As Texans continue to mourn with the families and the community of Uvalde, the Texas House has examined the circumstances surrounding this horrific tragedy and identified steps that can be taken to better ensure that senseless acts of violence never occur in our state again. 

Meanwhile, the Texas Legislature is making significant investments in the state’s mental health system – having increased funding by more than 34% since 2015. As such, Texas is building a robust mental health infrastructure which can be leveraged to address gaps in the system.  At this moment, we have an opportunity to ensure that Texas children and adolescents have access to intense home-based services that can not only identify and address mental health issues before they escalate into a crisis but also introduce effective, family-centered interventions for high-risk youth and families. 

Multisystemic Therapy

During the summer of 2022, through Executive Action, seven Local Mental Health Authorities (LMHAs) across Texas received funding to implement Multisystemic Therapy (MST), a widely known and highly-effective home-based service, to youth and families identified as high-risk.  At present,  there are an estimated 20,000 children and youth (ages 6 to 17) in Texas who are at very high risk for out-of-home placement because of their mental health needs. It is estimated that, of these 20,000, approximately 7,000 Texas youth and their families meet MST enrollment criteria and would benefit from MST services.

Using rigorous review standards, MST is rated a “Well-Supported”  evidence-based program that empowers parents and caregivers of youth (aged 12 to 17) to regain control of out-of-control youth behavior and to help them function responsibly over the long term. Over 40 years of research on the model shows that MST reduces delinquent and antisocial behavior by addressing the core causes of such conduct.

Therapists have small caseloads and provide services in the homes at times convenient to the family. The average length of treatment is between three and five months, and therapists and provider agencies are held accountable for achieving change and positive outcomes.

EBA helps visionary leaders implement evidence-based programs using effective strategies to achieve socially significant impacts.  To help child-serving agencies achieve greater impact in delivering meaningful social services, EBA provides implementation support quality assurance and project management services that foster the success of proven interventions and programs.  Since 2004, EBA has been actively helping states and other public systems address high risk youth and families of serious system consequences such as child removal or incarceration (i.e., in the juvenile or criminal justice systems) within numerous jurisdictions including the District of Columbia; the Commonwealth of Virginia; and the City of New York; and the states of Florida, Georgia, Louisiana, Texas, and Washington.

Since conception of the MST project in Texas, EBA remains as an ongoing director in overseeing all aspects of MST implementation with pre-implementation support through all efforts related to MST Workforce Development specific to the statewide project.  EBA has assisted seven funded Texas teams across the state with hiring and recruitment of licensed therapists to fill open MST positions within each local mental health authority.  EBA continues to provide ongoing support to MST program support staff, MST model experts, and the MST Institute, by assisting each LMHA with program development and collaboration with local stakeholders.  EBA operates under the philosophy of doing ‘whatever it takes’ to increase communication, fidelity of the MST model, establish and monitor data collection, and analysis in collaboration with MSTS.

Related News

Texas Annual Report 10.30.2023

MST Texas Project- Quarterly Report March 2024 - May 2024 Final

Quarterly Report December 2023 - February 2024 (final).docx

Quarterly Report September - November 1.12.24 Final

Specialized Therapy Team Launches in Texas Counties

Specialized Therapy Team Launches in Hays County

New Therapy Program in Comal County

PermiaCare implements new therapy for at-risk youth in Midland and Ector counties - Odessa American (oaoa.com)


Evidence-Based Associates is currently working with seven MST Teams across the state of Texas.  Testimonials of working with EBA are as follows:

Hill Country: It’s been such a pleasure working alongside the EBA team. They have made what initially felt like a daunting and overwhelming process feel so much more manageable, organized, and fluid. They are supportive, responsive, and are ALWAYS solution focused – shoutout Deidra and Elaine for always showing out and showing up

 Bluebonnet:  EBA has been wonderful to work with and has played an integral part in building our MST Program. Both Elaine and Deidra have been extremely helpful and supportive in the hiring process. Elaine’s thorough phone screening procedure has helped us find quality candidates in an organized, efficient way. The EBA team has consistently provided open and consistent communication while treating everyone with the upmost respect and kindness.  

