Articles
One‐Year Follow‐up of Multisystemic Therapy as an Alternative to the Hospitalization of Youths in Psychiatric Crisis

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ABSTRACT

Objective

This study presents findings from a 1‐year follow‐up to a randomized clinical trial comparing multisystemic therapy (MST), modified for use with youths presenting psychiatric emergencies, with inpatient psychiatric hospitalization.

Method

One hundred fifty‐six children and adolescents approved for emergency psychiatric hospitalization were randomly assigned to home‐based MST or inpatient hospitalization followed by usual services. Assessments examining mental health symptoms, out‐of‐home placement, school attendance, and family relations were conducted at five times: within 24 hours of recruitment, shortly after the hospitalized youth was released from the hospital (1‐2 weeks after recruitment), at the completion of MST (average of 4 months postrecruitment), and 10 and 16 months postrecruitment.

Results

Based on placement and youth‐report measures, MST was initially more effective than emergency hospitalization and usual services at decreasing youths' symptoms and out‐of‐home placements and increasing school attendance and family structure, but these differences generally dissipated by 12 to 16 months postrecruitment. Hospitalization produced a rapid, but short‐lived, decrease in externalizing symptoms based on caregiver reports.

Conclusion

Findings suggest that youths with serious emotional disturbance might benefit from continuous access to a continuum of evidence‐based practices titrated to clinical need.

Section snippets

Sample and Recruitment

As discussed in the article describing the short‐term outcomes of the first 116 youths participating in this study (Henggeler et al., 1999), all youths met American Academy of Child and Adolescent Psychiatry (1996) level‐of‐care placement criteria for psychiatric illness. Additional inclusion criteria were youth age between 10 and 17 years, Medicaid‐funded or no health insurance, and existence of a noninstitutional residential environment (e.g., family or relative home, foster home [n = 5]).

Sample Characteristics

The average age of youth participants was 12.9 years, with 65% male, 65% African American, 33% white, 1% Asian American, and 1% Hispanic. Thirty‐one percent of the youths lived in two‐parent households that included at least one biological or adoptive parent, 50% lived in singleparent households that included at least one biological or adoptive parent, and 18% lived with someone other than a biological or adoptive parent. Parental employment status and income describe a relatively disadvantaged

DISCUSSION

The central purpose of this report was to examine the effects of treatment on individual change trajectories for symptoms, family functioning, and out‐of‐home placements from the time that youths in psychiatric crisis have been approved for emergency psychiatric hospitalization to 16 months later. With regard to the course of symptoms, two sets of findings are noteworthy. First, across treatment conditions and measures, symptoms generally decreased from well above the clinical range to below

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      For all youth, average externalizing scores remained within the clinical range by all assessments, and the average severity did not differ significantly. A follow-up study found that none of the reported gains was maintained at one year (Henggeler et al., 2003). In the year following treatment, roughly the same percentage of MST-Psychiatric and hospitalized children had experienced out-of-home placement (48% and 47%, respectively), with comparable lengths of stay: in both conditions, youth spent > 50 days, on average, outplaced from their homes.

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    This project was funded by NIMH grant R01MH51852 . The authors gratefully acknowledge the support of Thom Hiers, Ph.D., and Bill McDaniel, M.Ed., from the South Carolina Department of Mental Health; and Stacey A. Miller, M.A., Joseph J. Zealberg, M.D., Lisa D. Hand, M.D., Alberto B. Santos, M.D., Mark Demidovich, M.F.A., Anita Gordon, M.S.W., Mary Price, M.Ed., Flo Sanders, M.A., Brad Benjamin, Beth Cunningham, M.S., Janice Key, M.D., Linda Marsh, R.N., Byron Hammer, M.D., Langdon Ellington, and Linda D. Lewis, R.N., from MUSC.

    Drs. Henggeler and Rowland are stockholders in MST Services Inc., which has the exclusive licensing agreement through MUSC for the dissemination of MST technology and intellectual property.

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