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Finding the Fit The primary purpose of assessment is to understand the  fit between identified problems and their broader systemic context. 2. Positive & Strength Focused Therapeutic contacts should emphasize the positive and should use systemic strengths as levers for change.4  m Principles of MST43. Increasing Responsibility Interventions should be designed to promote responsibility and decrease irresponsible behavior among family members. 4. Present-Focused, Action-Oriented & Well Defined Interventions should be present-focused and action-oriented, targeting specific and well-defined problems45w4l Principles of MST!5. Targeting Sequences Interventions should target sequences of behavior within and between multiple systems that maintain identified problems. 6. Developmentally Appropriate Interventions should be developmentally appropriate and fit the developmental needs of the youth and family.4"{ o  Principles of MST97. Continuous Effort Interventions should be designed to require daily or weekly effort by family members. 8. Evaluation and Accountability Intervention effectiveness is evaluated continuously from multiple perspectives, with providers assuming accountability for overcoming barriers to successful outcomes.4:X" Principles of MST9. Generalization Interventions should be designed to promote treatment generalization and long-term maintenance of therapeutic change by empowering care givers to address family members needs across multiple systemic contexts. U5V6W7X8 MST SUPERVISIONNOT focused on paperwork, story telling, or providing emotional support IS manualized Focuses on: Achieving outcomes Delineating and resolving barriers to achieving outcomes Maintaining treatment fidelity Developing clinicians competence <bbMST QUALITY ASSURANCE SYSTEMTTo Promote Treatment Fidelity, Achieve Outcomes, and Address Barriers to Outcomes Specified treatment protocol ( Henggeler et al., 1998, Guilford Press) Specified supervisory protocol (Henggeler & Schoenwald, 1998) Specified consultation protocol (Schoenwald, 1998) Ongoing consultation to address organizational barriers to program success"RUMST QUALITY ASSURANCE SYSTEMOn site 5-day orientation training Quarterly booster training Clinicians work within MST teams for peer support On site clinical supervision from MST-trained supervisor Weekly consultation with MST expert via conference call Standardized adherence ratings from caregiver via internet system Expert coding of audiotaped treatment sessions for adherence (research studies only)  C/TRANSPORTABILITY OF MSTCurrently, licensed MST teams across U.S. (>30 states) and 10 nations treating 14,000 youths and their families per year OJJDP funded research on MST transportability (Henggeler, PI; 15 sites) NIMH funded research on MST transportability (Schoenwald PI, 41 sites)H2Where is MST being used? Over 30 states in the U.S. State-wide programs in Connecticut, Hawaii, Ohio, and South Carolina Nation-wide program in Norway (25+ teams) Other international replications: Australia, Canada, Denmark, Ireland, England, Sweden, Netherlands, and New Zealand.Y9J0Size of Current MST Programs  K3MST Network PartnersMST Network Partner (NP) organizations A key element of the MST dissemination strategy Over 70% of operating MST teams are supported by MST Network Partner organizations MST NP staff are fully trained in MST program development , clinical staff training and development, and program QA oversight. MST Services maintains an on-going working relationship with each MST Network Partner organization focused on staff development, quality improvement and quality assurance activities *''!MST Program DevelopmentProgram design and start-up Program design and development Program support activities Clinical training Key elements of program implementation<L'$L '$"MST Program DevelopmentProgram Design Community needs Target population Referral sources Referral criteria Inclusionary Exclusionary* Funding options Program evaluation*RE@K$ E$ Clinical Implementation Case load size* Supervision practices* Staff training and support* Adherence monitoring* MST consultation* Treatment discharge criteria* Outcome tracking* * MST specific recommendations, requirements, or limitations nA  ?  