Systematic Review and Meta-Analysis: Multisystemic Therapy and Functional Family Therapy Targeting Antisocial Behavior in Adolescence.

Objective: Youth criminal justice systems are under growing pressure to reduce re-offending behavior and to support young people's health and developmental needs. This systematic review and meta-analysis sought to synthesise evidence for 2 prominent community-based interventions for delinquent and antisocial behavior, namely, multisystemic therapy (MST) and functional family therapy (FFT).

Method: We searched Medline, PsycInfo, Scopus, Web of Science, and Social Services Abstracts for randomized controlled trials (RCTs) and quasi-experimental studies evaluating MST/FFT. Included studies involved participants aged under 18 years; included interventions targeted delinquent/antisocial behavior, but not maltreatment. We estimated effect sizes for 6 primary outcomes, synthesising RCTs comparing MST/FFT to usual care using correlated hierarchical effects meta-analysis. We assessed risk of bias and evidence strength using best-practice tools. Given the additional resources needed to implement MST/FFT, we rated evidence strength against a minimum clinically important difference rather than a null effect. This study is registered with PROSPERO, CRD42021279736.

Results: We included 35 studies for MST (16 RCTs meta-analyzed comprising 4,095 participants, 26% female) and 19 studies for FFT (7 RCTs meta-analyzed comprising 1,471 participants, 22% female). MST had a likely clinically important effect on time in out-of-home care, but no clinically important effects on other primary outcomes (delinquency, new offenses/convictions, placement in out-of-home care, substance use), with low-to-moderate evidence strength. FFT demonstrated possible clinically important effects for the number of new offenses/convictions, time in out-of-home care, and substance use, but evidence strength was low.

Conclusion: Contrary to reports in some evidence clearinghouses indicating that MST/FFT are supported by the highest level of evidence strength, there is limited evidence that these interventions are superior to usual care in reducing delinquent and antisocial behavior in adolescence. These findings should be viewed in the context of important methodological differences with prior reviews, including the rating of evidence strength against a minimum clinically important difference.

Plain Language Summary: Delinquent and antisocial behavior by young people imposes high costs on the wellbeing of individuals and the broader community. This systematic review summarized evidence for two prominent community-based interventions for delinquent and antisocial behavior: multisystemic therapy ([MST], 35 studies) and functional family therapy ([FFT], 19 studies). MST led to a reduced time in out-of-home care compared to usual treatment. FFT had larger favorable effects on delinquency, new offenses and convictions, placement in out-of-home care, and substance use, but the quality of the evidence was poor. The authors concluded that there is limited evidence that either MST or FFT are superior to usual care in reducing delinquent and antisocial behavior in adolescence.

Study Preregistration Information: The effect of Multi-Systemic Therapy and Functional Family Therapy in addressing child and adolescent delinquent and/or antisocial behavior and childhood maltreatment; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=279736.