Abstract
Hospitalization and out-of-home placement data for 113 youth participating in a randomized trial comparing home-based multisystemic therapy (MST; n = 57) with hospitalization(n = 56) for psychiatric crisis stabilization were analyzed following the completion of MST treatment—approximately 4 months post approval for emergency psychiatric hospitalization. Analyses showed that MST prevented any hospitalization for 57% of the participants in the MST condition and reduced the overall number of days hospitalized by 72%. Importantly, the reduction in use and length of hospitalization was not offset by increased use of other placement options, as MST reduced days in other out-of-home placements by 49%. The cost implications for the viability of MST as an alternative to hospitalization for youth presenting psychiatric emergencies are discussed.
Similar content being viewed by others
REFERENCES
Amini, F., Zilberg, N. J., Burke, E. L., & Salasnek, S. (1982). A controlled study of inpatient vs. outpatient treatment of delinquent drug abusing adolescents: One year results. Comprehensive Psychiatry, 23, 436-444.
Bickman, L. (ed.). (1996a). The Fort Bragg experiment. Journal of Mental Health Administration, Special Issue, 23.
Bickman, L. (1996b). A continuum of care: More is not always better. American Psychologist, 51, 689-701.
Bickman, L., Foster, E. M., & Lambert, W. (1996). Who gets hospitalized in a continuum of care? Journal of the Academy of Child and Adolescent Psychiatry, 35, 74-80.
Bickman, L., Summerfelt, W. T., Firth, J., & Douglas, S. (1997). The Stark County Evaluation Project: Baseline results of a randomized experiment. In C. Nixon & D. Northrup (Eds.), Evaluation in mental health services: How do programs for children ''work'' in the real world? (pp. 231-258). Thousand Oaks, CA: Sage.
Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press.
Burchard, J. (1991, February). An evaluation of the individualized care alternative for severely maladjusted youth in Vermont. Paper presented at the 4th Annual Research Conference, A System of Care for Children's Mental Health: Expanding the Research Base, Florida Mental Health Institute, University of South Florida, Tampa, Florida.
Burns, B. J., Hoagwood, K., & Maultsby, L. T. (1998). Improving outcomes for children and adolescents with serious emotional and behavioral disorders. In M. H. Epstein, K. Kutash, & A. Duchnowski (Eds.), Outcomes for children and youth with behavioral and emotional disorders and their families. Programs and evaluation best practices (pp. 685-707). Austin, TX: PRO-ED Inc.
Cunningham, P. B., Rowland, M. D., Pickrel, S. G., & Henggeler, S. W. (1999). Multisystemic therapy crisis intervention manual. Unpublished document.
Epstein, M. H., Cullinan, D., Quinn, K. P., & Cumblad, C. (1994). Characteristics of children with emotional and behavioral disorders in community-based programs designed to prevent placement in residential facilities. Journal of Emotional and Behavioral Disorders, 2, 51-57.
Evans, M. E., Boothroyd, R. A., & Armstrong, M. I. (1997). Development and implementation of an experimental study of the effectiveness of intensive in-home crisis services for children and their families. Journal of Emotional and Behavioral Disorders, 5, 93-106.
Flomenhaft, K. (1974). Outcome of treatment for adolescents. Adolescence, 9, 57-66.
Glisson, C. (1994). The effects of services coordination teams on outcomes for children in state custody. Administration in Social Work 18, 1-23.
Haley, J. (1976). Problem solving therapy. San Francisco: Jossey-Bass.
Hansson, L., & Sandlund, M. (1992). Utilization and patterns of care in comprehensive psychiatric care organizations: A review of studies and some methodological considerations. Acta Psychiatrica Scandinavica, 86, 255-261.
Hawkins, R. P., Almeida, M. C., Fabry, B., & Reitz, A. L. (1992). A scale to measure restrictiveness of living environment for troubled children and youth. Hospital and Community Psychiatry, 43, 54-58.
Henggeler, S. W., & Borduin, C. M. (1990). Family therapy and beyond: A multisystemic approach to treating the behavior problems of children and adolescents. Pacific Grove, CA: Brooks/Cole.
Henggeler, S. W., & Borduin, C. M. (1992). Multisystemic therapy adherence scales. Unpublished instrument. Department of Psychiatry and Behavioral Sciences, Family Services Research Center, Medical University of South Carolina, Charleston, South Carolina.
Henggeler, S. W., Brondino, M. J., Pickrel, S. G., Donkervoet, J. C., Penman, J., & Rowland, M. D. (1996). Multisystemic therapist adherence measure II. Unpublished instrument. Department of Psychiatry and Behavioral Sciences, Family Services Research Center, Medical University of South Carolina, Charleston, South Carolina.
