Aidan is a 15-year-old White male ninth grader who lives at home with his unemployed biological mother, mother’s live-in boyfriend, and two younger brothers (ages 9 and 11). Aidan was referred to the MST program by his probation officer Mr. Gonzalez, for verbal aggression in the home and at school (e.g., he threatened to seriously injure a family member and peer), marijuana use (e.g., he has been arrested twice for possession of marijuana at school), and truancy (e.g., he is absent from school 2 or 3 times per week). Aidan becomes verbally aggressive to other family members following arguments that escalate with his mother. Aidan primarily associates with delinquent peers and has some association with known gang members. The family resides in a low-income neighborhood with high rates of violence and gang affiliation. His mother receives disability benefits and food stamps, and her boyfriend is inconsistently employed.

The therapist’s task is to conduct a strengths and needs assessment in collaboration with the family and key informants to determine the youth’s social ecological factors that contribute to the identified problems, along with systemic strengths that might be used to modify problem behavior (Henggeler et al., 1998). The MST therapist will strive to consider all factors that may exist due to ecological interactions between the youth, family, peers, neighborhood, school, and community. Key informants may include the parent, youth, siblings, peers, teachers, coaches, and probation officer. During the assessment with Aidan and his family, the therapist discovered the following ecological needs/factors: The mother and her boyfriend are frequently away from the home, the boys are rarely given consequences, high conflict exists between Aidan and his mother, there is a weak link between home and school, parents have little knowledge about Aidan’s peers, Aidan associates with negative peers and obtains marijuana from his friends, Aidan’s mother says he becomes angry quickly, they live in a high crime neighborhood, and their household income is inconsistent. Some of the strengths included that Aidan is athletic, is social, and has a sense of humor; he watches over his siblings while they play in the neighborhood; they have extended family in town; his mother used to work full time and has several connections in the community; there is a YMCA near their home; and the school has an athletic program.

Following the analysis of strengths and needs, treatment goals are established by the therapist and family that target each problem behavior and the systemic factors that influence each targeted behavior. This process of identifying systemic factors is Principle 1: understanding the fit between the identified problems and their broader systemic content (Henggeler et al., 1998). Once these factors have been identified, hypothesis development is conducted, followed by interventions that are primarily implemented by the youth’s caregiver in the natural ecology of the youth (i.e., home).

The therapist, in collaboration with the treatment team and clinical supervisor, develops testable hypotheses constructed around the problem behaviors (Henggeler et al., 1998). In Aidan’s case, it is hypothesized that high conflict with his mother contributes to his verbal aggression toward family members and peers, in the absence of consequences. Henggeler et al. (1998) note that hypotheses should be measurable and concrete, with an initial focus on proximal (versus distal) causes of behavior; otherwise, the ability to measure and evaluate hypotheses decreases. For example, Aidan’s level of verbal aggression can be measured by frequency, intensity, and duration in the presence or absence of consequences. In contrast, if the hypothesis attributed Aidan’s verbal aggression to depression, then direct observation would not be an effective measure.

Interventions are based on the hypotheses that were developed by the treatment team. For example, one hypothesis was that mother-son conflicts precede Aidan’s verbal aggression at home; therefore, the intervention would target decreasing mother-son conflicts. Intervention selection is a collaborative process that occurs between the therapist and family, and incorporates treatment Principle 2, which is to use systemic strengths (Henggeler et al, 1998). For example, given Aidan’s interest in athletics, he may want to engage in prosocial activities that will decrease his contact with his mother and also give him an outlet to release some tension. Other strategies could be using extended family members during times of heightened stress, teaching his mother conflict resolution skills, promoting warmth-building relationship exercises, and teaching his mother how to set and enforce rules and consequences.

After interventions have been consistently implemented, if it is determined that Aidan’s baseline verbal aggression has not changed, then the team would reevaluate the initial hypothesis and include additional information that has been gathered over the intervention implementation period. After this process of finding the “fit,” new or modified interventions are established and the implementation period begins again. As stated by Henggeler et al. (1998), this process of conceptualization of the fit, hypothesis development, intervention development, intervention implementation, and reevaluation is part of the MST analytic process and is a reiterative process from the beginning of treatment to the end.

DISCUSSION QUESTIONS

1. Why is sexual identity an important component of an adolescent’s identity development? Why do you think little is known about gender identity?
2. How do social structures and expectations influence the experience an adolescent may have with dating violence, problem behaviors, eating disorders, or depression? How might this be compounded for an adolescent with same-sex or both-sex attractions?
3. Utilizing the concept of systemic theory, which domains are shown to influence success in maneuvering the multiple challenges that adolescents face? How do you think mental health providers can best support adolescents?
4. Using the case example and drawing on the research cited in this chapter, what additional factors might need to be considered in Aidan’s ecological assessment if he were gay or an ethnic minority? What other cultural factors might affect his assessment?