Jane (not her real name) has four foster children, all relatives. Their ages are 12, 10, 7 and 7. Three boys and a girl.

"They never really had any structure in their lives," Jane said.

The mother of the children had problems with drugs, Jane said, declining to be more specific. The mother lost custody because she left the children in a motel with another relative who had no means to care for them. The children's relative had to call police to have the children taken care of.

The children have had a horrible life, Jane said. So she decided to step in. She is a widow and decided it would be best for the children.

"I just could not see them go into the (foster care) system," Jane said.

In motel living, the children didn't know where their next meal would come from. They never were given boundaries and depended mainly on the charity of churches. They would curse, scream and throw horrible tantrums. Jane didn't know how to effectively address the behaviors, so she asked for help and got it.

Jane and her new family have successfully completed Multisystemic Therapy. MST, offered through Touchstone Behavioral Health in Flagstaff, offers training to parents to help them cope with troubled youth with extreme behaviors.

MST FOCUSES ON FAMILIES

MST, according to information from Touchstone, focuses on helping families monitor and discipline troubled children by coming into the home, the school and the community to offer treatment. Families are referred to the program through the Regional Behavioral Health Authorities, the Arizona Department of Economic Security, juvenile court systems and school systems.

Bryon Matsuda, director of Coconino County Juvenile Court Services, lauded the MST services provided by Touchstone.

"Those services are used for our Juvenile Court families who need a higher level of intensity of family work," Matsuda said.

He said the model is a good one where the therapist actually works with parents and youth in the home and are available on call any time. Therapists are often in the home two or three times a week, he added.

MST has been statistically proved to be effective, Matsuda said.

Juvenile court has a contract through the Administrative Office of the Courts and The Guidance Center to acquire MST services from Touchstone. The court typically attempts to use money from the Arizona Health Care Cost Containment System instead of using state or county law enforcement funds to make "limited treatment dollars stretch," Matsuda said.

The therapists work with probation officers, families and the youth in collaboration.

NEEDING HELP

"We needed so much help in the beginning," Jane said.

Tera Ess, MST clinical supervisor at Touchstone, said the game plan initially with Jane and the children was to address the behavior of the oldest, and by doing so, the younger children would follow by example.

Before MST, the oldest boy's tantrums would be met by screaming by her, Jane said. The screaming matches would upset the entire household. The tantrums would last more than two hours sometimes.

Ess said the boy initially had the "power" at Jane's home because adults in his past weren't knowledgeable of parenting and lacked giving the children any structure.

The first order of business, Ess said, was to take the boy's anger and divert it — through time-outs, or disciplinary actions like writing a sentence 100 times. For instance, "I will not say bad words."

"They hate to write," Jane said laughing. "But they don't have to much anymore."

If the children improve over a one- or two-week time frame, they get a gift — a movie, or ice cream. Jane said.

"So they know I appreciate it," Jane said, adding that any extra effort the children make beyond what has been established as their responsibilities is met with high praise — something she wasn't used to doing.

"It's just given me a lot of good parenting techniques of the past year," Jane said of the MST work with Touchstone. "I've learned some pretty awesome parenting skills."

By working in tandem with the therapists and getting on the same page with discipline, improvement gradually became apparent and a normal living structure could be incorporated into the children's lives, Ess said.

The children have chores. They're to bed by 8:30 p.m., and they wear their pajamas to bed instead of whatever is available or whatever they wore that day.

"Now they keep their beds made and they use them like they're supposed to," Jane said.

THE PROCESS

Ess and the other two therapists who work for Touchstone begin their work with families by conducting a 10-day assessment. They find out who is in the home, what the relationships are and what the behaviors are and why they are happening. They then prescribe a course of treatment that is continually being evaluated and fine tunes.

The process is called "finding the fit," Ess said.

"It's the nuts and bolts of what we do," she added.

First, the therapist helps find the target behavior. For instance, Ess said if a mother with two teens on probation feels "exhausted" from her daily routine, the mother won't be able to adequately monitor the teens.

