MST’s analytical model

And a clinical case

Side 1

Side 2

MST Treatment Principles

1. Finding the Fit

The primary purpose of assessment is to understand the “fit” between the 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.

3. 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 problems.

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.

7. Continuous Effort

Interventions should be designed to require daily or weekly effort by family members.

8. Evaluation and Accountability

Interventions efficacy is evaluated continuously from multiple perspectives, with providers assuming accountability for overcoming barriers to successful outcomes.

9. 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.

Side 3

Team:

Reasons for Referral

Initial Goals\Desired Outcome

Superior MST goals

Side 4

Case Summary for Supervision & Consultation

Family: Age: Therapist: Date: Startdate:

Behavioe Duration Frequency ExtentAffectedsystems

Participant Goal

Side 5

Team:

Genogram:

Case Summary for Supervision & Consultation

Family: Therapist: Dato: Startdate:

Side 6

Team:

Case Summary for Supervision & Consultation

Family: Therapist: Dato: Startdate:

Systematic strengts Systemic Weaknesses\Needs

Individual

Family

School

Peers

Community

Side 7

Team:

Weekly Case Summary for Supervision & Consultation

Family: Age: Therapist: Date:

Startdate:

Number of calls:

Number of meetings:

I. Overarching\Primary MST Goals

II. Previous Intermediary Goals Met Partially Not

III. Barriers to Intermediary Goals

IV. Advances in Treatment

V. Assessment of “fit” between identified problems and their broader systemic context.

VI. New Intermediary Goals for Next Week

Side 8

Team:

“Fit” circle:

Case Summary for Supervision & Consultation

Family: Therapist: Dato: Startdate:

Side 9

GENOGRAM OLA

67

40

39

30 24

48

8072

35

19

11 15

5027

D 1961

B 75D 77

Terapeut: 1001 Familie: 0002 Dato: 15/10 2003

Behavior Duration Frequency Intensity Involved systems

Drugabuse The past year Ca. 2 -3 times a week

Hasj, alcohol og pills

Individually, family, school,friend

Schoolproblems

Started in 7th grade Increased the past year

Truancy days or classes every week. Does not participate in the class for the past 6 months

Truancy, no classroom work Reacts negativly when talked to. Conflicts with students and teacher. Physically agressive towards teacher +other students.

Individually, family, school

Verbally and physically aggressive.

From 9 –10 years age. Worsening the past year.

Daily quarreling and acting out

Shouting at and threatening his parents and at school.

Breaks things and sometimes hits and kicks parents

School, home

Does not follow the family’s rules

From 9 – 10 years age. Ran away at night

Daily Does what he wantsl, does not follow curfew, away nights

Hjem, skole,venner

Side 11

Desired Outcomes of Family and key participants

Participants Goal

Mother Wishes Ola was happier, that he stops drugs, goes to school every day, stops physical and verbal agressiveness, does not stay away at night

Father Same as mother

Ola Wants his parents to leave him alone

School Wants Ola moved to an institution with classes there

Grandparents He must have help to stop using drugs and to stop the conflicts at home

Child Welfare

Ola to stop using drugs and to participate more at school. Lower conflicts at home, help parents to set limits for Ola.

Side 12

A summary for supervision and consultation

Terapeut: 1001 Familie: 0002 Dato: 15/10 2003

Systemic strengths Needs

Individually:

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.

Side 13

Systemic strengths Needs

Family:

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.

Side 14

Systemic strengths Needs

School:

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.

Side 15

Systemic strengths Needs

Friends:

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.

Side 16

Systemic strengths Needs

Community:

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.

Side 17

Weekly Case Summary for Supervision and Consultation

1. Ola will be clean. This will be confirmed by negative urine specimen and information from parents, school and police.

2. Ola will actively participate in a school sitiation adapted for him. Confirmed by information from school and parents.

3. Ola will stop both verbal and physical aggression. Confirmed by information from school and parents.

4. Ola will follow the family rules. Confirmed by information from parents.

Therapist: Familiy: Date:

I. Overarching\Primary MST Goals

Side 18

VERBAL AND

PHYSICAL AGGRES-

SION

PEER STATUSConfirmed by: child services

GETS WHAT HE WANTS/GETS POWERConfirmed by: parents

COMMUNICATION STYLE IN THE FAMILYConfirmed by: parents, Ola

COVERS UP SADNESSConfirmed by: mom

UNCLEAR RULES AND CONSE-QUENSESConfirmed by: parents

LOW IMPULS CONTOL Confirmed by: school, mom

INCONSITENT PARENTINGConfirmed by: parents, Ola

SUBSTANCE ABUSEConfirmed by: parents

PHYSICALLT STOPPED BY DAD IN CONFLICT SITUATIONSConfirmed by: Ola, parents

Side 19

SUB-STANCE ABUSE

PEERS WHO USEConfirmed by: youth support team, parents

EASY ACCESS TO DRUGSConfirmed by: youth support team, and Child Services CURBS UNREST

