Long-Term Youth Criminal Outcomes in MST Transport: The Impact of Therapist Adherence and Organizational Climate and Structure

Abstract

This study investigated relations among therapist adherence to an evidence-based treatment for youth with serious antisocial behavior (i.e., Multisystemic Therapy), organizational climate and structure, and youth criminal charges on average 4 years posttreatment. Participants were 1,979 youth and families treated by 429 therapists across 45 provider organizations. Results showed therapist adherence predicted significantly lower rates of youth criminal charges independently and in the presence of organizational variables. Therapist perceptions of job satisfaction and opportunities for growth and advancement relative to the organizational average predicted youth criminal charges, as did organizational average levels of participation in decision making. These associations washed out in the presence of adherence, despite the fact that job satisfaction and growth and advancement were associated with adherence.

Preparation of this article was supported by grants DA018107 and K23DA015658 from the National Institute on Drug Abuse and grant MH59138 from the National Institute of Mental Health.

The first author is a board member and stockholder in MST Services, LLC, which has the exclusive licensing agreement through Medical University of South Carolina for the dissemination of MST technology.

The authors are particularly grateful to Charles Glisson and Philip Green, Children's Mental Health Services Research Center, University of Tennessee–Knoxville, for their generous consultation and examination of our organizational climate and structure data; to Don Hedeker for his consultation regarding the design of the statistical analyses for the original and follow-up study; and to Judith Singer of Harvard University and David Mackinnon of the University of Arizona for their consultation regarding the testing of mediation models using multilevel data.

Notes

¹The model coefficients and probability values for age, gender, ethnicity, and number of lifetime pretreatment charges, respectively, are γ₁₀₀ = − 0.010, SE = 0.041, p = .020; γ₂₀₀ = − 0.544, SE = 0.114, p = < .001; γ₃₀₀ = 0.271, SE = 0.089, p = .005; and γ₄₀₀ = 0.049, SE = 1.050, p ≤ .001. For each model, the T-ratio test statistic was computed as (γ/SE) and df = 38.

Note. T-ratio test statistic (omitted) computed as (γ/SE). Event Rate (omitted) computed as exp(γ _ijk ). TAM-R = Therapist Adherence Measure–Revised.

^a Model adjusted for variable length of exposure, age, gender, ethnicity, and number of lifetime pretreatment charges.