Journal of Consulting and Clinical Psychology 1995, Vol. 63. No. 4, 569-578 Copyright 1995 by the American Psychological Association, Inc. 0022-006X/95/S3.00 Multisystemic Treatment of Serious Juvenile Offenders: Long-Term Prevention of Criminality and Violence Charles M. Borduin University of Missouri—Columbia Barton J. Mann University of North Carolina at Chapel Hill Lynn T. Cpne University of Missouri—Columbia Scott W. Henggeler Medical University of South Carolina Bethany R. Fucci, David M. Blaske, and Robert A. Williams University of Missouri—Columbia This article examined the long-term effects of multisystemic therapy (MST) vs. individual therapy (IT) on the prevention of criminal behavior and violent offending among 176juvenile offenders at high risk for committing additional serious crimes. Results from multiagent, multimethod assess- ment batteries conducted before and after treatment showed that MST was more effective than IT in improving key family correlates of antisocial behavior and in ameliorating adjustment problems in individual family members. Moreover, results from a 4-year follow-up of rearrest data showed that MST was more effective than IT in preventing future criminal behavior, including violent offending. The implications of such findings for the design of violence prevention programs are discussed. The prevention of violent criminal acts and other serious crimes perpetrated by youths has become a pressing issue on the national health care agenda, as the staggering fiscal and so- cial costs of such crimes become evident (Children's Defense Fund, 1992). To address this issue, mental health professionals and policy makers have justifiably argued for the promotion of childhood programs that may prevent the development of vio- lent behavior (e.g., Zigler, Taussig, & Black, 1992). Although primary prevention programs targeted at young children are certainly needed and promising programs are currently being examined (e.g., Tolan, Guerra, Van Acker, Huesmann, & Eron, 1994), the development of effective interventions with youths who are the most likely to perpetrate serious crimes has been relatively neglected. Clearly, as longitudinal studies graphically Charles M. Borduin, Lynn T. Cone, Bethany R. Fucci, David M. Blaske, and Robert A. Williams, Department of Psychology, University of Missouri—Columbia; Barton J. Mann, Department of Psychology, University of North Carolina at Chapel Hill; Scott W. Henggeler, De- partment of Psychiatry and Behavioral Sciences, Medical University of South Carolina. This research was supported by grants from the Missouri Depart- ment of Social Services and the University of Missouri—Columbia Re- search Council. Sincere thanks go to Robert Perry, Gene Hamilton, and Alan Sirinek of the Missouri 13th Judicial Circuit Juvenile Court for their support and cooperation and to the therapists and community professionals, too numerous to mention individually, who worked on this project. We also appreciate the efforts of the many research assistants, and we extend special thanks to Janette Concepcion, Peter Ambrose, and John Draper. Correspondence concerning this article should be addressed to Charles M. Borduin, Department of Psychology, 21 McAlester Hall, University of Missouri, Columbia, Missouri 65211. demonstrate (e.g., Lewis, Lovely, Yeager, & Famina, 1989; Weisz, Martin, Walter, & Fernandez, 1991), serious juvenile offenders are, by far, at the greatest risk for committing addi- tional serious crimes. Preventing or attenuating further crimi- nal activity in such youths would favorably affect their lives, families, and communities. Unfortunately, however, interventions with serious juvenile offenders historically have had little success. Several reviews of the delinquency treatment literature in the 1970s concluded that "nothing works" (Henggeler, 1989, p. 84). More recently, Kazdin (1987, p. 189) has described several empirically driven treatments as "promising" (e.g., behavioral parent training, cognitive-behavioral therapy), and Lipsey (1992) has argued that such structured, skill-oriented treatments have demon- strated the largest effects on juvenile offenders in general. How- ever, in clinical trials with serious juvenile offenders, such treat- ments have failed to produce favorable long-term effects (Bank, Marlowe, Reid, Patterson, & Weinrott, 1991; Guerra & Slaby, 1990; Weisz, Walter, Weiss, Fernandez, & Mikow, 1990). More- over, even favorable outcomes of these treatments with less se- vere antisocial behavior are mitigated by findings that univer- sity-based successes rarely extend to community settings (Weisz, Weiss, & Donenberg, 1992). In consideration of the continued difficulty of even well-con- ceived treatments to produce lasting change in youth antisocial behavior, investigators have argued that the major limitation of such treatments is their relatively narrow focus and failure to account for the multidetermined nature of antisocial behavior (e.g., Borduin, 1994; Mulvey, Arthur, & Reppucci, 1990; Zigler et al., 1992). Overwhelming evidence supports a social-ecolog- ical view (Bronfenbrenner, 1979) in which antisocial behavior in youths is conceptualized as multidetermined (e.g., Heng- 569