Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: clinical outcomes

J Am Acad Child Adolesc Psychiatry. 1999 Nov;38(11):1331-9. doi: 10.1097/00004583-199911000-00006.


Objective: The primary purpose of this study was to determine whether multisystemic therapy (MST), modified for use with youths presenting psychiatric emergencies, can serve as a clinically viable alternative to inpatient psychiatric hospitalization.

Method: One hundred sixteen children and adolescents approved for emergency psychiatric hospitalization were randomly assigned to home-based MST or inpatient hospitalization. Assessments examining symptomatology, antisocial behavior, self-esteem, family relations, peer relations, school attendance, and consumer satisfaction were conducted at 3 times: within 24 hours of recruitment into the project, shortly after the hospitalized youth was released from the hospital (1-2 weeks after recruitment), and at the completion of MST home-based services (average of 4 months postrecruitment).

Results: MST was more effective than emergency hospitalization at decreasing youths' externalizing symptoms and improving their family functioning and school attendance. Hospitalization was more effective than MST at improving youths' self-esteem. Consumer satisfaction scores were higher in the MST condition.

Conclusions: The findings support the view that an intensive, well-specified, and empirically supported treatment model, with judicious access to placement, can effectively serve as a family- and community-based alternative to the emergency psychiatric hospitalization of children and adolescents.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Activities of Daily Living
  • Adolescent
  • Adolescent Health Services
  • Emergency Service, Hospital
  • Female
  • Home Care Services*
  • Hospitalization
  • Humans
  • Male
  • Mental Disorders / therapy*
  • Outcome Assessment, Health Care*
  • Psychotherapy
  • Self Concept