Association Between Cumulative Stress and Family Environment as a Predictor of Arrest Following Multisystemic Therapy
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Multisystemic Therapy (MST) is an intensive, family-based treatment that is well-established for youth with serious criminal offenses. MST has produced significant short- and long-term treatment success in numerous randomized controlled trials and published outcome studies, including rearrest ranging from 20% to 70%, with a median of 42%. While this outcome is impressive, not all youth who receive MST avoid rearrest. Despite high levels of support for the effectiveness of MST, relatively little is known about how end-of-treatment child and family characteristics (that are direct or indirect therapeutic targets of MST) interact to influence arrest outcomes. This study used a prospective, longitudinal design to examine the association between the number of stressful life events experienced by youth by the end of treatment (cumulative stress) and family environment (i.e., family cohesion and flexibility) at the end of MST predict the likelihood of arrest one year later. Results showed a significant interaction between cumulative stress and family environment. At higher levels of family cohesion and flexibility, more cumulative stress increased the likelihood of arrest after treatment. The findings are consistent and inconsistent with the extant literature, suggesting that the relation between cumulative stress and family environment is complicated for families with youth exhibiting serious aggression and delinquent behaviors. The results further highlight the importance of examining the mechanisms of change for MST. Limitations in the measurement of family environment are discussed, calling for the development of measures that may more adequately capture family environment in families referred to MST.