Table II.

Multisystemic treatment (MST).

			Methods		Results
References	Characteristics of the patients	Treatment conditions	Outcome measures	Treatment efficacy
Borduin et al. (1990)USARandomised study	N=16 MalesSex offenders arrested:6 rapes, 5 sexual assaults, 4 sodomy, 1 exhibitionismType of paraphilia?Mean age: 14 yearsPrevious history of sexual abuse?Comorbidities:Majority of conduct disorders	Multisystemic therapy (MST) N=8Adolescent and family systemic approachMean 37 hoursvs.Individual therapyN=8Combination of psychodynamic, behavioural and psychotherapyMean 45 hoursMean duration of treatment: 4 monthsDuration of follow-up: 21–49 months (mean 37)	Timepoints:Pre- and post-treatmentOutcome measures:No scalesRecidivism rate for sexual offences	Drop out: 3 cases in each groupRe-arrest rates:In 4/6 cases: re-arrest for sexual offenceMST group recidivism rate for sexual offences: 12.5%IT group recidivism rate for sexual offences: 75%p=0.04
Borduin et al. (2009)USARandomised controlled study	N=48 MalesSex offenders arrested as well as non sexual offencesPrevious offences mean 4.3 (sexual 1.6 and non sexual 2.7)Moderate baseline risk of reoffendingMean age: 14 ± 2 yNo differences between the 2 groups except for more behavioural problems in the MST groupType of paraphilia?Previous history of sexual abuseComorbidities:No psychosis, no mental retardation	Multisystemic therapy (MST) at home N=24 (Borduin et al. 2003)Duration: 31 wks ± 12vs.Usual community services (UCS) using CBT N=24(CBT group, 90 min twice a week + individual treatment 60–90 min once a week)2 withdrawn in the UCSDuration: 30 weeks ±18Duration of follow-up: mean 9 years	Timepoints:Pre- and post-treatmentOutcome measures:Scales:–Global Severity Index of theBrief Symptom Inventory(self-report scale 53-item(from 0 to 4)–Youth behaviour problems:89 item form, 0 to 2–Revise Behaviour Problem Checklist(report by parents)– Family Adaptability and CohesionEvaluation Scales II (parents and youth reports) 30-item (1–5)–Missouri Peer RelationsInventory (parents, youths and teachers reports) 13-item (1–5)–Self-report delinquency scale: 40-itemNumber of offencesNumber of days of incarcerationRe-arrest: sexual assault or attempted sexual assault	Post-treatment:MST participants had 83% fewer arrests for sexual crimes than UCSand 70% fewer arrests for other crimesthan the UCS groupAfter 9 years:MST participants spent 80% fewer days in detention facilities than UCSReoffenders: 2/24 MST vs. 11/24 in the control groupRelative risk of reoffending: 0.18 (0.04–0.73)Re-arrest rates for sexual and non-sexual crimes: 45.8% of UCS for sexual crimes and 58.3% for a non sexual crime compared with 8.3 and 29.2% respectively of MST casesCox proportional hazards tests showed small to medium effect sizes for MST versus UCS (sexual offences, beta = 0 .124, p = 0.007; non sexual offences, beta=.433, p = 0.050).All other items were significantly improved in MST and deteriorated in UCS Drop outs: MST: 0vs. 2 in UCS
Henggeler et al. (2009)USARandomised studyAndLetourneau et al. (2009, 2013)	N=127124 Males 3 FemalesSex offenders35% of youths had no sexual offencesTreatment completion was mandatory (probation or diversion)Type of paraphilia?Mean age: 14.6 y (range 11–17)Previous history of sexual abuse?Comorbidities:No psychosis, no mental retardation	Multisystemic therapy (MST) at home delivered by community-based practitioners N=67Mean duration of treatment: 7 monthsvs.Standard treatment (TAU) N=60Primarily group-based CBT including: weekly group-based treatment with decreasing deviant arousal, increasing victim empathy, addressing cognitive distortions, relapse prevention, and family counselling.Mean duration of treatment: 14.6 months, and 8.2 months for diverted youthsDuration of follow-up: 2 years	Timepoints:From baseline through 2-year follow-upEvaluation at 6 and 12 monthsEvaluation at 24 monthsOutcome measures:Scales:–Externalising T scores of the Youth Self-Report (YSR) and of the Child Behaviour Checklist (youth externalising behaviours.)–The Child Behaviour Checklist (CBCL) (youth mental health functioning)–40-item Self Report Delinquency Scale (SRD)–General Delinquency subscale during the previous 3 months–Two items from the Personal Experience Inventory (PEI) (frequency of self-reported alcohol and marijuana use for the previous 3 months–Adolescent Sexual Behaviour Inventory, a 45-item instrument (inappropriate sexual behaviours reported by youth and parents (2 subscales were used)Sexual offence re-arrests	Drop out: 6 in each groupAt 1 year:Caregiver reports of youth sexual risk/misuse declined by about 77% for youths in the MST vs. minimal decline for youth in the TAUSelf-reported delinquent behaviour and substance use decreased by respectively 60 and 50% in the MST vs. 18% and an increase of 65% in the TAUThe probability that an MST youth was in an out-of-home placement (i.e., detention, residential treatment, foster care) during the past 30 days remained approximately 7% vs. an increase from 8 to 17% in the TAU groupAt 2 years:MST treatment effects were maintained for 3 of 4 measures of youth problems: sexual behaviour, self-reported delinquency, out-of-home placements.The base rate for sexual offence was too low for statistical analyses and no between-groups difference were observed for other criminal arrests