FY25: HFY1: The annual target for youth/young adult completion of the full course of treatment is 60%.  During HFY1, 37% or 3 of 8 youth/young adults discharged from the program completed the full course of treatment.  Clients 61, 62 and 68 completed the full course of treatment. Clients 69, 71, 73, 76 and 79 did not complete treatment. Client 69 did not complete a full course of treatment due to ongoing engagement issues throughout treatment that were compounded by the client being unstably housed, not having access to medication, increased substance use, inconsistent access to a phone.  Ultimately, even after emergency psychiatric supports had been sought out for the client, the client asked to end services. There had been multiple attempts at using the social network members to engage the client, however, outside of the referral source, once the client’s placement was disrupted, and no additional placement was identified, there was limited social network support.  The client often stayed in the homes of people the client had met that same day. This client completed only 25% of the targeted outcomes by program discharge. Client 71 did not complete a full course of treatment and stopped engaging in treatment after the client’s probation case closed. Client 71 did discharge with 75% of target outcomes met. Client 73 did not complete a full course of treatment. Client 73 was a previous client who had not completed a full course of treatment, with unstable housing being a main barrier during the first course of treatment. The client specifically asked their worker to be re-referred, and, after confirming stable housing and communication, it was decided that the client could return to treatment. By the time the client discharged, they had aged out of care and there were no formal supports to help with engagement. The client was inconsistently engaged and struggled with boundaries put in place by the therapist. Per the client’s request, a change of therapist was accommodated with the hope that it would be a better fit, however, the client stopped engaging. Client 73 did discharge with 75% of target outcomes met. Client 76 did not complete treatment due to a restrictive placement with no timeline for a potential court date to determine if client would be released back into the community. The client was minimally engaged throughout treatment. The client entered the program with the referral source having concerns due to the lack of compliance with probation to that point, specifically around curfew. Despite being on GPS monitoring, the client consistently was not home for sessions and eventually, cut off the GPS device and went AWOL until being picked up on new legal charges. Client 79 did not complete a full course of treatment. The client had fluctuating engagement during treatment, but was willing to engage as it was a requirement for probation. The client’s probation case closed, unexpectedly, with the team being unaware of the case closure. At that point, the client ended all involvement with the program.  If # is not within or greater than the target number, please provide a brief explanation:

HYF1: The annual target for youth/young adult completion of the full course of treatment is 60%. During HFY1, 3 of 8 or 37.5% of youth/young adults discharged from the program completed the full course of treatment. Clients 61, 62 and 68 completed the full course of treatment. Clients 69, 71, 73, 76 and 79 did not complete treatment. Client 69 did not complete a full course of treatment due to ongoing engagement issues throughout treatment that were compounded by the client being unstably housed, not having access to medication, increased substance use, inconsistent access to a phone, and ultimately, even after emergency psychiatric supports had been sought out for the client, the client ultimately asked to end services. There had been multiple attempts at using the social network members to engage the client, however, outside of the referral source, once the client’s placement was disrupted, and no additional placement was identified, there was limited social network support, with the client often staying in the homes of people the client had just met as early as the same day. This client completed only 25% of the targeted outcomes by program discharge. Client 71 did not complete a full course of treatment and stopped engaging in treatment after the client’s probation case closed. Client 71 did discharge with 75% of target outcomes met. Client 73 did not complete a full course of treatment. Client 73 was a previous client who had not completed a full course of treatment, with unstable housing being a main barrier during the first course of treatment. The client specifically asked their worker to be re-referred, and, after confirming stable housing and communication, it was decided that the client could come back into the treatment. By the time the client discharged, they had aged out of care and there were no formal supports to help with engagement. The client was inconsistently engaged and struggled with boundaries put in place by the therapist. Per the client’s request, a change of therapist was accommodated with the hope that it would be a better fit, however, the client stopped engaging. Client 73 did discharge with 75% of target outcomes met. Client 76 did not complete treatment due to a restrictive placement with no timeline for a potential court date to determine if client would be released back into the community. The client was minimally engaged throughout treatment. The client entered into the program with the referral source having concerns due to the lack of compliance to probation to that point, specifically around curfew. Despite being on GPS monitoring, the client consistently was not home for sessions and eventually, cut off the GPS device and went AWOL until being picked up, having received new legal charges. Client 79 did not complete a full course of treatment. The client had fluctuating engagement during treatment, but was willing to engage as it was a requirement for probation. The client’s probation case closed, unexpectedly, with the team being unaware of that being the case. The client communicated that they were informed that no longer had to participate with MSTEA as their probation case had closed and the client communicated that they did not to move forward since their DJS case was closed.   

