3MST Treatment Principles 1. Finding the FitThe primary purpose of assessment is to understand the “fit” between the identified problems and their broader systemic context.2. Positive & Strength FocusedTherapeutic contacts should emphasize the positive and should use systemic strengths as levers for change.3. Increasing ResponsibilityInterventions should be designed to promote responsibility and decrease irresponsible behavior among family members.4. Present-focused, Action-oriented & Well-definedInterventions should be present-focused and action-oriented, targeting specific and well-defined problems.5. Targeting SequencesInterventions should target sequences of behavior within and between multiple systems that maintain identified problems.6. Developmentally AppropriateInterventions should be developmentally appropriate and fit the developmental needs of the youth.7. Continuous EffortInterventions should be designed to require daily or weekly effort by family members.8. Evaluation and AccountabilityInterventions efficacy is evaluated continuously from multiple perspectives, with providers assuming accountability for overcoming barriers to successful outcomes.9. GeneralizationInterventions 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.
4Case Summary for Supervision & Consultation Team:Reasons for ReferralInitial Goals\Desired OutcomeSuperior MST goalsCase Summary for Supervision & ConsultationFamily:Age:Therapist:Date:Startdate:BehavioeDurationFrequencyExtentAffected systemsParticipantGoal
5Case Summary for Supervision & Consultation Team:Genogram:Case Summary for Supervision & ConsultationFamily:Therapist:Dato:Startdate:
6Systemic Weaknesses\Needs Team:Case Summary for Supervision & ConsultationFamily:Therapist:Dato:Startdate:Systematic strengtsSystemic Weaknesses\NeedsIndividualFamilySchoolPeersCommunity
7Weekly Case Summary for Supervision & Consultation Team:Weekly Case Summary for Supervision & ConsultationFamily:Age:Therapist:Date:Startdate:Number of calls:Number of meetings:I. Overarching\Primary MST GoalsII. Previous Intermediary GoalsMetPartiallyNotIII. Barriers to Intermediary GoalsIV. Advances in TreatmentV. Assessment of “fit” between identified problems and their broader systemic context.VI. New Intermediary Goals for Next Week
8Case Summary for Supervision & Consultation Team:“Fit” circle:Case Summary for Supervision & ConsultationFamily:Therapist:Dato:Startdate:
9GENOGRAM OLA6740393024488072351911155027D 1961B 75 D 77
10Terapeut: 1001 Familie: 0002 Dato: 15/10 2003 BehaviorDurationFrequencyIntensityInvolved systemsDrugabuseThe past yearCa times a weekHasj, alcohol og pillsIndividually, family, school,friendSchoolproblemsStarted in 7th grade Increased the past yearTruancy days or classes every week. Does not participate in the class for the past 6 monthsTruancy, no classroom work Reacts negativly when talked to. Conflicts with students and teacher. Physically agressive towards teacher +other students.Individually, family, schoolVerbally and physically aggressive.From 9 –10 years age. Worsening the past year.Daily quarreling and acting outShouting at and threatening his parents and at school.Breaks things and sometimes hits and kicks parentsSchool, homeDoes not follow the family’s rulesFrom 9 – 10 years age. Ran away at nightDailyDoes what he wantsl, does not follow curfew, away nightsHjem, skole,venner
11Desired Outcomes of Family and key participants GoalMotherWishes Ola was happier, that he stops drugs, goes to school every day, stops physical and verbal agressiveness, does not stay away at nightFatherSame as motherOlaWants his parents to leave him aloneSchoolWants Ola moved to an institution with classes thereGrandparentsHe must have help to stop using drugs and to stop the conflicts at homeChild WelfareOla to stop using drugs and to participate more at school. Lower conflicts at home, help parents to set limits for Ola.
12A summary for supervision and consultation Terapeut: 1001Familie: 0002Dato: 15/Systemic strengthsNeedsIndividually:Ola goes well together with other people, can be polite and sociable. Cares for his little brother. Plays guitar, interested in computers and og snowboard.Is easily lead to negative activities. Use of drugs, conflicts at home. Out all night. Can be threatening or violent if he feels pushed. Interchangeable friends. Always restless and easily gets into trouble. Suspecting ADHD.
13Systemic strengthsNeedsFamily:Mom has a permanent job, involved in the childres, caring. Dad is good with practical matters. Nice house, OK economy.Family has experience with doing positive things together (outdoor activities, holidays, eating nice meals together). Parents have some close friends and good neighbours.Mom nags a lot and is not heard. Dad is irretabe and hot-tempered/explosive. Disagree with the child upbringing. Mom is compliant, dad strict. Mom feels alone in the upbringing and fells she has little support. Has considred divorce. Dad is on social security because of back problems from a occupational injury. Depressed because of pain, no job. Problems with alchohol and mental sufferings in dads familiy. Little family live near.
