Brenda Ann Kenneally
Three years ago, Mary Beth Towell, a counselor in Canton, Ohio, was assigned to a family in a crumbling neighborhood of dilapidated houses, drug dealers and gangs. Even in that tough neighborhood, this family stood out as desperate. In a single month, child-protective services fielded more than 30 calls from teachers, police officers and others demanding that the children be removed.
The mother had bipolar disorder and was a heavy marijuana user. The children's father no longer lived in the home. Two of the girls, 15 and 10, and a boy, 11, were violent and suicidal. They threatened one another with knives and fought viciously. (The remaining child, a 14-year-old girl, was somehow O.K.)
Few families in such bad shape survive intact. The children may be sent to residential treatment centers or juvenile corrections facilities. "These programs generate high recidivism rates," says Bart Lubow, director of the program for high-risk young people at the Annie E. Casey Foundation in Baltimore. And they can cost at least $50,000 a year per child. "That would be O.K. if you were getting a reasonable return on your investment," Lubow says. "But the outcomes are very poor."
Stark County in Ohio is trying something different. Towell was part of a team using an innovative antiviolence program called multisystemic therapy, or MST. Developed over the last 30 years by Scott Henggeler, a clinical psychologist and a professor of psychiatry at the Medical University of South Carolina, it is based on the assumptions that families should remain together and that all of the causes of antisocial behavior should be attacked at once.
Taking his cues from family therapy as well as from social ecology, which emphasizes that behavior is shaped by multiple aspects of the environment, Henggeler studies the ecosystem composed by family, neighborhood, schools, peer groups and the broader community. Instead of removing children from that ecosystem, he tries to change it: solve the drug problems and the legal problems, get kids away from delinquent peers and encourage academic success.
A central idea is to focus on the parents. "We want the therapist to build the competency of the parents, because the parents are going to be there after the therapist leaves," he says. If the parents can't handle the job, he might ask an uncle, aunt or grandparent to fill in.
MST therapists like Towell have small caseloads — four to six families at a time. They visit the families every day, if necessary, and are always on call. If the police grab a child at 2 a.m., the therapist can help sort things out. Because of this intensive effort, MST isn't cheap. It typically lasts four to five months and costs between $5,000 to $7,500 per child. To make it cost-effective, it is directed at kids at high risk of expensive out-of-home placements. If enough of them can be kept at home, the program can pay for itself — and even save communities money.
MST is one of only a handful of "evidence based" programs that have been shown to be effective for violent children. In a recent 14-year evaluation, kids who had been through MST programs had 54 percent fewer arrests and spent 57 percent fewer days in jail. "These programs have a higher success rate than what else is out there," Henggeler says. The single most important piece of the treatment is getting children away from deviant peers.
While the program has become more popular in recent years, it is still relatively small. Edward Latessa, head of the division of criminal justice at the University of Cincinnati, contends that MST is one of the best programs for delinquent kids, but he adds that it isn't for everyone. "The problem with MST is it's a difficult model to implement," he says. "It requires a caregiver that's really committed. It's not easy, so some agencies give up." With such concerns in mind, Henggeler has set up a private company called MST Services to help communities develop programs, train therapists and make sure they stick with the program. Meanwhile, he is extending MST-style programs to other arenas, like the treatment of sexual offenders and abused or maltreated kids.
Towell had surprisingly good luck with the Canton family. She discovered that the children liked to draw, and she helped them join art classes. There they met the sort of other kids she wanted them to associate with. With pressure from Towell, the mother cleaned herself up and made the commitment to turn things around. It wasn't easy, but it worked. "She was willing to do whatever it took," Towell says. "That's when we have the most successful cases."
Paul Raeburn is the author of "Acquainted With the Night," a memoir of raising children who have depression and bipolar disorder.