Promising - One study
Randomized Controlled Trial
Date: This profile was posted on September 14, 2012
The program provides integrated individual and family services to juvenile offenders who have co-occurring mental health and chemical dependency disorders during their transition from incarceration back into the community. The program is rated Promising. Results showed the intervention had a significant effect on felony recidivism at 36 months postrelease. However, it did not appear to have a significant effect on overall recidivism (misdemeanor or felony).
The Multisystemic Therapy–Family Integrated Transitions (MST–FIT) program provides integrated individual and family services to juvenile offenders who have co-occurring mental health and chemical dependency disorders. Services are provided during a juvenile’s transition from incarceration back into the community. The overall goal of MST–FIT is to provide necessary treatment to youth, thereby reducing recidivism. The program also seeks to connect youth and their families to appropriate community supports, achieve youth abstinence from alcohol and other drugs, improve youth mental health, and increase youth prosocial behavior.
The program was developed after the Washington State Legislature initiated a pilot rehabilitation program for juvenile offenders with co-occurring substance abuse and mental health disorders who had received sentences to enter a state Juvenile Rehabilitation Administration (JRA) institution.
To be eligible to participate in MST–FIT, a youth must meet the following criteria:
Youth must also reside in King, Pierce, Snohomish, Kitsap, Thurston, Mason, Yakima, Benton, or Kittitas counties, where the MST–FIT program is currently available.
- The youth must be younger than 17 ½ years old.
- The youth must be in a JRA institution and scheduled to be released to 4 or more months of parole/supervision.
- The youth must have a substance abuse or dependence disorder and any of the following: any Axis 1 disorder, currently prescribed psychotropic medication, or demonstrated suicidal behavior within the past 3 months.
The MST–FIT program begins in a youth’s final 2 months in a residential facility and continues for 4 to 6 months during parole supervision. MST–FIT is based on components of three programs: Multisystemic Therapy (MST), Dialectical Behavior Therapy (DBT), and Motivational Enhancement Therapy (MET). The overarching framework of the program is derived from MST, a family-based preservation model for community-based treatment. MST provides the foundation of the intervention, while the other intervention strategies are delivered within the MST framework. MST tailors treatment goals to a youth’s individual risk and protective factors within his or her natural environment (i.e., family, school, and community). This treatment component uses therapists to coach caregivers in establishing productive partnerships with schools, community supports, parole, and other systems, and to help caregivers develop skills to be effective advocates for those in their care.
Although the MST component concentrates on the extent to which the youth’s surrounding environments support prosocial behavior, MST–FIT incorporates elements of DBT to address individual-level characteristics in both youth and caregivers by replacing maladaptive emotional and behavioral responses with more effective and skillful responses. The skills training component of DBT targets emotional dysregulation that underlies problems youth with co-occurring disorders have, such as anger, impulse control, and moodiness. Throughout the intervention, coaches look for opportunities to encourage youth to apply the skills they learn in real-world settings.
Finally, MST–FIT uses aspects of MET to engage youths and their families in treatment, with the objective of increasing their commitment to change. MST–FIT therapists use MET techniques to develop the initial engagement of all parties and to maintain their commitment throughout treatment.
Relapse prevention/community reinforcement is also used to increase the youth's and family’s awareness of issues such as substance use and high-risk situations. A range of effective coping strategies are provided, and a plan is established for youth to resume treatment, should they relapse.
The MST–FIT team consists of contracted therapists with backgrounds in children’s mental health, family therapy, and chemical dependency. The team serves four to six families at any given time. Service delivery occurs in the families’ homes and communities, and services are available 24 hours a day, 7 days a week.
Overall, Trupin and colleagues (2011) found mixed results. Results showed that Multisystemic Therapy–Family Integrated Transitions (MST–FIT) had a significant effect on felony recidivism at 36 months postrelease. However, the MST–FIT intervention did not appear to have a significant effect on overall recidivism (misdemeanor and felony), misdemeanor recidivism, and violent felony recidivism.
Of the entire sample of study participants, 78 percent had some type of recidivism. However, the MST–FIT intervention did not have a significant impact on overall recidivism (misdemeanor or felony).
Fifty-eight percent of the entire sample had a felony by the time of the follow-up. At 36 months post-release, the MST–FIT intervention was significantly associated with a lower risk of felony recidivism. The hazard ratio (0.70) indicated the hazard of recidivism for youths in the MST–FIT treatment group was 30 percent lower than it was for youths in the control group.
Violent Felony Recidivism
Violent felony recidivism was less common. Only 28 percent of the entire sample had a violent felony at the time of follow-up. However, the MST–FIT intervention did not have an impact on violent felony recidivism.
Misdemeanor recidivism was also uncommon. Only 18 percent of the entire sample had a misdemeanor at the follow-up. However, the MST–FIT intervention did not have an impact on misdemeanor recidivism.