14Systemic strengthsNeedsSchool:Ola has previously shown good work in arts and crafts and computer science. School is relatively new. Many motivated teachers and a psincipal who seems interested in Olas problems. Curious about MST.Has not worked in class for the last six months. Lots of absence. Acts out according to teachers and pupils. School means he should be placed in an institution for youths with behavior problmes. Many in the same class also has problems (drugs and disturbance). Mange i samme klasse som har problemer (uro og rus). Conflict between school and parents about situation.
15Systemic strengthsNeedsFriends:Has one positive friend, they play on the computer and og snowboarding.Stays in a negative youth environment. Drugs, petty crime and skip school. Parents have little control over where tjey are and what they do.Spends the night at friends the parents don’t know.
16Systemic strengthsNeedsCommunity:Residental area close to the city center with all services.Activity house open once a week for a drug and alchohol free disco for youths.Good bus service to city centre.Few activities for youth. Large mall with an arcade near by. Typical hang out place for youth from the entire district. Criminal, drug abusing youth hang out at the mall.Drug sales, older youth buy alchohol for the younger.New estate with a high level of insecurity. Many don’t know eachother.
17Weekly Case Summary for Supervision and Consultation Therapist:Familiy:Date:I.Overarching\Primary MST GoalsOla will be clean. This will be confirmed by negative urine specimen and information from parents, school and police.Ola will actively participate in a school sitiation adapted for him. Confirmed by information from school and parents.Ola will stop both verbal and physical aggression. Confirmed by information from school and parents.Ola will follow the family rules. Confirmed by information from parents.
18VERBAL AND PHYSICAL AGGRES-SION GETS WHAT HE WANTS/GETS POWERConfirmed by: parentsPEER STATUSConfirmed by: child servicesCOMMUNICATION STYLE IN THE FAMILYConfirmed by: parents, OlaCOVERS UP SADNESSConfirmed by: momVERBAL AND PHYSICAL AGGRES-SIONUNCLEAR RULES AND CONSE-QUENSESConfirmed by: parentsLOW IMPULS CONTOLConfirmed by: school, momPHYSICALLT STOPPED BY DAD IN CONFLICT SITUATIONSConfirmed by: Ola, parentsINCONSITENT PARENTINGConfirmed by: parents, OlaSUBSTANCE ABUSEConfirmed by: parents
19EASY ACCESS TO DRUGSConfirmed by: youth support team, and Child ServicesPEERS WHO USEConfirmed by: youth support team, parentsCURBS UNRESTConfirmed by: Ola, parentsSUBSTANCE ABUSE PROBLEMS IN THE FAMILYConfirmed by: parentsSUB-STANCE ABUSENO CONSEQUENSESConfirmed by: parentsTHRILL/RUSHConfirmed by: OlaNO PARTICIPATION IN AFTER SCHOOL ACTIVITIESConfirmed by: OlaCONFLICTS AT HOMEConfirmed by: familyNO MONITORINGConfirmed by: parents
20FRIENDS NOT ATTENDING SCHOOL/NO JOB Confirmed by: school, OlaNOR FRIENDS IN SCHOOLConfirmed by: lead teacherCONFLICT SCHOOL-HOMEConfirmed by: parents, schoolPROBLEM CONCENTRA-TING, SUBJECT.Confirmed by: school, rapport from Educational-Psychological ServiceTRUANCYNO CONSEQUENSES AT HOME OR SCHOOLConfirmed by: school, parentsBAD RELATIONSHIP WITH TEACHERConfirmed by: OlaNO PARENT FOLLOW UP WITH SCHOOLConfirmed by: parentsSUBSTANCE ABUSE; GETS HOME LATE; TIEREDConfirmed by: parentsPARENTS HAVE NO CONTROL OVER ACTIONSConfirmed by: parents
21Social Support Key particpants Identify need/tasks to ask for in supportMake a plan for meeting participants individually or in a groupMake agenda for meetingTherapist is secretary at the meeting and writes all agreementsExamples of tasks:Come to the home in difficult situationsHelp in search for youthBabysit other children when parents needBe support for parents as neededBe support for youth with activities
22II. Previous Intermediary Goals Make safety plan METPARTIALLYNOTMake safety planMom contacts neighbour and a friend to ask if they can be contacted in an emergencyParents agree on rules that will be included in the contractXIII. Barriers to Intermediary GoalsParents disagree on rules. They think it is hard to find privileges. They’d rather punish than reward. One serious conflict situation led to Ola hitting dad. After this he ran away and did not come home all night.