L4"MST Core Implementation Components##(TFidelity to the MST model Adherence to all QA, training, and supervision protocols including expert MST consultation Effective on-call system for 24/7 coverage Strong on-site clinical supervisor Clearly defined target population, program goals and referral process Well managed caseloads/ referral process Outcome-based discharge criteriaUU$Influences of Key Stakeholders(rFunding structure in place Ability of MST therapist to take the  lead in clinical decision making Key stakeholders usually include: Juvenile Justice, Family Court, Mental Health, Social Welfare, School Systems, Parent and Community Groups Interagency agreements define MST services and articulate relationships::%#Influences within Host Organization$#(/Clear understanding of MST at all levels Commitment to implement MST fully Target MST compatible populations Willingness to modify policies and dedicate resources to achieve outcomes Commitment to training and supervision Policies (e.g., flex-time, transportation) Resources (e.g., pay, cellular phones)(yy&Influences within a Team(Supervisor: committed, credible authority Distinct and dedicated MST staff Low caseloads Weekly group supervision per MST protocol Weekly MST consultation for clinical team Adequate on-call coverage system Outcome-based discharge criteria'Influences within a Therapist(Motivated, strong work ethic, feels accountable Flexible, creative, open minded Intelligent, common sense ( street smarts ) Can shift to family/ecology as client Open to peer supervision Volunteers to be trained Clinical acumen (e.g., prior experience in family, marital, or behavioral work) and a background in child development*<J( MST Program Support(X Purpose: To increase the likelihood of achieving positive outcomes through identifying and removing barriers to effective implementation of the MST treatment model. Program structure, specification, and goals Site assessment MST training for clinical staff Outcome measurement systems including tracking of treatment fidelity and adherence6 NB.For more information(Log on to: www.mstservices.com Call: Marshall Swenson, MSW, MBA Manager of Program Development MST Services (843) 856-8226 ext. 14 ms@mstservices.com/)*+,N O P Z [  0` 3` ff>>\fg` J*T333` QYmx~3ft` \ғhEy`` cb^DDf`Y˵W` sg7xGr` K%ޯd{mG/` 33f>?" dd@,?nFd@    @ `  n?" dd@   @@``PR    @ ` `<p>> &T(  T T 6 #" `b `  b*0   T 6ԝ #" `` `  d* 0  xT ~ T "~\ { T "{ T c BB CDEFd @ bb   H   T W6Vw}\gFQ6<1++11 1L b6xQrq 6\}N   - c    0 A Q g     S    6N KawF bFy0 a*ly7lE;uz  B | a F 0 ! 1 < B < & l L 0  @`"T  T c |BC+DEFyd @ ==gL6cI}\eA& w6m!W<! &<W!r6W}F6\}>68QNlX^XH8+Sgg|@`"Jo 5 J T  B! 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ff33___PPT10.+`@D' E= @B D' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*$D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*$D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$R%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*$RD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*$RD{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$R%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*$RD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*$RD{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*$%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*$D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*$+p+0+$0 ++0+$0 +  0 ((  ( ( c $S T `}<$D 0    ( c $TT `<$D 0  H ( 0޽h ? ff33UM___PPT10-.+`@D' V= @B DP' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*(%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*(D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*(D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*(%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*(D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*(D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*(%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*(D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*(D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*(%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*(D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*(D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*( %(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*( D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*( +p+0+(0 ++0+(0 +  0 ,(  , , c $g T `}<$D 0    , c $hT `<$D 0  H , 0޽h ? ff33UM___PPT10-.+`@D' k= @B DP' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*,%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*,D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*,D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*,%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*,D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*,D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*,%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*,D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*,D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*,%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*,D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*,D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*,5%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*,5D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*,5+p+0+,0 ++0+,0 +  0 0(  0 0 c $`z T `}<$D 0    0 c $`{T `<$D 0  H 0 0޽h ? ff33UM___PPT10-.