So, Ess sits down with the mother and comes up with interventions to change the target behavior to engage the mother more in the teens' lives and improvement.

Ess discovered the mother had multiple appointments to keep with the two teens, she has other children who need appointments, she cleans the house, the family only has one car and the husband wants time with her as well.

In order to help the mother make her life more manageable, Ess helped her create a weekly schedule, posted on the refrigerator. The schedule helped the mother know where the children need to be, who would be monitoring them and how to prioritize multiple daily tasks for the one-vehicle household.

The fit process is made with all members of the household and is updated each week to determine what activities are working to advance positive behaviors and remove barriers to advancement, Ess said.

"We have a very clear picture every week, and we share that with our families," Ess said. As behaviors improve, goals are changed and amended. And all interventions are appropriate for the age and development of the children.

"It's not a cookie-cutter program, by far," Ess said.

Ess said the sure sign of success is when the targeted behavior of the child has not been demonstrated in a 30-day period.

Families are set up with a "sustainability plan" that helps the family sustain the child's pro-social behavior when probationers, the court system and other controls are not in place. Families also receive a discharge plan at the time the MST treatment is complete, Ess said.

GRADUALLY IMPROVING

The Guidance Center offers counseling to the children, Jane said.

Academically, the children are still behind. The oldest is in fourth grade at 12 years old. Before Jane, if he didn't want to go to school, he wasn't made to by his mother. One study of the boy's academic life showed he missed about 50 percent of his schooling, Jane said. He's in an Individual Education Plan and now exhibits behaviors considered "normal" in school.

But Ess said that because of Jane's dedication to the children's schooling, they are improving and slowly making their way back to appropriate grade level.

Jane bought a home for her and the four children, and she is in the process of adopting the children. The mother's parental rights have been severed, although the children still see their mother. In fact, they see their mother more frequently than before as she tries to begin gaining the skills needed to become a better parent, Jane said.

For more information on Touchstone Behavioral Health or the MST therapy, visit www.touchstonebh.org.

Larry Hendricks can be reached at 556-2262 or lhendricks@azdailysun.com.

By the numbers

Touchstone Behavioral Health Services Multisystemic Therapy services

Began in Flagstaff in 2004

Total youth served: 99

Total open cases: 9 (capacity 12, for 40 to 50 a year).

Of youth served:

- 73 percent completed Multisystemic Therapy treatment

- Average length of stay: 110 days

- Average cost: $5,000 to $7,000 (through Arizona Health Care Cost Containment System)

- 82 percent of parents have skills for future

- 82 percent of families have improved relations

- 70 percent of youth living at home at time of discharge

- 72 percent of youth now working at time of discharge

- 67 percent of youth have no new arrests.

— Source: Touchstone Behavioral Health Services.

What is Multisystemic Therapy?

MST is an "evidence-based" treatment approach where therapists come to families to provide treatment, according to information from MST Services, the South Carolina-based company that trains therapists in the MST discipline.

The philosophy of MST is that the most effective way to help a family with a child with problem behaviors is through the family.

Families with children who have behavioral problems — substance abuse, physical or verbal aggression, associating with peers who have a negative influence, running away, etc. — are referred to MST therapy from a number of agencies.

Danielle M. Gutowski, MST program manager for Touchstone, said the therapists are trained in a very specific methodology on how to deliver the treatment. The therapists are constantly monitored and counseled on how not to deviate from the treatment model. The treatment model and gathering of data allows for a very clear picture of whether the treatment regimen is working and what can be done to advance improvement.

Therapists have between four and six clients at any given time, Gutowski said. The treatment regimen lasts between three and six months and has an average cost of $5,000 to $7,000.

The majority of the clients in MST, because they qualify, have the cost of the service paid by the Arizona Health Care Cost Containment System.

According to information from the Washington State Institute for Public Policy, for every dollar spent on MST treatment, communities can experience a savings of more than $5 by preventing "out-of-home" placement in a treatment or correctional facility as well as reducing future need for prison beds and lower crime rates.