Multisystemic therapy modifications for child welfare-focused implementation

• MST-PRV appears to be an effective modification to support adherent MST delivery in child welfare. • The FRAME-IS is useful to document MST modifications for child welfare labeled MST-PRV. • At MST-PRV discharge, 3% of youth were in placements versus 7% in traditional MST. • Context-driven modifications may expand the reach of evidence-based interventions. Youth with significant behavioral problems present challenges for the child welfare system and effective treatments are needed. Few interventions have stronger evidence than Multisystemic Therapy (MST) for reducing adolescent behavior problems and out-of-home placement. However, standard delivery of MST does not provide tailored guidance for working collaboratively within the child welfare setting and, in some cases, may not address the needs of the service system. The need for modification to address system challenges to the treatment model became evident during implementation of MST in a large child welfare preventive services system. This paper utilizes the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS; Miller et al., 2021; Wiltsey Stirman et al., 2019) to describe how modifications, labeled MST-Prevention (MST-PRV), were developed, evaluated, and documented while retaining the evidence base of the original treatment model. Pilot data compared outcomes for families receiving MST-PRV versus standard MST in 2024. Results suggest that MST-PRV was model-adherent and delivered strong outcomes typical of MST, including a high proportion of youth who completed treatment, remained living at home, attended school or work, had no new arrests or maltreatment reports, and demonstrated significant improvements in problematic behaviors. Potential benefits of the MST modifications to child welfare preventive service system partners are discussed.