+`@D' }= @B DP' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*0%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*0D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*0D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*0%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*0D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*0D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*0%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*0D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*0D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*0%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*0D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*0D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*0"%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*0"D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*0"+p+0+00 ++0+00 +  0 4(  4 4 c $< T `}<$D 0    4 c $T `<$D 0  H 4 0޽h ? ff33UM___PPT10-.+`@D' = @B DP' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*4%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*4D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*4D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*4%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*4D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*4D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*4n%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*4nD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*4nD{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*4n%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*4nD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*4nD{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*4:%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*4:D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*4:+p+0+40 ++0+40 +  0 8(  8 8 c $ T `}<$D 0    8 c $pT `<$D 0  H 8 0޽h ? ff33OG___PPT10'.+`@D' = @B DJ' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*8%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*8D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*8D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*8%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*8D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*8D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*8%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*8D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*8+p+0+80 ++0+80 +  0L0 !!4(  4kL @ 4# PbP 4  hA1))?10%=u 4  hA1))?10%uh { 4  hA1))?10%cR " 4  nG A1))?10%@> 4 S 0xaxaA1))?10%y ! FEnvironment of Alignment and Engagement of Family and Key ParticipantsGG 4  hA1))?10%T Pc  4  hA1))?10%H [   4  hA1))?10%    4  hA1))?10% d   4  hA1))?10%    4 S <xaxaA1))?10%  AMeasure 4 S ØxaxaA1))?10%Jt   E Re-evaluate   4 S xaxaA1))?10% cZ  D Prioritize   4 S ǘxaxaA1))?10%   <Do 4 # lΘxaxa1))?P F  ^Intermediary Goals0 4 # lTԘxaxa1))?)D ]^ dIntervention Development042 4  CfENG^MHZJQAp))? ,`TfPRf,`TfPRfPRf10%u "2 4 S ENGH{QAp))? `T`T=T`T`T=T`T`T=T`T10% > 2 4  CpsE$GeH I`TQAp))? ps9Tps9T`T`Tps9T`T`T10%p P , 4 # l٘xaxa1))?l  <MST Conceptualization of  Fit 0/ 4 # lޘxaxa1))? j  ?Assessment of Advances & Barriers to Intervention Effectiveness0@?.2 4 s ENGZHI`TJQAp))? `T`T`T`T`T`T`T`T`T`T10% _   4 # lxaxa1))?a C ^ gIntervention Implementation0xB 4B Hp))?8 4  4  fxaxa1))?]V bMST Analytical Process0  2 4 3 zGAp))?10%R)  4 # lxaxa1))?( ]Referral Behavior0 2 4 s E$GH* I`TQAp))? `TT`TT`T`T`TT`T`T10% n ^.2 4 s BTENG* IQAp))? TT`TTT`T`TT`T`T10%   4 # lxaxa1))?W_  ]Overarching Goals0% !4 # l0xaxa1))?g  ^ 5Desired Outcomes of Family and Other Key Participants065Z 4 B3d޽h @ ?p4444444 a( 0 <4 <(  <2 < 00 P ,$D 02 < 0p p ,$D 0 < <5  JETOH/ Drug Use P < <0 ^  LRunning/ Illegal PdB <@ <D  dB < <D  dB < <D 2  < 0p p ,$D 0  < < % `  KSexual Behavior P  < <`0 4 :   < 0P0- O Key Behaviors&(2  B < s *޽h ? eoHff33Ҷ 0 H@D(  D2 D 00 P ,$ 02 D 0p p ,$ 02 D 0p p ,$ 0 D <5 ,$ 0 ? ETOH/ Drug UseP D < % ` ,$ 0 @ Sexual BehaviorP D <#0 ^ ,$ 0 BRunning/ IllegalPdB D@ <D  dB  D <D  dB  D <D 2  D 0*,$D 0 : 2  D s *@`,$D 02  D s *@ p,$D 0B D <D0@0,$D 0 D <lz,$D 0 EPermissive ParentingP D <X2J,$D 0 ?Deviant PeersP D <6 p ,$D 0 G School PerformancePB D 6D 00 ,$D 0B D <D@ ,$D 0 D <=0 ,$D 0 7AnxietyB D 6D ,$D 0B D@ <D @@,$D 0B D@ 6DP ,$D 0B D@ 6D ,$D 0B D@ <D``p,$D 0B D 0D PP ,$D 0 D 0@,$D, 0 IInitial ConceptualizationB D s *޽h ? ̙33 0 <