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Negative Peer Involvement in Multisystemic Therapy
for the Treatment of Youth Problem Behavior:
Exploring Outcome and Process Variables in “RealWorld” Practice
Paul Boxer
a
a
Department of Psychology, Rutgers University
Available online: 24 Oct 2011
To cite this article: Paul Boxer (2011): Negative Peer Involvement in Multisystemic Therapy for the Treatment of Youth
Problem Behavior: Exploring Outcome and Process Variables in “Real-World” Practice, Journal of Clinical Child & Adolescent
Psychology, 40:6, 848-854
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Journal of Clinical Child & Adolescent Psychology, 40(6), 848–854, 2011
Copyright # Taylor & Francis Group, LLC
ISSN: 1537-4416 print=1537-4424 online
DOI: 10.1080/15374416.2011.614583
Negative Peer Involvement in Multisystemic Therapy for the
Treatment of Youth Problem Behavior: Exploring Outcome
and Process Variables in ‘‘Real-World’’ Practice
Paul Boxer
Downloaded by [University of Michigan] at 18:33 24 October 2011
Department of Psychology, Rutgers University
Associating with a negative peer group is related to involvement in problem behavior,
yet very little research has considered the role of negative peer group affiliations in
the context of ‘‘real-world’’ community-based treatments for problem behavior. This
study examined the effects of negative peer involvement on case closure status and treatment characteristics in a large sample (N ¼ 1,341) of adolescents (M age ¼ 15.3 years,
SD ¼ 1.5 years) enrolled in Multisystemic Therapy services. Data were drawn from
the clinical records of a nonprofit youth and family services provider. Findings suggest
that negative peer involvement is significantly related to treatment failure, particularly
when negative peer involvement is comprised of gang affiliation.
Youth problem behaviors emerge as the result of multiple interacting risk factors (Dodge & Pettit, 2003;
Guerra, Williams, Tolan, & Modecki, 2008). Thus the
treatment of youth showing high levels of problem behavior often will be a challenging task with multiple intervention targets. One of the more vexing aspects of
treatment for youth showing high levels of problem
behavior is the role of the peer context in maintaining
problem behavior. Deviant ‘‘peer contagion’’ can interfere with the successful treatment of youth exhibiting
problem behavior (e.g., Dishion, McCord, & Poulin,
1999). Research suggests that associations with antisocial peers can accelerate involvement in juvenile
offending (Elliott & Menard, 1996), and involvement
in violent peer networks (i.e., gangs) can facilitate
engagement in acts of serious violence (Dishion,
Veronneau, & Myers, 2010). Of importance, reports
from controlled studies demonstrate that reductions in
youths’ associations with delinquent or ‘‘bad’’ peers
I acknowledge the support provided for this study by Community
Solutions, Incorporated (CSI), including Susan Pribyson, Prakash
Parikh, Richard Lutz, and Michael Bradley. CSI generously provided
the dataset for analysis and ongoing consultation concerning the
clinical information included therein.
Correspondence should be addressed to Paul Boxer, Department of
Psychology, Rutgers University, 101 Warren Street, Newark NJ 07102.
E-mail: [email protected]
account partially for significant positive effects of treatment on problem behavior (Henggeler, Letourneau,
et al., 2009; Huey, Henggeler, Brondino, & Pickrel,
2000). Yet the role played by deviant peers in the outcomes of youth in routine clinical care has not been
assessed conclusively.
Despite a resurgence in organized gang activity
(Dinkes, Kemp, Baum, & Snyder, 2009; Egley, Howell,
& Moore, 2010), no published studies have documented
the effectiveness of targeted individual treatment for
youth involved in gangs (Parker et al., 2008). This study
considers the effectiveness of Multisystemic Therapy
(Henggeler, Schoenwald, et al., 2009) with respect to serving youth whose problem behavior presentation is
marked by involvement in negative peer groups generally
and=or gangs specifically. Data for this investigation
were obtained from a large, nonprofit clinical services
organization and collected during the course of routine
service provision. Analyses consider the extent to which
identified involvement in negative peer groups, and in
gangs specifically, reduces the likelihood of successful
treatment and=or modifies the delivery of services.
