***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The mechanisms through which multisystemic therapy ( MST ) decreased delinquent behavior were assessed in 2 sample s of juvenile offenders . Sample 1 included serious offenders who were predominantly rural , male , and African American . Sample 2 included substance-abusing offenders who were predominantly urban , male , and Caucasian . Therapist adherence to the MST protocol ( based on multiple respondents ) was associated with improved family relations ( family cohesion , family functioning , and parent monitoring ) and decreased delinquent peer affiliation , which , in turn , were associated with decreased delinquent behavior . Furthermore , changes in family relations and delinquent peer affiliation mediated the relationship between caregiver-rated adherence and reductions in delinquent behavior . The findings highlight the importance of identifying central change mechanisms in determining how complex treatments such as MST contribute to ultimate outcomes This article examined the long-term effects of multisystemic therapy ( MST ) vs. individual therapy ( IT ) on the prevention of criminal behavior  and violent offending among 176 juvenile offenders at high risk for committing additional serious crimes . Results from multiagent , multi method assessment batteries conducted before and after treatment showed that MST was more effective than IT in improving key family correlates of antisocial behavior and in ameliorating adjustment problems in individual family members . Moreover , results from a 4-year follow-up of rearrest data showed that MST was more effective than IT in preventing future criminal behavior , including violent offending . The implication s of such findings for the design of violence prevention programs are discussed OBJECTIVE Although several treatments for adolescent substance abuse have been identified as promising by review ers and federal agencies , treatment effects extending beyond 12 months have not been demonstrated in r and omized clinical trials . The primary purpose of this report was to examine the 4-year outcomes of an evidence -based treatment of substance-abusing juvenile offenders . METHOD Eighty of 118 substance-abusing juvenile offenders participated in a follow-up 4 years after taking part in a r and omized clinical trial comparing multisystemic therapy ( MST ) with usual community services . A multi method ( self-report , biological , and archival measures ) assessment battery was used to measure the criminal behavior , illicit drug use , and psychiatric symptoms of the participating young adults . RESULTS Analyses demonstrated significant long-term treatment effects for aggressive criminal activity ( 0.15 versus 0.57 convictions per year ) but not for property crimes . Findings for illicit drug use were mixed , with biological measures indicating significantly higher rates of marijuana abstinence for MST participants ( 55 % versus 28 % of young adults ) . Long-term treatment effects were not observed for psychiatric symptoms . CONCLUSIONS Findings provide some support for the long-term effectiveness of an evidence d-based family-oriented treatment of substance-abusing juvenile offenders . The clinical , research , and policy implication s of these findings are noted Hospitalization and out-of-home placement data for 113 youth participating in a r and omized 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 implication s for the viability of MST as an alternative to hospitalization for youth presenting psychiatric emergencies are discussed OBJECTIVE The primary purpose of this study was to determine whether multisystemic therapy ( MST ) , modified for use with youths presenting psychiatric emergencies , can serve as a clinical ly viable alternative to inpatient psychiatric hospitalization . METHOD One hundred sixteen children and adolescents approved for emergency psychiatric hospitalization were r and omly assigned to home-based MST or inpatient hospitalization . Assessment s examining symptomatology , antisocial behavior , self-esteem , family relations , peer relations , school attendance , and consumer satisfaction were conducted at 3 times : within 24 hours of recruitment into the project , shortly after the hospitalized youth was released from the hospital ( 1 - 2 weeks after recruitment ) , and at the completion of MST home-based services ( average of 4 months postrecruitment ) . RESULTS  MST  was more effective than emergency hospitalization at decreasing youths ' externalizing symptoms and improving their family functioning and school attendance . Hospitalization was more effective than  MST  at improving youths ' self-esteem . Consumer satisfaction scores were higher in the MST condition . CONCLUSIONS The findings support the view that an intensive , well-specified , and empirically supported treatment model , with judicious access to placement , can effectively serve as a family- and community-based alternative to the emergency psychiatric hospitalization of children and adolescents OBJECTIVE This study presents findings from a 1-year follow-up to a r and omized 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 r and omly assigned to home-based MST or inpatient hospitalization followed by usual services . Assessment s 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 practice s titrated to clinical need The effectiveness and transportability of multisystemic therapy ( MST ) were examined in a study that included 118 juvenile offenders meeting DSM-III-R criteria for substance abuse or dependence and their families . Participants were r and omly assigned to receive MST versus usual community services . Outcome measures assessed drug use , criminal activity , and days in out-of-home placement at posttreatment ( T2 ) and at a 6-month posttreatment follow-up ( T3 ) ; also treatment adherence was examined from multiple perspectives ( i.e. , caregiver , youth , and therapist ) . MST  reduced alcohol , marijuana , and other drug use at T2 and total days in out-of-home placement by 50 % at T3 . Reductions in criminal activity , however , were not as large as have been obtained previously for MST . Examination of treatment adherence measures suggests that the modest results of MST were due , at least in part , to difficulty in transporting this complex treatment model from the direct control of its developers . Increased emphasis on quality assurance mechanisms to enhance treatment fidelity may help overcome barriers to transportability The effects of multisystemic therapy ( MST ) in treating violent and chronic juvenile offenders and their families in the