Henggeler, S. W., Melton, G. B., Brondino, M. J., Scherer, D. G., & Hanley, J. H. (1997). Multisystemic therapy with violent and chronic juvenile offenders and their families: The role of treatment fidelity in successful dissemination. Journal of Consulting and Clinical Psychology, 65, 821-833.
Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology, 60, 953-961.
Henggeler, S. W., Pickrel, S. G., & Brondino, M. J. (1999). Multisystemic treatment of substance abusing and dependent delinquents: Outcomes, treatment fidelity, and transportability. Mental Health Services Research, 1, 171-184.
Henggeler, S. W., Pickrel, S. G., Brondino, M. J., Ward, D. M., & Rowland, M. D. (1997). Service Utilization Tracking Form II. Charleston, SC: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina.
Henggeler, S. W., Rowland, M. D., Pickrel, S. G., Miller, S. L., Cunningham, P. B., Santos, A. B., Schoenwald, S. K., Randall, R., & Edwards, J. E. (1997). Investigating family-based alternatives to institution-based mental health services for youth: Lessons learned from the pilot study of a randomized field trial. Journal of Clinical Child Psychology, 26, 226-233.
Henggeler, S. W., Rowland, M. R., Randall, J., Ward, D., Pickrel, S. G., Cunningham, P. B., Miller, S. L., Edwards, J. E., Zealberg, J., Hand, L., & Santos, A. B. (1999). Home-based multisystemic therapy as an alternative to the hospitalization of youth in psychiatric crisis: Clinical outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1331-1339.
Henggeler, S. W., & Schoenwald, S. K. (1998). Multisystemic therapy supervisory manual, promoting quality assurance at the clinical level. Charleston, SC: MST Institute.
Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents. New York: Guilford Press.
Jensen, P. S., Hoagwood, K., & Petti, T. (1996). Outcomes of mental health care for children and adolescents: II. Literature review and application of a comprehensive model. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1064-1077.
Langsley, D. G., Pittman, F. S., Machotka, P., & Flomenhaft, K. (1968). Family crisis therapy: Results and implications. Family Process, 7, 145-158.
Lyons, J. S., Kisiel, C. S., Dulcan, M., Cohen, R., & Chesler, P. (1997). Crisis assessment and psychiatric hospitalization of children and adolescents in state custody. Journal of Child and Family Studies, 6, 311-320.
Martin, C., & Hawkins, R. (1992). The Restrictiveness of Living Environments Scales (ROLES): West Virginia replication of a simple device for program evaluation, policy planning, and placement decision-making. Community Alternatives: International Journal of Family Care, 4, 71-79.
National Institute of Mental Health. (1992).
Schoenwald, S. K., Henggeler, S. W., & Donkervoet, J. C. (1995). A comparison of youth in high and moderate management group homes. Columbia, SC: South Carolina Health and Human Services Finance Commission.
Schoenwald, S. K., Ward, D. M., Henggeler, S. W., Pickrel, S. G.,& Patel, H. (1996). Multisystemic therapy treatment of substance abusing or dependent adolescent offenders: Costs of reducing incarceration, in patient, and residential placement. Journal of Child and Family Studies, 5, 431-444.
Sondheimer, D. L., Schoenwald, S. K., & Rowland, M. D. (1994). Alternatives to the hospitalization of youths with a serious emotional disturbance. Journal of Clinical Child Psychology. 23(Suppl.), 7-12.
Stroul, B. A., & Friedman, R. M. (1994). A system of care for children and youth with severe emotional disturbances (rev. ed.). Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center.
Washington State Institute for Public Policy (January, 1998). Watching the bottom line: Cost-effective interventions for reducing crime in Washington. Olympia, WA: Evergreen State College.
Weithorn, L. A. (1988). Mental hospitalization of troublesome youth: An analysis of skyrocketing admission rates. Stanford Law Review, 40, 773-837.
Winsberg, B. G., Bialer, I., Kupietz, S., Botti, E., & Balka, E. B. (1980). Archives of General Psychiatry, 37, 413-418.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Schoenwald, S.K., Ward, D.M., Henggeler, S.W. et al. Multisystemic Therapy Versus Hospitalization for Crisis Stabilization of Youth: Placement Outcomes 4 Months Postreferral. Ment Health Serv Res 2, 3–12 (2000). https://doi.org/10.1023/A:1010187706952
Issue Date:
DOI: https://doi.org/10.1023/A:1010187706952