Multisystemic Therapy-Emerging Adults Trial

Serious antisocial behavior, including criminal offending, is extremely costly to society.
Rates of such behavior are highest during emerging adulthood. Antisocial behavior is
especially high among emerging adults (EAs) with mental illness (MI); findings suggest the
majority of EAs with MI will be arrested by age 25, most with multiple arrests, and for
serious charges. Thus, there is a clear public health need for effective treatments to reduce
serious antisocial behavior in EAs with MI. Astonishingly, there are no established
interventions with evidence of efficacy to reduce serious antisocial behavior among EAs, with
or without MI. Effective antisocial behavior interventions in adolescents address the
comprehensive causes of that behavior. Similarly, this team has developed and completed
research on a well-defined age-tailored intervention for EAs with MI and serious antisocial
behavior that addresses the correlates of EA antisocial behavior, and provides MI treatment.
The intervention is an adaptation of the well-established effective juvenile antisocial
behavior intervention, Multisystemic Therapy (MST). MST-EA is a single source that targets
the EA correlates of antisocial behavior, including gainful activity (school, work, housing,
and positive relationships) and reduced substance use, in part by targeting the proximal
mechanism of poor self-regulation. MST-EA also addresses these correlates through reducing MI
symptoms. The investigative team has already established the safety, feasibility, and
preliminary efficacy of this type of intervention in a successfully completed community-based
open trial (R34MH081374-01, PI: Davis). The proposed study will rigorously evaluate the
effectiveness of MST-EA for reducing serious antisocial behavior. Specifically, 240 EAs with
MI and recent arrests or release from justice facilities will be randomized to receive MST-EA
or Enhanced Treatment as Usual (E-TAU). Assessments will be completed at months 0, 2, 4, 6,
8, 12, and 16, with confirmation of outcome data using collateral reports and system records.
The first aim will be to evaluate the effect over time of MST-EA for improving the ultimate
outcome of treatment: reduced serious antisocial behavior. The second aim is to evaluate the
effect of MST-EA on (a) the key proximal target of treatment (self-regulation) and (b) the
proposed intermediate outcomes of treatment (gainful activity, substance use, and MI
problems). The final aim will be to determine whether MST-EA's effect on the ultimate outcome
is the result of its effect on the proximal target and intermediate outcomes of treatment.
There is a current absence of any antisocial behavior treatments with demonstrated efficacy
in this age group. The ultimate effect of the proposed research would be decreased antisocial
behavior and other public health-related behaviors (MI symptoms, substance use, homelessness,
unemployment) among one of the highest-risk population of individuals with MI. With an
emphasis on treatment mechanisms and the near absence of MI research focused on EAs, this
innovative research has high potential to advance the field.

Inclusion Criteria:

- age 17-21

- recent arrest or release from jail/prison/detention (within the past 18 months but
excluding arrests for probation/parole violations)

- presence of mood, anxiety, and/or psychotic disorders

- able to reside in a stable community setting (not currently homeless, not currently
inpatient; can include individual ready for discharge to the community)

- subject consent.

Exclusion Criteria:

- actively psychotic, suicidal, or homicidal

- Pervasive Developmental Disorders (PDD) or mental retardation

- sex offending as the primary antisocial behavior.

- adults unable to consent will also be excluded from this study.