Littell J H, Popa M, Forsythe B
Graduate School of Social Work and Social Research, Bryn Mawr College, 300 Airdale Road, Bryn Mawr, Pennsylvania 19010-1697, USA.
Cochrane Database Syst Rev. 2005 Jul 20(3):CD004797. doi: 10.1002/14651858.CD004797.pub3.
Multisystemic Therapy (MST) is an intensive, home-based intervention for families of youth with social, emotional, and behavioral problems. Masters-level therapists engage family members in identifying and changing individual, family, and environmental factors thought to contribute to problem behavior. Intervention may include efforts to improve communication, parenting skills, peer relations, school performance, and social networks. Most MST trials were conducted by program developers in the USA; results of one independent trial are available and others are in progress.
To provide unbiased estimates of the impacts of MST on restrictive out-of-home living placements, crime and delinquency, and other behavioral and psychosocial outcomes for youth and families.
Electronic searches were made of bibliographic databases including the Cochrane Library, C2-SPECTR, PsycINFO, Science Direct and Sociological Abstracts) as well as government and professional websites, from 1985 to January 2003. Reference lists of articles were examined, and experts were contacted.
Studies where youth (age 10-17) with social, emotional, and/or behavioral problems were randomised to licensed MST programs or other conditions (usual services or alternative treatments).
Two reviewers independently reviewed 266 titles and abstracts; 95 full-text reports were retrieved, and 35 unique studies were identified. Two reviewers independently read all study reports for inclusion. Eight studies were eligible for inclusion. Two reviewers independently assessed study quality and extracted data from these studies.Significant heterogeneity among studies was identified (assessed using Chi-square and I(2)), hence random effects models were used to pool data across studies. Odds ratios were used in analyses of dichotomous outcomes; standardised mean differences were used with continuous outcomes. Adjustments were made for small sample sizes (using Hedges g). Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were used.
Pooled results show no significant effects of MST on the likelihood or duration of restrictive out-of-home placements, proportion of youth who were arrested or convicted, or numbers of arrests/convictions within one-year post-intervention. There were no significant differences on drug tests or self-reported drug use at a 6-month follow-up. In analyses of post-treatment data for program completers, there were no significant between-group differences on self-reported delinquency, peer relations, youth behavior problems, youth psychiatric symptoms, parent psychiatric symptoms, or family functioning.
AUTHORS' CONCLUSIONS: There is little evidence of the superiority of MST over other interventions with youth. There is also no evidence that MST has harmful effects.
多系统治疗（MST）是一种针对有社会、情感和行为问题的青少年家庭的强化家庭干预措施。硕士水平的治疗师让家庭成员参与识别和改变被认为导致问题行为的个人、家庭和环境因素。干预措施可能包括改善沟通、育儿技巧、同伴关系、学业成绩和社交网络等方面的努力。大多数MST试验由美国的项目开发者进行；一项独立试验的结果已可得，其他试验正在进行中。
对MST对青少年和家庭的限制性家庭外安置、犯罪和违法行为以及其他行为和心理社会结果的影响提供无偏估计。
对1985年至2003年1月期间的文献数据库（包括Cochrane图书馆、C2 - SPECTR、PsycINFO、科学Direct和社会学文摘）以及政府和专业网站进行了电子检索。检查了文章的参考文献列表，并联系了专家。
将有社会、情感和/或行为问题的青少年（10 - 17岁）随机分配到获得许可的MST项目或其他条件（常规服务或替代治疗）的研究。
两名评审员独立评审了266篇标题和摘要；检索到95篇全文报告，确定了35项独特研究。两名评审员独立阅读所有研究报告以确定是否纳入。八项研究符合纳入标准。两名评审员独立评估研究质量并从这些研究中提取数据。研究之间存在显著异质性（使用卡方和I(²)评估），因此使用随机效应模型对研究数据进行合并。二分结果分析中使用比值比；连续结果使用标准化均值差异。对小样本量进行了调整（使用Hedges g）。合并估计值采用逆方差法加权，并使用95%置信区间。
合并结果显示，MST对干预后一年内的限制性家庭外安置的可能性或持续时间、被捕或被定罪的青少年比例或逮捕/定罪次数没有显著影响。在6个月随访时，药物检测或自我报告的药物使用方面没有显著差异。在对项目完成者的治疗后数据进行分析时，自我报告的违法行为、同伴关系、青少年行为问题、青少年精神症状、父母精神症状或家庭功能方面，组间没有显著差异。
几乎没有证据表明MST优于针对青少年的其他干预措施。也没有证据表明MST有有害影响。
