Testing MST to Improve Adherence Among Youth With Chronic Poor Metabolic Control

• adherence behaviors [ Time Frame: 2 years ]
  
• metabolic control [ Time Frame: 2 years ]
  
• rates of diabetic complications [ Time Frame: 2 years ]
  
• hospital utilization [ Time Frame: 2 years ]
  
• quality of life [ Time Frame: 2 years ]
  

• general family functioning [ Time Frame: 2 years ]
  
• diabetes-specific family functioning [ Time Frame: 2 years ]
  
• child behavior [ Time Frame: 2 years ]
  
• stress [ Time Frame: 2 years ]
  
• patient-provider relationships [ Time Frame: 2 years ]
  

Behavioral: Multisystemic Therapy (MST)

MST is a family and community-based treatment model that draws upon social-ecological and family systems theories of behavior. Extra-familial systems, such as the health care system, school, work, peers, and even community and cultural institutions are seen as interconnected with the individual and his or her family. Problem behavior such as severe adherence problems may be a function of difficulty within or between any of these systems (e.g., family-health provider relations, family-school relations, child-peer relations).

MST is an individualized approach that begins with a comprehensive, multi-informant assessment that allows for the development of treatment goals and interventions that are individually tailored for each family. Therapists draw upon a menu of evidenced-based interventions that include cognitive-behavioral therapy, parent training and behavioral family systems therapy.

Substantial data exists to demonstrate that improving metabolic control in persons with Type 1 diabetes mellitus (T1DM) can delay the onset of diabetes complications and reverse some existing complications as well. Unfortunately, those adolescents with T1DM who are at highest risk for diabetes complications are often the most resistant to hospital based care and traditional education/ supportive interventions. They are also faced with multiple barriers to improved metabolic control, which may include lack of knowledge about diabetes, family disorganization and disengagement, high levels of stress and an unhealthy lifestyle. Multisystemic Therapy (MST), a flexible and home-based therapeutic intervention originally designed for use with mental health populations, seems to be a promising approach to providing diabetic adolescents with the ability to engage in consistent and attentive illness management.

The study recruited a sample of 127 adolescents in poor metabolic control and randomly assigned them to either the treatment intervention, MST plus standard medical care, or standard medical care alone. Families randomized to MST received intensive, home-based family therapy for approximately six months. Families completed data collection at baseline and then again at 7, 12 18 and 24 months after study entry.