This study by Trupin and colleagues (2011) evaluated the ability of the Multisystemic Therapy–Family Integrated Transitions (MST–FIT) program to affect recidivism rates. The total sample size was 274 youths who were transitioning back to the community from one of five Washington State Juvenile Rehabilitation Administration (JRA) facilities between 2001 and 2005. The sample included 105 youths who participated in MST–FIT and served as the treatment group. The control group consisted of 169 eligible youths who did not participate in MST–FIT because they returned to counties where the program was unavailable; this group received treatment-as-usual JRA parole services. The average age of youth in the total sample was 16.35 years. Eighty-three percent of the sample were male; 70 percent were white, 15 percent were African American, 12 percent were Hispanic, and 4 percent were American Indian/Alaska Native.
Since the study did not use random assignment, logistic regression was used to determine significant differences between groups. There were no significant differences for gender, age at release, Native American ethnicity, age at first prior conviction, prior drug convictions, criminal history, or prior person (violent) convictions. However, there were significant differences on four variables: African American ethnicity, Hispanic ethnicity, the degree to which a county was either urban or rural, and Initial Security Classification Assessment (ISCA) risk assessment scores. (ISCA is a JRA tool that measures an offender’s overall risk for re-offense.) Treatment group participants were more likely to be African American and less likely to be Hispanic. This was expected because counties that were eligible for the MST–FIT program were more urban, more ethnically black, and less Hispanic than counties without MST–FIT.
The evaluation period was 36 months postrelease from the JRA facility. For youths in both the treatment and control groups, the evaluation period began on the first day the youth was released. The primary outcome of interest was recidivism. Recidivism was measured as convictions, to align with the Washington State Legislature’s official definition. Three types of reconvictions were examined: total misdemeanor and felony convictions, felony convictions, and violent felony convictions. Felony and violent felony categories were not mutually exclusive, with felony convictions incorporating all types of felonies. Recidivism data was collected from administrative databases available through Washington State’s Administrative Office of the Courts and Department of Corrections.
The study used an intent-to-treat model, meaning all youths were included in program effects analyses, regardless of the extent of their participation in the MST–FIT program. A nonproportional hazards model using Cox regression was used to evaluate the difference in survival rate between the MST–FIT treatment group and control group for overall and felony recidivism. Binary logistic regression was used to evaluate differences between the groups for violent felony and misdemeanor recidivism due to lower incidences of these convictions. Chi-square and t-tests were used to examine group differences in regard to demographics and propensity for recidivism.
Aos (2004) conducted an outcome evaluation and cost-benefit analysis of the Multisystemic Therapy–Family Integrated Transitions (MST–FIT) program in Washington State. The outcome evaluation showed results similar to those found in the study by Trupin and colleagues (2011). A cost-benefit analysis of the MST–FIT program indicated that for every $1 spent on FIT, $3.15 is saved in criminal justice expenses and avoided criminal victimization (a link to the 2004 study by Aos is available under Additional References).
Evidence-Base (Studies Reviewed)
These sources were used in the development of the program profile:Study 1Trupin, Eric J., Suzanne E. U. Kerns, Sarah Cusworth Walker, Megan T. DeRobertis, and David G. Stewart. 2011. “Family Integrated Transitions: A Promising Program for Juvenile Offenders with Co-Occurring Disorders.” Journal of Child & Adolescent Substance Abuse 20:421–36.
These sources were used in the development of the program profile:Anderson, Carol, and Karen Bogenschneider. 2007. A Policymaker’s Guide to Effective Juvenile Justice Programs: How Important Are Family Approaches? Madison, Wis.: Policy Institute for Family Impact Seminars.http://wisfamilyimpact.org/wp-content/uploads/2014/10/s_wifis25c03.pdfAos, Steve. 2004. Washington State’s Family Integrated Transitions Program for Juvenile Offenders: Outcome Evaluation and Benefit-Cost Analysis. Olympia, Wash.: Washington State Institute for Public Policy.http://www.wsipp.wa.gov/rptfiles/04-12-1201.pdf Barnoski, Robert. 2009. Providing Evidence-Based Programs With Fidelity in Washington State Juvenile Courts: Cost Analysis. Olympia, Wash.: Washington State Institute for Public Policy.http://www.wsipp.wa.gov/rptfiles/09-12-1201.pdf Lee, Terry, and Megan DeRobertis. 2006. “Overview of the FIT Treatment Model.” Focal Point 20(2):17–19.http://pathwaysrtc.pdx.edu/pdf/fpS0606.pdf Public Behavioral Health and Justice Policy. 2008. “Juvenile Rehabilitation Administration: Family Integrated Transitions™ (FIT™) Overview.” Accessed July 17, 2012.http://depts.washington.edu/pbhjp/projects/fit.php