Multisystemic Therapy (MST) is a community-based,
multiple-component intervention strategy for adolescents designed by Henggeler, Schoenwald, and colleagues (2009). MST has been recognized as a ‘‘Model’’
program by the University of Colorado’s Blueprints
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NEGATIVE PEER INVOLVEMENT
for Violence Prevention (see http://www.colorado.edu/
cspv/blueprints/), which has vetted more than 800 different intervention approaches. Per Blueprints criteria
for model programs, which are the most stringent
applied by such evaluative authorities, MST has produced deterrent effects on youth problem behavior as
evidenced through a strong research design (i.e., experimental or quasi-experimental evaluation), sustained
effects to a minimum of 1-year postprogram, and
yielded multisite replication of positive treatment effects.
MST is a multifaceted intervention that bridges multiple
individual practitioners from various community-based
agencies in the service of treating individual youth.
MST results in substantial short-term (Henggeler et al.,
1986) and long-term (up to 13 years; Schaeffer &
Borduin, 2005) reductions in conduct problems and
recidivism.
Since the initial validation and dissemination of the
original MST treatment model, MST has undergone
several adaptations to address youth problem behavior
in the context of other cooccurring behavioral or
environmental concerns, including child maltreatment
(Swenson, Schaeffer, Henggeler, Faldowski, & Mayhew,
2010), substance abuse (Henggeler, Pickrel, & Brondino,
1999), suicidality (Huey et al., 2004), and sexual offending (Henggeler, Letourneau, et al., 2009). Notably,
although MST can target peer group factors (Henggeler,
Schoenwald, et al., 2009), assessments of the effectives
of MST for youth entrenched in or affiliated with negative peer groups have not been put forth. This omission
does not diminish the overall quality of MST as a highly
effective treatment for youth problem behavior generally, but it does represent a potentially fruitful avenue
for inquiry with respect to factors that might inhibit
treatment success.
As previously noted, deviant peer groups can be
problematic in the context of targeted interventions for
problem behavior. Dishion et al. (1999) suggested in
their seminal review that aggregating antisocial youth,
particularly adolescents, in group treatments might produce the iatrogenic effect of increasing problem behaviors in those youth. Although not all studies of
deviant peer influence have yielded negative peer contagion effects (some have shown both positive and negative influence or generally positive influence of deviant
peers; Boxer, Guerra, Huesmann, & Morales, 2005;
Huefner, Handwerk, Ringle, & Field, 2009), negative
peers certainly appear to play a meaningful role in
whether individual youth can make changes for the
better in their positive adjustment.
Further evidence in support of the impact of deviant
peer groups on youth problem behavior has come
directly from MST trials. For example, Huey et al.
(2000) found that reductions over time in affiliation with
delinquent peers were associated with subsequent
849
decreases in delinquent behavior. More recently,
Henggeler, Letourneau, et al. (2009) reported that
decreases in caregiver disapproval of and concern about
their youths’ friends were associated with reductions in
problem behavior and deviant sexual interests and risky
behaviors. It should be emphasized that as part of its
broad set of specific intervention modalities, MST typically will include some effort to intervene directly in the
peer ecology, such as by enrolling youth in prosocial
group activities (e.g., organized sports, after-school
clubs) and rewarding them for sustained involvement
and participation in those activities (Henggeler,
Schoenwald, et al., 2009).
The present study examined the role of negative peer
involvement generally, and gang involvement in particular, for youth receiving MST services. Data for this
study were provided by Community Solutions, Incorporated (CSI), a nonprofit youth and family services
agency that has been providing MST services since
1999 and currently offers MST at numerous sites in
eight different states (see http://www.csi-online.org).
Analyses explored two questions: (a) Does negative peer
involvement, when identified as a key referral issue,
reduce the likelihood of successful treatment? (b) Does
negative peer involvement, in the context of successful
treatment, lead to different treatment strategies on the
part of the therapist? Based on prior research, it was
hypothesized, first, that negative peer involvement
would be associated with a reduced likelihood of successful treatment and, second, that a referral issue of
negative peer involvement would produce treatment
strategies different from the absence of identified negative peer involvement. In regard to the latter hypothesis,
data were not available to yield specific predictions
regarding the nature of those treatment strategy
differences.
