Hester van Eeren

Comparative effectiveness of MST and FFT | 5 91 | Introduction Multisystemic Therapy (MST) and Functional Family Therapy (FFT) both originated in the US. Their proven effectiveness in reducing adolescents’ antisocial behavior and delinquency has led to the worldwide dissemination of these interventions. Both MST and FFT are aimed at reducing the behavioral problems of 12–18 year old adolescents by intervening in the youth’s family and environmental system. Functional Family Therapy has an integrated theoretical base in which behavioral techniques, system perspectives, and cognitive theory are combined while remaining informed by intrapsychic perspectives (Breuk et al., 2006; Sexton & Alexander, 2003). Antisocial behavior is thought to be mediated and embedded in a complex sequence of relations between the adolescent and his or her family members (Sexton & Alexander, 2003). Therefore, FFT is specifically aimed at improving family communication and supportiveness while decreasing negativity and dysfunctional behavioral patterns (Blueprints for healthy youth development, 2015). The therapy mainly consists of direct contact with family members, but may be coupled with support system services, such as school or work. Research has shown that FFT is effective in reducing (delinquent) behavioral problems, recidivism, and substance abuse, and that it guides family members in improving their family situation (Alexander & Sexton, 2002; Sexton & Turner, 2010; Sexton & Alexander, 2000)). Caregivers are also seen as the most important link in the treatment process of MST, but MST also actively involves all other systems surrounding the youth, such as friends, schools, and neighborhoods (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2009). This approach is founded in the social-ecological theory of Bronfenbrenner (Bronfenbrenner, 1979), in which it is thought that antisocial behavior is multi-determined by the different social systems in which an individual acts. By intervening in and with these social systems, risk factors are reduced and a youth’s social environment is changed such that it stimulates prosocial activities instead of antisocial behavior (Henggeler et al., 2009). Multisystemic Therapy is more intensive than FFT because a therapist visits the family at home and is available to the family round-the- clock. Research has shown that MST effectively reduces behavioral problems and delinquency, recidivism, substance abuse, out-of-home placement, family problems, and involvement with deviant peers (Henggeler, 2011; van der Stouwe, Asscher, Stams, Deković, & van der Laan, 2014). The effectiveness of both MST and FFT is well-established compared to regular treatment, such as individual treatment or family-based interventions, such as parenting counseling (Asscher, Dekovic, Manders, van der Laan, & Prins, 2013; Sundell et al., 2008). Multisystemic Therapy and FFT clearly show overlap in their target populations and treatment goals (e.g., Chorpita et al., 2011; Henggeler, 2011; Sexton & Turner, 2010). However, little is known about their relative effectiveness (i.e., whether one intervention outperforms the other). A recent study by Baglivio and colleagues (2014) compared the effectiveness of MST and FFT in juvenile practice in the US. In this study, youth receiving MST or FFT had been referred by probation officers from the juvenile justice department. Results showed little significant difference in the effectiveness of the two interventions. However, low-risk youth receiving FFT committed fewer offenses during treatment than low-risk youth receiving MST.