The authors concluded that it appeared from research that multisystemic therapy showed great promise in child welfare and further research was warranted. Although the authors’ conclusions are cautious, lack of reporting of review methods and results of individual studies combined with an inadequate assessment of study quality made the reliability of the conclusions unclear.

To evaluate the effectiveness of multisystemic therapy (MST) in youths with serious mental health problems.

The search included PsycINFO, Academic Search Premier, Social Work Abstracts and Social Services Abstracts. Keywords were reported. Search dates were not reported. Only peer-reviewed studies were eligible.

Randomised controlled trials (RCTs) of youths with serious mental health problems were eligible if they evaluated the effects of multisystemic therapy on the outcomes: family relations, interactions or functioning; out-of-home placement; psychiatric symptoms; and school functioning or attendance. Studies that involved ethnic minorities were of particular interest.

Most included studies compared multisystemic therapy to individual counselling or usual community services; other studies compared multisystemic therapy to parent behaviour training or compared a modified version of multisystemic therapy to psychiatric hospitalisation. Most studies were of chronic and/or violent juvenile offenders; other studies included maltreating families and youths with severe emotional disturbance who were not involved in the juvenile justice system. Most participants were male, African American (range 16% to 81% across studies) and lived with at least one biological parent (most commonly the mother). Nearly all caregivers were of lower socioeconomic status. The mean age of participants ranged from nine to 17 years.

The authors did not state how papers were selected for the review.

Validity appeared to be assessed by considering methods used to control for attrition and adherence to multisystemic therapy treatment fidelity.

The authors did not state how many reviewers assessed the validity criteria.

The authors did not state how data were extracted for the review.

The studies were combined in a narrative synthesis.

Ten RCTs were included (n=861). Sample size ranged from 31 to 160.

The authors stated that most, but not all, studies reported statistical control of attrition and that not all studies reported multisystemic therapy treatment fidelity outcomes. No further details were provided. The authors noted that all of the included studies except one were conducted by one of the founders of multisystemic therapy.

Multisystemic therapy was associated with improved family relationships (number of studies unclear), improved peer-relationships (one study), improved school attendance and/or performance (three studies), decreased behaviour problems (seven studies), decreased aggression and improved conduct (one study), improved parent-child relationships (two studies) and decreased out-of-home placement (one study).

Modified multisystemic therapy was associated with initial decreases in externalisation problems and improved family relationships and school attendance compared to psychiatric hospitalisation (one study), but there was no difference between groups at one year. Another follow-up study found a decrease in the rate of suicide attempts and reduced psychiatric symptoms at one year post-treatment for modified multisystemic therapy compared to control, but this study had methodological problems.

The only study that did not involve the founders of multisystemic therapy reported that multisystemic therapy was associated with significant improvements in functioning and mental health symptoms compared to usual treatment; improvements were maintained at six months.

It appeared from research that multisystemic therapy showed great promise in child welfare. Further research was warranted.

The review question was stated and inclusion criteria were defined. Several relevant sources were searched, but no attempts to minimise publication or language bias were reported. Some aspects of validity were considered, but this did not amount to an adequate assessment of study quality and so results from these studies and any synthesis may not be reliable. Methods used to select studies, assess validity and extract data were not described and so any efforts made to reduce reviewer errors and bias were unknown. A narrative synthesis was appropriate because of differences between studies. Results data were not reported and so it was not possible to confirm findings reported in the review. As noted by the authors, all of the studies except one were conducted by founders of the intervention being evaluated.

The authors’ conclusions are cautious, but lack of reporting of review methods and results of individual studies combined with an inadequate assessment of study quality made the reliability of these conclusions unclear.

Practice: The authors stated that it was important that evidence-based interventions for multi-problem families were introduced into the child welfare system.

Research: The authors stated a need for further research into the effects of multisystemic therapy in children and adolescents in child welfare, particularly those in ethnic minority families.

Not stated.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.