METHOD
Participants
Data were obtained from the computerized clinical
records of youth enrolled in services with CSI. All
records were deidentified prior to electronic transmission from the agency. All records represented unique
(no duplicates, no repeats) closed-case files. From an
initial data set containing 2,049 cases, a reduced data
set was created to include only those cases in which (a)
referral information was available (i.e., lists of presenting problems=issues), (b) the target youth was seen on
at least one occasion by an MST therapist, (c) clear reasons for case closure were indicated in the data set, and
(d) full demographic information on participants was
available. This led to a data set containing 1,341 cases,
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850
BOXER
or 65% of the initial data transfer. It should be noted
that the initial data set comprised cases that had been
integrated into the clinical record system after a number
of improvements had been made in case-tracking software and expansions of available data fields. Thus, data
were missing by design and not through record-keeping
errors or case-specific problems. Consistent with typical
MST practice, youth were referred to CSI by a number
of different sources. Of the 1,071 cases (80% of the
analysis sample) for which data on referral source were
available, 32% were referred by probation officials,
24% by court agencies, 22% by social services or child
protection agencies, and the remainder by other agents.
Participants in this study were 927 male (69%) and
414 female (31%) adolescents (M age ¼ 15.3 years,
SD ¼ 1.5 years) of diverse ethnic backgrounds (42%
White=Non-Hispanic, 40% Black=African American,
16% Hispanic=Latino=a, 3% multiracial). As a broad
indicator of socioeconomic status, 36% of participants
(n ¼ 478) were eligible for Medicaid. Arrest data were
available for 1,189 participants. Most participants
(64%, n ¼ 862) had no arrests, 17% (n ¼ 230) had one
prior arrest, 5% had two priors (n ¼ 68), 2% had three
priors (n ¼ 20), and less than 1% had four priors
(n ¼ 7) or five priors (n ¼ 2).
Measures
Three broad classes of treatment characteristics were
examined in this investigation: (a) Outcome (i.e.,
whether the course of MST treatment was determined
to be successful), (b) Process (i.e., how MST therapists
allocated their time in the service of treating youth),
and (c) Referral (i.e., the number and nature of specific
presenting problems recorded by the therapist via initial
consultation with participating families).
Outcome. Outcome was measured by a single indicator reporting a categorical reason for case closure.
Positive closure was indicated by the category of ‘‘completion,’’ meaning that the therapist and family agreed
that treatment goals had been met satisfactorily. Negative case closure was indicated by one of four possible
categories: (a) ‘‘Lack of engagement’’ (therapist unable
to engage or encourage family to commit to treatment,
despite concerted effort), (b) ‘‘New arrest’’ (participant
was arrested and detained due to behavior exhibited
during the course of treatment), (c) ‘‘Placement’’ (participant was removed from home and placed in detention or restrictive residential care due to behavior
exhibited during the course of treatment), and (d) ‘‘Probation revocation’’ (participant was reconfined due to a
probation violation that occurred during the course of
treatment). Other discharge categories not considered
in the present analysis relate to factors beyond the purview of the specific treatment relationship, including a
family’s need to relocate, a loss of funding for the participating family to receive MST, or administrative issues
related to the MST program and not to the participating
family. These cases were not considered in subsequent
analyses because the reasons for discharge are neither
positive nor negative with respect to the MST services
provided.
Process. Data were available describing the nature,
number, and duration of contacts between the therapists
and those with whom they worked in the service of individual cases. Contacts could include individual meetings
with youth clients; separate collateral meetings with
family members, school officials, court officials, and=
or ‘‘other’’ collateral sources (e.g., community members,
neighbors); or combined meetings involving youth along
with family members, school officials, court officials,
and=or ‘‘other’’ collateral sources. It should be noted
that these summary indicators were not completely independent. For example, if a collateral appointment
included family members and school officials, it would
be counted in both categories. Therapist contacts were
indicated as the number of meetings held in each category. In addition to the number of contacts, the total
time of therapist contacts (in minutes) also was included,
and a score representing the average length of contacts
was calculated for analyses (i.e., total time in minutes
divided by total number of contacts).
Referral. Referral problem entries in the clinical
records database were verbatim recordings of families’
presenting complaints at the outset of treatment, or
restatements of those complaints in fairly standard
terms. Given the target population served by MST,
youth typically present with a variety of concerns (e.g.,
intense family conflict, delinquency, substance use, truancy, academic failure). The present study focused on
youths’ involvement in ‘‘negative,’’ antisocial or deviant
peer groups. Thus, two separate variables were created
from the referral issue descriptions entered into clinical
records by therapists. The first variable, negative peer
involvement, included participants who were categorized
as having a presenting problem with negative peer
involvement if their referral description included any
mention of involvement with such peers (1 ¼ any negative peer involvement noted, 0 ¼ no negative peer
involvement noted). Examples included ‘‘associates with
a negative peer group,’’ ‘‘mixed antisocial and prosocial
peers,’’ and ‘‘negative peer involvement.’’ The second
referral variable, gang involvement, was scored separately but also considered a subset of negative peer
involvement generally. Participants were categorized as
NEGATIVE PEER INVOLVEMENT
TABLE 1
Case Closure Status
Case Closure Status
information in clinical records ultimately reflects the
consensus of at least three clinicians. As previously
noted, clinical record data were transmitted to the
author electronically after being deidentified. The
research protocol for this study was determined to
be exempt from review by the human subjects
Institutional Review Board of Rutgers University.
