles 1.Finding the Fit The primary purpose of assessment is to understand the “fit” between the identified problems and their broader systemic context. 2.Positive & Strength Focused Therapeutic contacts should emphasize the positive and should use systemic strengths as levers for change. 3.Increasing Responsibility Interventions should be designed to promote responsibility and decrease irresponsible behavior among family members. 4.Present-focused, Action-oriented & Well-defined Interventions should be present-focused and action-oriented, targeting specific and well-defined problems. 5.Targeting Sequences Interventions should target sequences of behavior within and between multiple systems that maintain identified problems. 6.Developmentally Appropriate Interventions should be developmentally appropriate and fit the developmental needs of the youth. 7.Continuous Effort Interventions should be designed to require daily or weekly effort by family members. 8.Evaluation and Accountability Interventions efficacy is evaluated continuously from multiple perspectives, with providers assuming accountability for overcoming barriers to successful outcomes. 9.Generalization Interventions should be designed to promote treatment generalization and long-term maintenance of therapeutic change by empowering care givers to address family members’ needs across multiple systemic contexts.

4. Team: Reasons for Referral Initial Goals\Desired Outcome Superior MST goals

5. Team: Genogram:

6. Team:

7. Team:

8. Team: “Fit” circle:

9. 67 80 72 D 1961 35 48 39 40 50 24 30 27 19 15 B 75D 77 11 GENOGRAM OLA

10. Terapeut: 1001 Familie: 0002 Dato: 15/10 2003

11. Desired Outcomes of Family and key participants

12. A summary for supervision and consultation

17. Weekly Case Summary for Supervision and Consultation • Ola will be clean. This will be confirmed by negative urine specimen and information from parents, school and police. • Ola will actively participate in a school sitiation adapted for him. Confirmed by information from school and parents. • Ola will stop both verbal and physical aggression. Confirmed by information from school and parents. • Ola will follow the family rules. Confirmed by information from parents. Overarching\Primary MST Goals I.

18. GETS WHAT HE WANTS/GETS POWER Confirmed by: parents PEER STATUS Confirmed by: child services COMMUNICATION STYLE IN THE FAMILY Confirmed by: parents, Ola COVERS UP SADNESS Confirmed by: mom VERBAL AND PHYSICAL AGGRES-SION UNCLEAR RULES AND CONSE-QUENSES Confirmed by: parents LOW IMPULS CONTOL Confirmed by: school, mom PHYSICALLT STOPPED BY DAD IN CONFLICT SITUATIONS Confirmed by: Ola, parents INCONSITENT PARENTING Confirmed by: parents, Ola SUBSTANCE ABUSE Confirmed by: parents

19. EASY ACCESS TO DRUGS Confirmed by: youth support team, and Child Services PEERS WHO USE Confirmed by: youth support team, parents CURBS UNREST Confirmed by: Ola, parents SUBSTANCE ABUSE PROBLEMS IN THE FAMILY Confirmed by: parents SUB-STANCE ABUSE NO CONSEQUENSES Confirmed by: parents THRILL/RUSHConfirmed by: Ola NO PARTICIPATION IN AFTER SCHOOL ACTIVITIES Confirmed by: Ola CONFLICTS AT HOME Confirmed by: family NO MONITORING Confirmed by: parents

20. FRIENDS NOT ATTENDING SCHOOL/NO JOB Confirmed by: school, Ola NOR FRIENDS IN SCHOOL Confirmed by: lead teacher CONFLICT SCHOOL-HOME Confirmed by: parents, school PROBLEM CONCENTRA-TING, SUBJECT. Confirmed by: school, rapport from Educational-Psychological Service TRUANCY NO CONSEQUENSES AT HOME OR SCHOOL Confirmed by: school, parents BAD RELATIONSHIP WITH TEACHER Confirmed by: Ola NO PARENT FOLLOW UP WITH SCHOOL Confirmed by: parents SUBSTANCE ABUSE; GETS HOME LATE; TIERED Confirmed by: parents PARENTS HAVE NO CONTROL OVER ACTIONS Confirmed by: parents

21. Social Support • Key particpants • Identify need/tasks to ask for in support • Make a plan for meeting participants individually or in a group • Make agenda for meeting • Therapist is secretary at the meeting and writes all agreements • Examples of tasks: • Come to the home in difficult situations • Help in search for youth • Babysit other children when parents need • Be support for parents as needed • Be support for youth with activities

24. Safety plan for Ola and his family

25. Family Cohersion • Identify strengths • Help parents to rebuild warmth and support • Establish clear expectations and rules • Make family contract with predictable rewards and consequences • Plan for family activities

27. School interventions • Identify strengths and needs • Plan meeting with school with the parents • Parents contact school for meeting • Plan for comunication flow between parents and school • Plan for implementation of rewards and consequences are made • Plan for school routines • Particpants in meeting: (Principle) Class teachers, social support teacher, parents and therapist

28. Family contract

30. Peer interventions • Identify peers • Who, when and what they do • Decide desired contact level • Monitoring interventions • Examples: • Contact parents of negative peers • Establish a collaborative approaches: Try to make agreements on limits and rules • Plan for activities with prosocial peers

31. Plan for finding Ola

32. Physical and verbal aggression • Make security plan • Identify strengths and needs • Rebuild family bonding • Identify clear rules • Identify triggers for aggresion • Decide rewards for reducing verbal aggression (which is always covered in the family contract)

33. OLA DID NOT RECEIVE MONEY DAD YELLED AT OLA OLA KNOWS IT HELPS -HE GETS WHAT HE WANTS CONFLICT BETWEEN OLA AND PARENTS ALREADY PRESENT OLA HIT DAD DAD PHYSICALLY HELD HIM BACK VAGUE RULES DID NOT FOLLOW THE SECURITY PLAN PARENTS GAVE CONFLICTING INSTRUCTIONS OLA WAS INTOXI-CATED

34. Drug Abuse Interventions • Identify level of addiction • Identify peers who also use, what, when and where • Plans urine tests • Make contract for stopping drug use