TY - JOUR
T1 - Transportability of multisystemic therapy
T2 - Evidence for multilevel influences
AU - Schoenwald, Sonja K.
AU - Sheidow, Ashli J.
AU - Letourneau, Elizabeth J.
AU - Liao, Jason G.
N1 - Funding Information:
Preparation of this manuscript was supported by Grant #59138 from the National Institute of Mental Health, the Annie E. Casey Foundation, and the MacArthur Foundation Initiative Linking Science and Practice to Improve Youth Mental Health Care. The authors thank Donald C. Hedeker for his helpful consultation and Scott W. Henggeler for his comments on an earlier draft. Many thanks are owed to the clinicians and provider organizations collaborating in this research and the families they serve. The first author is a Board member and stockholder of MST Services, LLC.
PY - 2003/12
Y1 - 2003/12
N2 - This study examines factors associated with the implementation and short-term outcomes in dissemination sites of Multisystemic Therapy (MST), an intensive, short-term, family- and community-based treatment for serious antisocial behavior in youth. Participants were 666 children and families served by 217 therapists in 39 sites. Pre- (T1) to immediate posttreatment (T2) differences in child problems and functioning were similar in magnitude to those found in randomized trials of MST. Results of random effects regression supported direct effects of therapist adherence, organizational climate, and structure at baseline on immediate posttreatment child outcomes. However, organizational factors were unrelated to adherence; thus, a hypothesized mediation model in which organizational climate and structure affect outcomes through therapist adherence to MST was not supported. Furthermore, the direction of associations between some organizational climate variables and outcomes countered expectations. Post hoc moderation analyses clarify these findings, with organizational effects differing by level of therapist adherence during treatment. Implications for the transfer of evidence-based psychosocial treatments for youth to usual care practice settings are discussed.
AB - This study examines factors associated with the implementation and short-term outcomes in dissemination sites of Multisystemic Therapy (MST), an intensive, short-term, family- and community-based treatment for serious antisocial behavior in youth. Participants were 666 children and families served by 217 therapists in 39 sites. Pre- (T1) to immediate posttreatment (T2) differences in child problems and functioning were similar in magnitude to those found in randomized trials of MST. Results of random effects regression supported direct effects of therapist adherence, organizational climate, and structure at baseline on immediate posttreatment child outcomes. However, organizational factors were unrelated to adherence; thus, a hypothesized mediation model in which organizational climate and structure affect outcomes through therapist adherence to MST was not supported. Furthermore, the direction of associations between some organizational climate variables and outcomes countered expectations. Post hoc moderation analyses clarify these findings, with organizational effects differing by level of therapist adherence during treatment. Implications for the transfer of evidence-based psychosocial treatments for youth to usual care practice settings are discussed.
KW - Children's mental health services
KW - Community implementation of evidence-based treatments
KW - Organizational climate and structure in mental health
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U2 - 10.1023/A:1026229102151
DO - 10.1023/A:1026229102151
M3 - Review article
C2 - 14672501
AN - SCOPUS:0344465987
SN - 1522-3434
VL - 5
SP - 223
EP - 239
JO - Mental Health Services Research
JF - Mental Health Services Research
IS - 4
ER -