n (%)
Positive
Negative
Lack of Engagement
New Arrest
Placement
Probation Revocation
1,130
211
43
14
148
6
851
(84.3%)
(15.7%)
(3.2%)
(1%)
(11%)
(0.4%)
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RESULTS
having a presenting problem with gang involvement if
their referral description included any mention of gang
membership, association, or activity (1 ¼ any gang
involvement noted, 0 ¼ no gang involvement noted).
Examples included ‘‘gang membership or strong affiliation,’’ ‘‘admits to gang membership,’’ and ‘‘refuses to
ever leave the ______ gang.’’ Gang involvement is a subordinate category of negative peer involvement and
thus also led to a score of 1 for that category. It is
important to clarify that youth positive for negative peer
involvement were not necessarily also positive for gang
involvement.
Procedures
The data included in this study were generated through
the course of regular MST treatment procedures for
intake, intervention, case management, and discharge.
The organization providing the data has been a network
provider of MST since 1998 after full licensing and recognition by MST Services, Inc. Master’s-level therapists
worked under the supervision of highly experienced,
master’s-level clinical supervisors who themselves
received regular supervision from significantly experienced and skilled consultants. Per MST procedures,
Table 1 presents information on detailed case closure
status for the full sample. Age was unrelated to case
closure status, r(1, 341) ¼ ".041, p ¼ .136, but both sex
and ethnicity were significantly related to case closure
status. Boys (18%) were more likely to experience negative case closures than were girls (11%), v2(1) ¼ 9.66,
p ¼ .002. Black participants (20%) and Hispanic=
Latino=a participants (18%) were more likely to experience negative case closures than were White=
Non-Hispanic participants (12%) and multiracial (5%)
participants, v2(3) ¼ 17.69, p ¼ .001. Medicaid clients
(14%) were somewhat less likely to experience negative
case closures than were non-Medicaid clients (17%),
v2(1) ¼ 3.08, p ¼ .079. Number of prior arrests was modestly but significantly related to case closure status; more
prior arrests increased the likelihood of a negative case
closure, r(1189) ¼ ".065, p ¼ .025. Table 2 presents
information on treatment process indicators for the full
sample, divided by case closure status. Generally, negative case-closure status was associated with fewer therapist contacts of most types and less total time spent in
treatment activities.
Table 3 presents information on the referral indicators for the full sample, divided by case closure status.
The rate of negative case closures in the context of negative peer involvement was almost twice the rate of
TABLE 2
Treatment Process Indicators
Positive Case Closurea
Treatment Process Indicator
Total Therapist Contacts
With Youth Only
With Youth þ Collateral
With Family
With School
With Court
With ‘‘Other’’
Time in Treatment (Minutes)
Average Contact Time (Minutes)
Negative Case Closureb
M
SD
Range
M
SD
Range
44.69a
13.01a
17.09a
33.99a
2.64a
2.32a
5.62a
2244.42a
52.55
23.13
17.97
12.80
25.82
4.28
3.85
11.15
1061.76
15.23
2–194
0–132
0–74
0–196
0–37
0–31
0–103
75–8665
7.5–133.3
33.57b
13.23a
9.86b
22.19b
1.29b
2.63a
4.38a
1584.90b
51.62
23.84
21.15
9.74
21.83
2.34
3.95
8.81
1073.80
21.15
1–139
0–132
0–51
0–98
0–13
0–29
0–69
10–5385
5.8–160.5
Note: Means with different subscripts are significantly different at p < .001 per independent-samples Mann–Whitney U test.
a
n ¼ 1,130.
b
n ¼ 211.