absence of ongoing treatment fidelity checks were examined . Across 2 public sector mental health sites , 155 youths and their families were r and omly assigned to MST versus usual juvenile justice services . Although MST improved adolescent symptomology at posttreatment and decreased incarceration by 47 % at a 1.7-year follow-up , findings for decreased criminal activity were not as favorable as observed on other recent trials of MST . Analyses of parent , adolescent , and therapist reports of MST treatment adherence , however , indicated that outcomes were substantially better in cases where treatment adherence ratings were high . These results highlight the importance of maintaining treatment fidelity when disseminating complex family-based services to community setting Multisystemic therapy ( MST ) delivered through a community mental health center was compared with usual services delivered by a Department of Youth Services in the treatment of 84 serious juvenile offenders and their multiproblem families . Offenders were assigned r and omly to treatment conditions . Pretreatment and posttreatment assessment batteries evaluating family relations , peer relations , symptomatology , social competence , and self-reported delinquency were completed by the youth and a parent , and archival records were search ed at 59 weeks postreferral to obtain data on rearrest and incarceration . In comparison with youths who received usual services , youths who received MST had fewer arrests and self-reported offenses and spent an average of 10 fewer weeks incarcerated . In addition , families in the MST condition reported increased family cohesion and decreased youth aggression in peer relations . The relative effectiveness of MST was neither moderated by demographic characteristics nor mediated by psychosocial variables OBJECTIVE This study examined the effects of an innovative treatment model that was design ed to reduce treatment dropout among substance abusing or dependent juvenile offenders . METHOD One hundred eighteen delinquents who met diagnostic criteria for substance abuse or dependence were r and omly assigned to receive either home-based multisystemic therapy ( N=58 ) or treatment that was provided by the usual community services ( N=60 ) . RESULTS In the multisystemic therapy condition , 98 % ( N=57 ) of the families completed a full course of treatment , which lasted an average of 130 days . In contrast , 78 % ( N=47 ) of the families assigned to treatment through the usual community services received no mental health or substance abuse treatment  in the 5 months after referral . CONCLUSIONS The serious and long-st and ing problem of high dropout rates in the substance abuse field can be greatly attenuated by services that increase accessibility and place greater responsibility for engagement on service providers The development and validation of family-based alternatives to  out-of-home placements  for children is an important goal in the mental health services field . The rigorous evaluation of such alternatives , however , can be difficult to accomplish . The purpose of this article is to describe initial barriers experienced during the pilot study of a r and omized trial , funded by the National Institute of Mental Health , conducted in a field setting , and the strategies that were used to overcome these barriers . The r and omized trial is examining home-based multisystemic therapy as an alternative to the psychiatric hospitalization of youths presenting psychiatric emergencies . The pilot study illuminated the interface of treatment and services research issues , prompting significant changes in the project 's clinical procedures , organization , and supervisory processes , as well as in the project 's interface with existing community re sources for serving youths with serious emotional disturbances BACKGROUND MST is an intensive home- and community-based intervention for youths with serious antisocial behaviour and other serious clinical problems , which has been effective at reducing out-of-home placements and producing favourable long-term clinical outcomes in the US . The aims of the study were to determine the degree to which these outcomes would be replicated in Norway for youths with serious behaviour problems and to conduct a r and omised trial of MST by an independent team of investigators . METHOD Participants were 100 seriously antisocial youths in Norway who were r and omly assigned to Multisystemic Therapy ( MST ) or usual Child Welfare Services ( CS ) treatment conditions . Data were gathered from youths , parents , and teachers pre- and post-treatment . RESULTS  MST  was more effective than CS at reducing youth internalising and externalising behaviours and out-of-home placements , as well as increasing youth social competence and family satisfaction with treatment . DISCUSSION This is the first study of MST outside of the US and one of the first not conducted by the developers of MST . The findings replicate those obtained by MST 's developers and demonstrate the generalisability of short-term MST effects beyond the US Two important theoretical assumptions of family therapy were examined : ( a ) Child behavior problems are associated with cross-generational coalitions , and ( b ) treatment of these coalitions using family therapy leads to decreases in individual symptomatology .  Ss were 45 delinquent adolescents assigned to multisystemic therapy ( MST ) or individual therapy and 16 well-adjusted adolescents . Pretreatment and posttreatment assessment s included measures of observed family relations and self-reported symptoms . Cross-generational coalitions were more evident in families of delinquents vs. families of well-adjusted adolescents . In addition , changes in adolescent and paternal symptoms in the MST group were linked with changes in marital relations . Implication s for systemic conceptualizations of symptom maintenance and change are highlighted 
    Output:
    
MAIN RESULTS The most rigorous ( intent-to-treat ) analysis found no significant differences between MST and usual services in restrictive out-of-home placements and arrests or convictions .
Pooled results that include studies with data of varying quality tend to favor MST , but these relative effects are not significantly different from zero .
The study sample size is small and effects are not consistent across studies ; hence , it is not clear whether MST has clinical ly significant advantages over other services .
There is inconclusive evidence of the effectiveness of MST compared with other interventions with youth .
There is no evidence that MST has harmful effects