Indiana Statewide Implementation of Multisystemic Therapy

Multisystemic Therapy is an effective family-focused and community-based treatment approach for youth ages 12-17 with serious externalizing behaviors (e.g., theft and other criminal behaviors, aggressive/violent behavior, substance use, and chronic school absences) who are at risk of out-of-home placement or are involved in the criminal justice system. To learn more about MST, visit mstservices.com.

Proven outcomes include:

• Reduced rates of criminal offending, arrests, and recidivism

• Reduced rates of out-of-home placements

• Extensive improvements in family functioning

• Reduced mental health problems and substance use

• Cost savings for communities relative to alternative treatments

Therapists work in the home, school and community, and a team member is on call 24/7 to provide caregivers with the tools they need to transform the lives of troubled youth. Therapists work with youth and their families for an average of three to five months. They have small caseloads and provide services at times convenient to the family.

Watch Jordan's story to see how MST helped him and his mother work through challenges.

Participating organizations can save upwards of $100,000 in MST start-up costs

Costs covered for organizations participating in the statewide implementation include:

• Start-up costs, including program development and blended in-person/virtual MST orientation training
• MST program support and licensing fees for two years
• Support towards administrative time spent participating in program development
• Staff hiring and recruitment services
• Hiring and retention bonuses for MST therapists and supervisors
• Funds for cell phones and plans for MST team members
• Flex funds for families participating in MST
  
  

MST is cost-saving for organizations

MST offers a variety of built-in services that can be tailored to meet clients' unique needs. MST is cost-saving for organizations, as other treatment models require outsourcing of certain services to meet those needs.

 

With the help of Indiana FSSA-DMHA and IU School of Medicine, youth-serving organizations across Indiana have the opportunity to bring MST to their communities to help at-risk youth access individualized, evidence-based care that targets the core causes of substance use, juvenile delinquency, and antisocial behaviors. Organizations participating in the statewide MST implementation project are responsible for the following tasks:

 

Assemble at least one MST Team	Complete program development & start-up activities	Provide MST to local eligible youth	Participate in ongoing program support & training activities
A team consists of one doctoral or master's-level supervisor (at least half time) and at least two master's-level therapists (full-time).	Each team is required to meet with MST Services to complete program development and complete the blended in-person/virtual MST orientation training.	Eligibility criteria includes theft and other criminal behaviors, aggressive/violent behavior, substance use, chronic school absences, etc.	Each team is required to attend quarterly booster trainings and weekly case plan review calls with MST Services.

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Which costs will be covered by Indiana FSSA-DMHA funds as part of the statewide implementation?

MST program development and start-up services are covered by the Indiana FSSA-DMHA funds for the first two years.

This includes:

• A needs assessment session to discuss the need for MST in the community and the feasibility of building a sustainable program
• A critical issues review session to discuss the key elements of a successful MST program
• An on-site readiness review meeting to provide an overview of MST to the community, and to meet with key stakeholders to refine the final implementation plan
• Staff recruitment assistance
• Blended in-person/virtual MST orientation training for each new program of up to five staff per team, which involves two days of in-person training and online modules to be completed within 30 days
• Weekly MST phone consultation for MST clinical teams (one hour per week for up to 45 weeks per year)
• Four booster trainings per year
• All required training materials and manuals.

FSSA-DMHA funds are also available to support organizations in covering costs related to administrative time spent participating in the MST program development process including:

• Hiring and recruitment support services
• Hiring and retention bonuses for MST team members
• Cell phone plans for MST team members
• Flex funds to support families participating in MST
  
  

Will providers be responsible for support after the second year?

After the second year, the annual program support and training services will be the responsibility of the provider agency.

Which funding streams are available for this model?

MST services can currently be funded through Medicaid reimbursement using therapy CPT codes and funding via Indiana Department of Child Services (DCS) can be utilized for cases that meet eligibility requirements. Specifically, providers can receive per-diem-based reimbursement for providing MST to youth who are eligible for Family Preservation Services. MST Services will work with provider agencies to work through funding and referral models to ensure sustainability.

What are the estimated costs for the re-training that will come with employee attrition after the second year?

The MST orientation training costs approximately $950/employee and travel expenses as needed.

In Indiana, does the therapist have to be licensed and does the supervisor have to be licensed in order to provide service in the MST program?

It depends on the funding stream/plan for reimbursement. For example, if an agency plans to fund an MST team through per-diem based reimbursement for providing MST to youth who are eligible for Family Preservation Services, the DCS Family Preservation Service Standard applies. This standard requires the supervisor to be master’s level or above and licensed. Remaining staff must be credentialed according to the service model used (i.e., MST), but DCS does not set specific state licensure requirements.

Can team members provide services other than MST while serving on five MST cases? For example, if the member is an LCSW or LPC, can they continue to provide outpatient therapy?

MST therapists need to be full-time and dedicated to just MST services. The MST supervisor needs to have at least 50 percent full-time equivalent dedicated to MST. 

If you have multiple teams, can one team member "sub" for another in another area if there is a personnel need?

This is a question that will need to be addressed on a provider-specific basis. MST is a team service (one supervisor for two to four therapist staff) review all of the cases and case plans in an ongoing way with the MST trainer. Team structure and support are important because it supports service delivery to youth and their families, but also support on-call responsibilities. This kind of “sub” arrangement would be highly unusual but can be explored.

What types of community organizations are most successful in providing MST?

All types of youth-serving organizations have been successful in providing MST, including behavioral health agencies, non-profits, government departments, etc. Please contact us at indmst@iu.edu to request a call to discuss the fit of MST within your agency.

Can other clinical services, such as in-home services, still occur while MST is in place?

Yes, other services such as a caregivers' individual therapy can still occur, as long as the family and primary caregiver voluntarily desire to have these services in place. MST staff will be accountable for the coordination of services while MST is in place. 

What is the training process and how long does it take?

MST program support and training are ongoing. The staff support Quality Assurance and Quality Improvement (QA/QI) and professional development activities that make up the MST on-the-job training structure are as follows: 

• MST blended orientation training, which includes two days of in-person training and online modules to be completed within 30 days
• Quarterly booster training (on-site one and a half days each quarter)
• Weekly case plan review and phone-based consultation calls with the full MST team to provide feedback on the prior week's progress and current case plans
• Additional weekly support and development calls with the on-site MST supervisor are a part of this support model

Annual MST program support and training costs are $37,200 for single teams per year, or $28,500 per team per year  for organizations with two to three teams, plus additional fees for agency and team licensing, adherence monitoring calls to families (i.e., TAM data collection), and trainer travel expenses. These costs are covered by Indiana FSSA-DMHA funds for the first two years.