852
BOXER
TABLE 3
Referral Indicators
Referral Indicator
Negative Peer Involvement
Yes
No
Gang Involvement
Yes
No
Positive Case
Closurea
Negative Case
Closureb
92 (8.1%)
1,038 (92.9%)
32 (15.2%)
179 (84.8%)
15 (1.3%)
1,115 (98.7%)
9 (4.3%)
202 (95.7%)
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Note: Percentages reflect proportion of total within columns.
a
n ¼ 1,130.
b
n ¼ 211.
positive case closures in the context of negative peer
involvement. The rate of negative case closure in the
absence of negative peer involvement was about 17%,
whereas the rate of negative case closure in the presence
of negative peer involvement was about 26%,
v2(1) ¼ 10.45, p ¼ .001. The rate of negative case closures
in the context of gang involvement was about 3 times the
rate of positive case closures in the context of gang
involvement. The rate of negative case closure in the
absence of gang involvement was about 15%, and this
rate in the presence of gang involvement was about
38%, v2(1) ¼ 8.73, p ¼ .003.
To assess the independence of the role of negative peer
and gang involvement in case closure status, follow-up
analyses were conducted. Negative peer involvement
was unrelated to sex, ethnicity, and Medicaid status (all
chi-square tests nonsignificant, p ¼ .954, .317, and .408,
respectively). However negative peer involvement
was modestly related to prior arrests, r(1, 189) ¼ .061,
p ¼ .036. Similar results were observed for gang
involvement with respect to no relation between this variable and sex (p ¼ .128), ethnicity (p ¼ .107), and Medicaid
status (p ¼ .126), and a modest relation between this variable and prior arrests, r(189) ¼ .050, p ¼ .087.
As a final test of the relative independence of negative
peer involvement and gang involvement in predicting
case closure status, two logistic regression analyses were
computed. The first included negative peer involvement
along with sex, ethnicity (entered as a categorical indicator), and Medicaid status. The second included gang
involvement along with those three variables. Alternative models that also incorporated prior arrests were
examined separately due to their impact on sample size.
As shown in Table 4, negative peer involvement and
gang involvement had significant effects that maintained
beyond the effects of demographic controls. Effects were
robust to the reduction in sample size attendant to the
inclusion of prior arrests as a control variable. Prior
arrests were not significant predictors of case closure,
but negative peer involvement (odds ratio [OR] ¼ .568,
p ¼ .020) and gang involvement (OR ¼ .372, p ¼ .035)
remained significant predictors. Hosmer–Lemeshow
tests for all models were nonsignificant, indicating close
correspondence between the models and the data.
The final set of analyses considered variations in
treatment characteristics. Specifically, we tested whether,
in cases closed successfully, negative peer and=or gang
involvement accounted for differences in the nature or
duration of treatment contacts. Nonparametic tests
(Independent Samples Mann–Whitney U Test) revealed
that therapist strategies differed as the function of negative peer involvement in terms of how they allocated
contacts. With no negative peer involvement, therapists
met with youth clients individually significantly more
often (M ¼ 13.22, SD ¼ 18.02) than in the context of
TABLE 4
Logistic Regression Analyses Predicting Case Closure Status
Predictor
Sex
Ethnicity
Black=African American
Hispanic=Latino=a
Multiracial
Medicaid Status
Negative Peer Involvement
Sex
Ethnicity
Black=African American
Hispanic
Multiracial
Medicaid Status
Gang Involvement
b
SE
Wald
p
OR
OR 95% CI
–.494
.181
7.44
.610
.428–.870
–.614
–.525
.950
.286
–.683
–.483
.173
.223
.741
.165
.225
.181
–.609
–.514
.935
.282
–1.012
.173
.222
.741
.165
.438
16.55
12.54
5.55
1.64
9.20
7.12
16.19
12.33
5.35
1.59
2.90
5.33
.006
.001
.000
.018
.200
.084
.002
.008
.001
.000
.021
.207
.088
.021
.541
.592
2.586
1.331
.505
.617
.385–.760
.382–.916
.605–11.053
.962–1.840
.325–.785
.433–.880
.544
.598
2.548
1.325
.364
.387–.764
.387–.925
.596–10.892
.959–1.832
.154–.858
Note: Sex: Girls ¼ 0, Boys ¼ 1; Medicaid status: No Medicaid ¼ 0, On Medicaid ¼ 1; Negative peer and Gang involvement: 0 ¼ No involvement,
1 ¼ Involvement. Outcome variable: Negative case closure ¼ 0, Positive case closure ¼ 1.
