Mechanisms of change in multisystemic therapy: Reducing delinquent behavior through therapist adherence and improved family and peer functioning

The mechanisms through which multisystemic therapy (MST) decreased delinque nt behavior were assessed in 2 samples of juvenile offenders. Sample 1 incl uded serious offenders who were predominantly rural, male, and African Amer ican. Sample 2 included substance-abusing offenders who were predominantly urban, male, and Caucasian. Therapist adherence to the MST protocol (based on multiple respondents) was associated with improved family relations (fam ily cohesion, family functioning, and parent monitoring) and decreased deli nquent peer affiliation, which, in turn, were associated with decreased del inquent behavior. Furthermore, changes in family relations and delinquent p eer affiliation mediated the relationship between caregiver-rated adherence and reductions in delinquent behavior. The findings highlight the importan ce of identifying central change mechanisms in determining how complex trea tments such as MST contribute to ultimate outcomes.