23IVAdvances in TreatmentSafetyplan is in place. Both neighbour and moms friend are willing to be available in a conflict situation. Both their names and numers are on the safetyVAssessment of “fit” between identified problems and their broader systemic context.
24Safety plan for Ola and his family LEVELSITUATIONWILL DORESPONSIBILITY1.Someone starts to yell at eachotherRemove yourselves form the situation, give a stop message (agree on a sign)Don’t start a discussionEveryone in the family.2.Someone threatens another family memberNotify the person on whats to come in level 3 and 4 in a calm voice.Person feeling threatened.3.Distroyed somethin in the house, breaks or destroys something.Call friends or other family to ask for help. Name/no:…………………………Mom or dad.4.Physically attacks someone.Calls the police and MST therapist.
25Family Cohersion Identify strengths Help parents to rebuild warmth and supportEstablish clear expectations and rulesMake family contract with predictable rewards and consequencesPlan for family activities
26VINew Intermediary Goalsfor Next WeekReview of possible rules, privileges and negative consequences with parents.Map this weekends episode of violence. Make a Fit circel on what happened and make a plan to make sure this does not happen again.Make an action plan on how to handle a situation where Ola is gone all night.Dad contacts the school to set up a meeting.
27School interventions Identify strengths and needs Plan meeting with school with the parentsParents contact school for meetingPlan for comunication flow between parents and schoolPlan for implementation of rewards and consequences are madePlan for school routinesParticpants in meeting: (Principle) Class teachers, social support teacher, parents and therapist
28Family contract RULE PRIVELIGE NEGATIVE CONSEQUENCE Ola will come to school at the right time and stay all day.2 points (=20 kr) per day to comply with the rule. If he comply to the rule a whole week he gets two hours with the computer group on the last two hours on Friday.No points on days he breaks the rule.Ola will og straight home afteer school and do his homework.Gets to use the computer/og online two hours every afternoon/nightLoses access on days he breaks the rule.Ola will stop threatening, yell at and hassle other family members2 points (=20 kr) per day to comply with the ruleFailure to comply with the rule loses him access to TV and phone the rest of the day.
29RULE PRIVELIGE NEGATIVE CONSEQUENCE Ola will be home by 10pm on a weekday and 1am on Friday/Saturday.He will inform his parents on where he is going, who he is going with and what he is doing when he goes out.2 points can be exchanged to a mobile cash card when he has enough points. When he comply with the rule for 1 week he gets to chose his favorite meal at a family dinner.Ola must be home earlier the day after, equivalent to the time he was late the previous day.If he does not come home and his parents have to go and find him he has to home by 6 pm the followingweekend.Ola will not use any illegal drugs. He will submit one urine sample a week. A refusal to give a urine sample is considered a positive test.With a negative test he will receive 5 points (=50 kr) that he can save for snowboarding.In addition the travel expences to get to the ski slope will be covered.With a positive test Ola will loose his privileges. He must come home earlier and prepare unexpected urine test.Poengene registeres hver dag, og kan veksles inn i en ting Ola ønsker seg når han har nok poeng For eksempel cd, klær, sportsutstyr etc
30Peer interventions Identify peers Who, when and what they do Decide desired contact levelMonitoring interventionsExamples:Contact parents of negative peersEstablish a collaborative approaches:Try to make agreements on limits and rulesPlan for activities with prosocial peers
31Plan for finding Ola Behavior What happens Responsibilty Ola fails to appear/does not keep his curfewCalls Olas cell phoneCalls his friendsCalls his friends’ parentsDrives around to find himMom and dad calls friend to help with the searchCall s MST, consider if the police should be contactedMom and dad
32Physical and verbal aggression Make security planIdentify strengths and needsRebuild family bondingIdentify clear rulesIdentify triggers for aggresionDecide rewards for reducing verbal aggression (which is always covered in the family contract)
33OLA DID NOT RECEIVE MONEY DAD YELLED AT OLAOLA KNOWS IT HELPS -HE GETS WHAT HE WANTSCONFLICT BETWEEN OLA AND PARENTS ALREADY PRESENTOLA HIT DADDAD PHYSICALLY HELD HIM BACKVAGUE RULESDID NOT FOLLOW THE SECURITY PLANPARENTS GAVE CONFLICTING INSTRUCTIONSOLA WAS INTOXI-CATED
34Drug Abuse Interventions Identify level of addictionIdentify peers who also use, what, when and wherePlans urine testsMake contract for stopping drug use