Confirmed by: Ola, parents

SUBSTANCE ABUSE PROBLEMS IN THE FAMILY Confirmed by: parents

NO CONSEQUENSESConfirmed by: parents

THRILL/RUSHConfirmed by: Ola

NO MONITORINGConfirmed by: parents

CONFLICTS AT HOMEConfirmed by: family

NO PARTICIPATION IN AFTER SCHOOL ACTIVITIESConfirmed by: Ola

Side 20

TRUANCY

NOR FRIENDS IN SCHOOLConfirmed by: lead teacher

FRIENDS NOT ATTENDING SCHOOL/NO JOBConfirmed by: school, Ola

CONFLICT SCHOOL-HOMEConfirmed by: parents, school

PROBLEM CONCENTRA-TING, SUBJECT.Confirmed by: school, rapport from Educational-Psychological Service

NO CONSEQUENSES AT HOME OR SCHOOLConfirmed by: school, parents

BAD RELATIONSHIP WITH TEACHERConfirmed by: Ola

PARENTS HAVE NO CONTROL OVER ACTIONSConfirmed by: parents

SUBSTANCE ABUSE; GETS HOME LATE; TIEREDConfirmed by: parents

NO PARENT FOLLOW UP WITH SCHOOLConfirmed by: parents

Social Support

• Key particpants• Identify need/tasks to ask for in support • Make a plan for meeting participants

individually or in a group• Make agenda for meeting• Therapist is secretary at the meeting and

writes all agreements

• Examples of tasks:• Come to the home in difficult situations• Help in search for youth • Babysit other children when parents need• Be support for parents as needed• Be support for youth with activities

Side 22

II. Previous Intermediary Goals

MET PARTIALLY NOT

1. Make safety plan

2. Mom contacts neighbour and a friend to ask if they can be contacted in an emergency

3. Parents agree on rules that will be included in the contract

X

X

X

III. Barriers to Intermediary Goals

Parents 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.

Side 23

IV Advances in Treatment

Safetyplan 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 safety

V Assessment of “fit” between identified problems and their broader systemic context.

Side 24

Safety plan for Ola and his family

LEVEL SITUATION WILL DO RESPONSIBILITY

1. Someone starts to yell at eachother

Remove yourselves form the situation, give a stop message (agree on a sign)

Don’t start a discussion

Everyone in the family.

2. Someone threatens another family member

Notify the person on whats to come in level 3 and 4 in a calm voice.

Don’t start a discussion

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.

Mom or dad.

Family Cohersion

• Identify strengths • Help parents to rebuild warmth and support• Establish clear expectations and rules• Make family contract with predictable

rewards and consequences• Plan for family activities

Side 26

VI New Intermediary Goals for Next Week

1.Review of possible rules, privileges and negative consequences with parents.

2.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.

3.Make an action plan on how to handle a situation where Ola is gone all night.

4.Dad contacts the school to set up a meeting.

School interventions

• Identify strengths and needs• Plan meeting with school with the parents• Parents contact school for meeting• Plan for comunication flow between

parents and school• Plan for implementation of rewards and

consequences are made• Plan for school routines• Particpants in meeting: (Principle) Class

teachers, social support teacher, parents and therapist

Side 28

Family contractRULE 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/night

Loses access on days he breaks the rule.

Ola will stop threatening, yell at and hassle other family members

2 points (=20 kr) per day to comply with the rule

Failure to comply with the rule loses him access to TV and phone the rest of the day.

Side 29

RULE 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 following

weekend.

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.

Peer interventions

• Identify peers• Who, when and what they do• Decide desired contact level• Monitoring interventions

• Examples:• Contact parents of negative peers• Establish a collaborative approaches:

Try to make agreements on limits and rules

• Plan for activities with prosocial peers

Side 31

Behavior What happens Responsibilty

Ola fails to appear/does not keep his curfew

1. Calls Olas cell phone

2. Calls his friends

3. Calls his friends’ parents

4. Drives around to find him

5. Mom and dad calls friend to help with the search

6. Call s MST, consider if the police should be contacted

Mom and dad

Plan for finding Ola

Physical and verbal aggression

• Make security plan • Identify strengths and needs• Rebuild family bonding• Identify clear rules• Identify triggers for aggresion• Decide rewards for reducing verbal

aggression (which is always covered in the family contract)

Side 33

OLA HIT DAD

DAD YELLED AT OLA

OLA KNOWS IT HELPS -HE GETS WHAT HE WANTS

CONFLICT BETWEEN OLA AND PARENTS ALREADY PRESENT

DAD PHYSICALLY HELD HIM BACK

VAGUE RULES

PARENTS GAVE CONFLICTING INSTRUCTIONS

OLA WAS INTOXI-CATED

DID NOT FOLLOW THE SECURITY PLAN

OLA DID NOT

RECEIVE MONEY

Drug Abuse Interventions

• Identify level of addiction• Identify peers who also use, what, when

and where• Plans urine tests• Make contract for stopping drug use