The Swedish Implementation of Multisystemic Therapy for Adolescents: Does Treatment Experience Predict Treatment Adherence?

Journal of Clinical Child & Adolescent Psychology

Treatment effects may not be observed if an empirically supported intervention is not

administered with treatment adherence. This retrospective study investigated how

therapists’ adherence to Multisystemic therapy (MST) varied during a 6-year period

in Sweden. Adherence was measured using the Therapist Adherence Measure, which

was provided by caregivers. The associations between treatment adherence and

therapist-reported posttreatment youth outcomes were also assessed. Retrospective

adherence data were obtained for 973 families with youths between 12 and 17 years

old who received MST from 68 therapists divided into 10 teams. Implementation of

MST occurred in 2 waves between March 2003 and August 2009. Multilevel structural

equation modelling was used to evaluate family- and cohort-level predictors and outcomes

of treatment adherence. The results confirm previous research: Treatment adherence

predicts MST treatment outcomes. With respect to the relationship between MST

treatment experience and MST treatment adherence, the analysis showed mixed results.

An increase in years that a team had been active predicted an increase in therapist

adherence to MST. Therapists from the 2nd implementation wave had higher therapist

adherence rates than therapists from the 1st implementation wave. Nevertheless, a

therapists’ experience with MST did not predict MST treatment adherence. The results

suggest that the found links among treatment experience, treatment adherence, and

treatment outcomes provide support for the hypothesis that the collective experience

of the team members promotes treatment adherence. However, results are mixed and

further research is needed.