NEGATIVE PEER INVOLVEMENT
Downloaded by [University of Michigan] at 18:33 24 October 2011
negative peer involvement (M ¼ 10.70, SD ¼ 17.40;
p ¼ .010). The reverse was observed for youth plus collateral contacts; therapists held these conjoint meetings
more often in the context of negative peer involvement
(M ¼ 20.18, SD ¼ 12.07) than in the absence of negative
peer involvement (M ¼ 16.81, SD ¼ 12.84; p ¼ .006).
Negative peer involvement also led to more meetings
with court officials (M ¼ 3.62, SD ¼ 4.52) compared
to the absence of negative peer involvement
(M ¼ 2.21, SD ¼ 3.76). With respect to gang involvement, the only significant difference observed was with
respect to therapist meetings with court officials. In
the context of gang involvement, therapists met more
often with court officials (M ¼ 4.33, SD ¼ 4.94) compared to the absence of gang involvement (M ¼ 2.29,
SD ¼ 3.83, p ¼ .042).
DISCUSSION
The findings from this study offer new information to
the field and especially to the arena of evidence-based
practice in the high-risk population of youth exhibiting
serious problem behavior. Negative peer involvement
reduced the likelihood of successful treatment, even in
the context of an established, validated treatment package. Following observations from controlled trials of
MST (Henggeler, Letourneau, et al., 2009; Huey et al.,
2000), perhaps therapists in those cases simply were
unable to reduce youths’ contact with or commitment
to their negative peer groups. Further, it might be that
when negative peer involvement is acknowledged at
treatment initiation as a significant referral issue, this
might be a signal that the youth is particularly
entrenched in negative peer relationships.
Negative peer dynamics might be especially pressing
for youth involved in gang activity. Beyond the more
generalized effects of deviant peer influence, gang
activity is tied to very powerful social relationship
forces. Membership can be spurred and maintained by
youths’ desire to affiliate with close and family-like peer
networks, it is typically tied to neighborhood residence,
and it might result from multigenerational family ties to
specific gangs (Dishion, Nelson, & Yasui, 2005; Rizzo,
2003). Although youth select into gang activity partly
on account of their elevated antisocial tendencies, gang
involvement also sparks significant increases in both
violent and nonviolent antisocial behavior (Barnes,
Beaver, & Miller, 2010). It is important to note that
the base rate in the analysis sample of identified gang
involvement was very low (>2%). This might reflect a
variety of factors including underreporting on the part
of youth and their caregivers or a failure to probe for
gang involvement at treatment intake on the part of
therapists. Then again, the real proportion of
853
gang-involved youth in the population of youth referred
for MST, which can function as an alternative to incarceration, might actually be quite low given perceived
risks to community safety of allowing gang-involved
youth to avoid confinement.
Underscoring the need for additional research, findings presented here suggest that therapists respond to
the presence of negative peer involvement generally by
differentially allocating their meetings with youth individually or with youth and others conjointly. The
present study suggests that individual meetings with
youth are less essential and conjoint meetings more
essential in the presence of negative peer involvement.
Of course, this study relied on peer concerns identified
statically at referral. Therefore, studies utilizing
ongoing, dynamic assessment of negative peer involvement throughout treatment would be important for
understanding the extent to which therapists respond
flexibly to those dynamics in treatment.
Implications for Research, Policy, and Practice
The methodology utilized here highlights the value of
bringing ‘‘real-world’’ clinical data to bear on issues of
relevance to advancing the field. Analyzing data collected during the routine practice of clinical care adds
value to those data and permits the investigation of
issues that arise during everyday practice (Boxer,
2007). Such data are not without their limitations, and
the present study is no exception. Further, and with
particular relevance to MST, it was not possible in this
study to assess the impact of therapist adherence to
the MST treatment model on case outcomes. Therapist
adherence is a fundamental aspect of treatment success
in the MST model and has been highlighted as a critical
factor in the transportability of MST from agency to
agency (Schoenwald, Letourneau, & Halliday-Boykins,
2005). Treatment fidelity more generally is a key issue
when considering the translation of research-based
therapies to community-based systems of care
(Hoagwood, Burns, Kiser, Ringeisen, & Schoenwald,
2001). Future studies considering the role of negative
peer influence during individual treatment for youth
problem behavior should explore whether negative
peer influence poses a challenge to therapists seeking
to maintain treatment fidelity.
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