HFY2: The annual target for youth/young adult completion of the full course of treatment is 60%. During HFY2, 3 of 11 or 27% of youth/young adults discharged from the program completed the full course of treatment. Clients 70, 74 and 85 completed the full course of treatment with the majority of their goals fully met and sustainable. Clients 75, 77, 81, 84, 88, 89, 91 and 94 did not complete treatment based on positive outcomes. Client 75 had fluctuating engagement throughout treatment and experienced a few instances of housing instability. The client had made some progress in different areas and identified that the program had been helpful, however, the client was not in a place due to the instability, to feel as if they could continue to commit to the program and its intensity. Despite not being a positive ending, the client had made improvements which is reflected by the fact that the client had 75% of target outcomes met. Client 77 was initially engaged in services, albeit minimally due to not seeing a need for services, however, once their probation case closed, the client’s engagement dropped off where there was little to no communication by the end of treatment. Client 77 did discharge with 75% of target outcomes met. Client 81 was initially engaged, however, after the client was able to transition back to mainstream schooling, after having been in an alternative placement, the client prioritized school that included night school. Despite offering accommodations to the intensity of services, the client reported not being able to focus on both. It was the hope that the client would be willing to meet for a few closing sessions as it was possible the client could have been a successful closing, however, there were some goals that were not able to be confirmed if they were achieved and sustained. As it relates to the target outcomes, however, the client did discharge meeting 100% Of target outcomes. Client 84 was engaged initially in services, but due to a rupture in the therapeutic relationship with the initial therapist and the client requesting a new therapist, the client was transitioned to a new therapist. The client eventually had a rupture in the relationship with the new therapist as well and, despite attempts to mend the relationship, the client was unwilling to continue with services at the time despite treatment goals never having been able to be established. The client did acknowledge that she had noticed improvements in different behavioral health measures and the client was actively enrolled in school, had stable housing and did not have any legal charges at the end of treatment, therefore discharging with 100% of target outcomes met. Client 88 was minimally engaged throughout treatment and went an extended period of not meeting with the therapist after signing on for services. The therapist was able to get some engagement with the support of DJS, however, shortly afterwards, the client was arrested and placed out of the community, but the charges were eventually dropped and he was released. The therapist was never able to get the client fully engaged after this point, despite many efforts of going unannounced and trying to have family support. This was also compounded by the client’s probation case closing, to which the therapist received notice of this late, as the DJS worker was most successful with helping with engagement. Client 88 discharged with 50% of target outcomes met. Client 89 was difficult to engage from the beginning of treatment and only met with the therapist 3 times over the duration of treatment. The client was adamant from the beginning that participation in the program was due to his court order as opposed to wanting to. The therapist made multiple attempts to engage and use DJS and family to help with engagement. The client eventually informed the therapist and the department that he would not engage in any of the programing or probation requirements any longer. With that information the department presented the information to the court and the client was granted an early termination of probation. The team attempted to see if there was a willingness for the client to remain open, the team did not hear anything back from the client and had to close the client. Client 89 discharged with 75% if target outcomes met. Client 91 only remained open for a little over a month before there was an administrative removal from the program. The client presented as a safety risk due to escalating aggressive and threatening behaviors towards the therapist and, due to the client’s housing situation, there was not many avenues for ensure the therapist’s safety when meeting with the client. The client was referred out. The client discharged with 50% of target outcomes met. Client 94 was also in services for about a month before an administrative discharge. The program was not the best fit for the client and, upon further discussion with the consultant, the referral may not have been an appropriate referral for MST-EA services. The client was also participating in FFT at the time of discharge and the family was happy with the improvements they had seen with those services. The client discharged with 100% of target outcomes met.  

