Cynthia Cupit Swenson

Multisystemic Therapy for Child Abuse and Neglect: A randomized effectiveness trial

The primary purpose of this study was to conduct a randomized effectiveness trial of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) for physically abused youth (mean age = 13.88 years, 55.8% female, 68.6% Black) and their families. Eighty-six families being followed by Child Protective Services due to physical abuse were randomly assigned to MST-CAN or Enhanced Outpatient Treatment (EOT), with both interventions delivered by therapists employed at a community mental health center. Across five assessments extending 16 months post baseline, intent-to-treat analyses showed that MST-CAN was significantly more effective than EOT in reducing youth mental health symptoms, parent psychiatric distress, parenting behaviors associated with maltreatment, youth out-of-home placements, and changes in youth placement. Also, MST-CAN was significantly more effective at improving natural social support for parents. Effect sizes were in the medium to large range for most outcomes examined. Although fewer children in the MST-CAN condition experienced an incident of reabuse than did counterparts in the EOT condition, base rates were low and this difference was not statistically significant. The findings of this study demonstrate the potential for broad-based treatments of child physical abuse to be effectively transported and implemented in community treatment settings.

The relationship of social support to physically abused children's adjustment.

OBJECTIVE This study had three main objectives: First, to assess physically abused childrens perceptions of teacher, peer, and family support; second, to determine whether the levels of perceived support differ according to the persons social role; and third to assess which sources of social support show stronger associations with adjustment in a physically abused sample. METHOD Perceived social support from teachers, families and peers was assessed in a sample of 37 physically abused children using a shortened version of the Survey of Childrens Social Support (Dubow & Ullman, 1989). Child adjustment was indexed by child and parent reports of child depression, anxiety, and anger. RESULTS Analyses indicated that the children rated their families, peers, and teachers highly as sources of social support, with families being rated as the most important source. Hierarchical multiple regression analyses indicated that perceived peer support was significantly negatively related to childrens and parents reports of childrens depression and anxiety. Furthermore, perceived family support was significantly negatively associated with child reported depression. No significant relationships were found between perceived teacher support and symptomatology. CONCLUSIONS Overall, the results suggest that peer and family support are particularly important for physically abused childrens psychological functioning, particularly for internalizing problems.

Changing the Social Ecologies of Adolescent Sexual Offenders: Implications of the Success of Multisystemic Therapy in Treating Serious Antisocial Behavior in Adolescents

Current treatment models for adolescent sexual offenders are individually oriented and have limited empirical support. These models may not be effective in reducing recidivism because they do not address the multiple factors (i.e., individual, family, peer, school) related to sexual offending. Multisystemic therapy (MST), an ecologically based treatment model that addresses multiple determinants of behavior, has proven effective with chronic, violent nonsexual offenders in several randomized trials. Preliminary research also indicates promise for MST with sexual offenders. This article: (a) presents empirical support for use of an ecological approach with adolescent sexual offenders based on a multidetermined etiology, (b) provides a theoretical and clinical description of MST, and (c) describes a recent adaptation of MST that maintains the ecological emphasis of MST and integrates important conceptualizations from the literature on adolescent sexual offending.

The abuse clarification process in the treatment of intrafamilial child abuse

OBJECTIVE One aspect of treatment for child abuse and neglect addresses the attributions that the child victim, offender, nonoffending parents, and other family members have about the occurrence of the maltreatment. This paper describes a formal approach for abuse clarification to be used with families in which maltreatment has occurred. The four primary components of the abuse clarification process are: (a) clarification of the abusive behaviors; (b) offender assumption of responsibility for the abuse; (c) offender expression of awareness of the impact of the abuse on the child victim and family; and, (d) initiation of a plan to ensure future safety. The process of abuse clarification is described and suggestions made for appropriate use of the procedure.

