Multisystemic Therapy Helps Sex Offenders, Saves Money
Boschert, Sherry, Clinical Psychiatry News
SAN FRANCISCO -- Several recent studies show that multisystemic therapy helped decrease behavioral problems and criminal activity among adolescent sexual offenders, Charles M. Borduin, Ph.D., said at the annual meeting of the American Psychological Association.
The complexity and costs of providing multisystemic therapy remain challenging, however. "We're probably going to need legal mandates to spread this," said Dr. Borduin, professor of psychology and director of the Missouri Delinquency Project at the University of Missouri-Columbia.
Dr. Borduin and his associates studied 48 adolescent sexual offenders--24 with violent sexual offenses against peer or adult victims, and 24 with nonviolent sexual molestation of younger victims--and randomized them to approximately 30 weeks of either multisystemic therapy or usual services (individual and group cognitive-behavioral therapy delivered in a juvenile court setting).
Immediately after therapy, the multisystemic therapy group showed greater improvement in rates of behavioral problems, delinquent behavior, and involvement with deviant peers, plus improved family relations and better school grades, compared with the control group.
Follow-up 9 years after treatment found lower rearrest rates in the multisystemic therapy group, compared with controls for both sexual offenses (13% vs. 42%) and non-sexual offenses (29% vs. 63%). The multisystemic therapy group averaged 77% fewer days in youth detention (22.5 days vs. 97.5 days in the control group) and 80% fewer days in adult detention (365 days vs. 1,843 days). The outcomes were affected by neither demographic factors nor the number or nature of offenses before treatment.
A cost-benefit analysis based on these results suggests that multisystemic therapy could save $182,789 in costs per adolescent sexual offender, compared with usual care, Dr. Borduin said. Every $1 spent on multisystemic therapy could save taxpayers around $12 per offender, compared with usual care.
The theory of multisystemic therapy is based on the identified correlates or causes of serious antisocial behavior and on Bronfenbrenner's social-ecological theory of behavior. The therapy is delivered in the natural environment by a master's-level therapist seeing four to five families, typically for 5-7 months.
The therapist follows nine treatment principles (see sidebar) to design interventions aimed at empowering parents with the skills and resources needed to address the challenges of raising a teenager. …