Annual:  FY25: The annual target for youth/young adult completion of the full course of treatment is 60%. During the FY25, 6 of 19 or 31.6% of youth/young adults discharged from the program completed the full course of treatment. While the number is lower than the target number, as seen in the explanations of the data above, the majority of cases that did discharge due to non-completion of treatment did so with having met the majority of the target outcomes reported below. In some of these instances, there was not enough evidence, due to lack of engagement, to determine if some of the other outcomes, specifically reduction in behavior health symptoms, were met. 
 

Client 34 did not complete a full course of treatment due to ongoing engagement struggles since the beginning of treatment.  The MST-EA team exhausted efforts to engage the client but ultimately the client was not aligned with continuing services.  While the client did not complete a full course of treatment the client did achieve 75% of the targeted outcomes at program discharge.  The client did not achieve a reduction in behavioral health symptoms largely due to lack of alignment with participating in behavioral health services.

The determination to discharge an EA from MST-EA is based upon evidence of intervention effectiveness as evaluated from multiple perspectives (e.g. EA, social network members, school, probation officer) indicating that:

• a majority of the Overarching Goals for the case have been met and sustained;
• the EA has few significant behavioral health and justice-related problems;
• the EA can effectively manage any recurring problems and functions reasonably well for at least 3 to 4 weeks;
• the EA is making reasonable educational/vocational efforts;
• the EA is involved with prosocial peers and is not involved with, or is minimally involved with problem peers; and
• the therapist and supervisor feel the EA has the knowledge, skills, resources, and support needed to handle subsequent problems.

Discharge from MST-EA may also occur when few of the Overarching Goals have been met, but despite consistent and repeated efforts by the therapist and supervisor to overcome the barriers to further success, the treatment has reached a point of diminishing returns for the additional time invested.

• MD Department of Juvenile Services
• Baltimore County Detention Center
• Baltimore County Court System
• Baltimore County Office of the Public Defender
• Baltimore County Department of Social Services
• Community Solutions, Inc.
• Prologue, Inc.

MST-EA is a manualized treatment that is an adaptation of the evidence-based treatment, Multi-Systemic Therapy (MST). MST-EA treatment targets are achieved by changing how clients function in their natural settings (home, school, community), leveraging the client’s strengths, pulling in positive supports, and developing the client’s skills and resources to overcome barriers to success.  Evidence-based interventions (e.g., cognitive behavioral therapy, behavioral interventions, motivational interviewing, affective education) are used to address treatment needs.

FY25: According to the model, a youth can be discharged for a number of reasons and completing the full course of treatment is just one of the reasons.  Lack of engagement is another example.

(Annual FY): The annual target percentage for youth/young adults completing the full course of treatment is 65%.  During HFY2, a total of 100% or 5 of 5 unduplicated youth/young adults completed the full course of treatment.

MST EA Reasons for Non-Completion of Treatment

1. Moved from Baltimore County
2. Lack of Engagement
3. Placed in detention for event prior to MST EA involvement
4. Placed in detention for event occurring at the very beginning of MST EA involvement

Definitions:

**Client Discharge: 

Discharge Criteria

The determination to discharge an EA from MST-EA is based upon evidence of intervention effectiveness as evaluated from multiple perspectives (e.g. EA, social network members, school, probation officer) indicating that:

• a majority of the Overarching Goals for the case have been met and sustained;
• the EA has few significant behavioral health and justice-related problems;
• the EA can effectively manage any recurring problems and functions reasonably well for at least 3 to 4 weeks;
• the EA is making reasonable educational/vocational efforts;
• the EA is involved with prosocial peers and is not involved with, or is minimally involved with problem peers; and
• the therapist and supervisor feel the EA has the knowledge, skills, resources, and support needed to handle subsequent problems.

Discharge from MST-EA may also occur when few of the Overarching Goals have been met, but despite consistent and repeated efforts by the therapist and supervisor to overcome the barriers to further success, the treatment has reached a point of diminishing returns for the additional time invested.