Comprehensive treatment for co-occurring child maltreatment and parental substance abuse: Outcomes from a 24-month pilot study of the MST-Building Stronger Families program

This manuscript presents outcomes from a pilot study of Multisystemic Therapy-Building Stronger Families (MST-BSF), an integrated treatment model for the co-occurring problem of parental substance abuse and child maltreatment among families involved in the child welfare system. Participants were 25 mother-youth dyads who participated in MST-BSF and an additional 18 families with similar demographic and case characteristics who received Comprehensive Community Treatment (CCT). At post-treatment, mothers who received MST-BSF showed significant reductions in alcohol use, drug use, and depressive symptoms; they also significantly reduced their use of psychological aggression with the youth. Youth reported significantly fewer anxiety symptoms following MST-BSF treatment. Relative to families who received CCT, mothers who received MST-BSF were three times less likely to have another substantiated incident of maltreatment over a follow-up period of 24 months post-referral. The overall number of substantiated reabuse incidents in this time frame also was significantly lower among MST-BSF families, and youth who received MST-BSF spent significantly fewer days in out-of-home placements than did their CCT counterparts. These promising preliminary outcomes support the viability of a more rigorous (i.e., randomized) evaluation of the MST-BSF model.

Multisystemic treatment of violent and chronic juvenile offenders: bridging the gap between research and practice.

The lack of communication between researchers and practitioners has hindered the development of effective interventions for children and adolescents. Recently, however, significant headway in bridging this researcher-practitioner gap has been made due to the emergence of multisystemic therapy (MST) as a treatment approach that combines the rigor of science and the “real world” aspects of clinical practice in treating violent and chronic juvenile offenders and their families in community-based settings. MST addresses the multiple known determinants of delinquency and delivers services in the familys natural environment, with considerable emphasis on treatment fidelity. This article describes MST and provides a case example of how MST treatment principles are applied.

Practical and Methodological Challenges in Validating Community-Based Interventions

Practical and methodological challenges in conducting research on community-based interventions for adolescent problems are described. First, a conceptual framework for the development of community-based interventions is provided, with an emphasis on the ecological and commonweal advantages of such interventions. Next, important issues that investigators confront when pursuing the dual goals of providing good community-based intervention and conducting rigorous intervention research are addressed. These issues include research design, intervention specification and integrity, participant concerns, changing clinical culture, community challenges, school challenges, and appropriate staffing. Finally, a summary of challenges to conducting good community-based intervention research and effective responses to these challenges is presented.

Neighborhood Solutions for Neighborhood Problems: An Empirically Based Violence Prevention Collaboration

Youth antisocial behavior is influenced, in part, by neighborhood context. Yet, rather than attempting to ameliorate factors contributing to youth antisocial behavior, service dollars are primarily devoted to expensive and often ineffective out-of-home placements. This article describes the development and implementation of a collaborative partnership designed to empower an economically disadvantaged neighborhood to address violent criminal behavior, substance abuse, and other serious antisocial problems of its youth while maintaining youth in the neighborhood. Through a collaboration between a university research center and neighborhood stakeholders, services are being provided to address the key priorities identified by neighborhood residents, and extensive efforts are being made to develop family and neighborhood contexts that are conducive to prosocial youth behavior.

Adapting multisystemic therapy to treat adolescent substance abuse more effectively

The article illustrates an adaptation of multisystemic therapy (MST) coupled with community reinforcement plus vouchers approach (CRA) to treat adolescent substance abuse and dependency. Key features of CRA enable the MST therapist and adolescent caregiver to more specifically detect and address adolescent substance use. These features include frequent random urine screens to detect drug use, functional analyses to identify triggers for drug use, self-management plans to address identified triggers, and development of drug avoidance skills. To highlight the integration of MST and CRA in treating substance abusing or dependent adolescents, a case example is provided. Prior to the case example, an overview of clinical and program features of MST and substance-related outcomes is presented.

Cognitive behavioral group treatment for physically abused children

The purpose of this case study was twofold: to assess the feasibility of implementing a multiple-module, 16-week cognitive behavioral group treatment program for physically abused children; and to evaluate preliminary data from this group treatment program designed to address the multiple sequelae common to school-aged physically abused children (i.e., aggression and other behavioral problems, social skills deficits, and trauma-related symptoms). Results indicate that the multiple components of this group treatment program were implemented successfully and allowed for flexibility across children, even within a group format. Preliminary data show decreases on self-report measures of trauma-related emotional symptoms targeted by the group treatment. Increases were evident in parent ratings of childrens internalizing and externalizing behaviors. Interpretations of these findings and future research recommendations are discussed.