MST
Core Mechanism
Intensive home-based intervention targets multiple ecological systems (family, peer, school) maintaining antisocial behavior
Ontology
Antisocial behavior maintained by factors across ecological systems, not just the individual youth
Therapeutic Voice
"Who is actually around at three o'clock when he gets out of school? We build the plan around people who are really there. If it doesn't hold this week, that's mine to fix, not yours."
View of the Person
A youth embedded in multiple systems (family, peer, school, community) that jointly maintain or restrain behavior
Evidence
NICE: recommended for conduct disorder. SAMHSA: listed
25+ RCTs across countries
Van der Stouwe et al. (2014)
Modest evidence for juvenile antisocial behavior: Van der Stouwe et al.'s (2014) meta-analysis found d = 0.20 overall, with the violent-offending subgroup not statistically significant (d = 0.12).
Conditions
Epistemology
Blind Spots
Extremely resource-intensive; requires 24/7 therapist availability; limited outside juvenile justice populations
Contraindications
Families unwilling to participate, youth not living with any identifiable family or caregiver system, active psychosis in the youth, cases where the primary issue is the caregiver's own severe mental illness
Training
Organizational licensure required. 5-day training + ongoing weekly consultation + fidelity monitoring
MST Services (MUSC): organizational model only
5-day initial + weekly consultation ongoing
Organizational licensing
Equity & Cultural Adaptations
Philosophical Roots
Bronfenbrenner (ecological systems theory); Haley (strategic family therapy); Minuchin (structural family therapy); pragmatism (what works in context)
Related Modalities
Test Yourself
What makes MST unique?
Show answer
Home-based, small caseloads, 24/7 availability, targeting all systems.