Denton:  Since I have been working with both Deidra and Elaine, I have very much appreciated their efficiency and humanistic presentation. They seem very sincere and willing to help our new team by doing “whatever it takes.”

Life Path Systems:  “EBA, has been a great experience to work with. The regular communication has provided not only accountability but also a smooth process in developing our program. EBA has provided that extra support and consistent guidance to help meet program needs and expectations.”

Frequently Asked Questions

* - Subject to change, last updated Jan 2024

What is MST?

Multisystemic Therapy (MST) is an evidence-based intervention for youth at high risk of severe system consequences due to serious anti-social and/or delinquent behaviors. Youth and families receive support within their communities via a full team of licensed MST providers. Central to the MST treatment approach is the view that the MST “client” includes not only the youth, but also the multiple systems within which the youth is embedded: immediate and extended family, peers, schools, neighborhood, providers, and other key participants. MST teams provide immediate support to families when and where it is needed—within any combination of these systems—and are dedicated to improving youth and family functioning. See full description of services under “Additional Information”.

MST Service's role in the MST Texas Project

The MST Services team preserves the integrity of the treatment model, thereby ensuring the best possible outcomes for the youth and families treated. MST Services maintains licensing agreements with all MST provider organizations, provides training and quality assurance procedures, in addition to leadership and support in program start-up/expansion, program adherence, program development, and adherent implementation of MST to have accountability for program outcomes. In Texas, MST Services employs three (3) experts and two (2) program developers, whose roles and functions are described above.

Where do MST services take place?

Services take place in the home, school, and community of the youth and their family. Local Mental Health Authorities (LMHAs) providing MST services include but are not limited to the following counties: Comal, Hays, Uvalde, Denton, Lubbock, Collin, Ellis, Guadalupe, Caldwell, Gonzales, and Hidalgo. See HHSC LMHA site map under “Additional Information”. Local Mental Health Authority Service Areas (texas.gov)

Who can make a referral?

Referrals can be made from a wide range of sources that come into direct contact with the child or youth including social workers, case managers, probation officers, community-based mental health providers as well as parents, legal guardians, foster parents, or other caregivers.

What does MST cost?

For the programs funded through HHSC, services are free for families who are referred to and enroll in the MST program.

What are the parameters for youth referral and involvement in MST?

The target population to receive MST services includes youth between 12-17* years of age at risk of serious system consequence due to serious externalizing, anti-social, and/or delinquent behaviors
*Exceptions for youth ages 10, 11, or 18 can be requested

Example Behaviors include:
• Theft and other criminal behaviors
• Aggressive/violent/assaultive behavior
• Substance abuse
• Selling substances
• Chronic school absences and/or problem behaviors at school
• Sexual offenses in conjunction with other anti-social behavior

Examples of Serious System Consequences include:
• Out-of-home placement (e.g., via juvenile justice mental health, youth care, or social care)
• Arrest and/or charges
• Violation of probation
• School expulsion
• Child Welfare involvement

Note also:
• Youth might present with diagnoses including, but not limited to Conduct Disorder, Oppositional Defiant Disorder, Substance Use Disorders, and/or ADHD
• Youth might also present with co-occurring needs in conjunction with anti-social behaviors
o e.g., trauma-related symptoms, depression, anxiety, mild or moderate intellectual disability, autism spectrum disorder level 1/childhood autism based on mild difficulties

Exclusionary criteria
• Youth living independently.
• Youth who engage in sex offending in the absence of other anti-social behavior
• Youth with moderate to severe autism (difficulties with social communication, social interaction, and repetitive behaviors)
• Youth who are actively homicidal, suicidal, or psychotic
Youth whose psychiatric problems are primary reason leading to referral, or who have severe and serious psychiatric problems.

How long do services last?

The average length of treatment for MST is 3 to 5 months. MST program discharge criteria, however, are based on achievement of goals set by the family and the MST team (i.e., are outcome-based rather than duration-focused).

What credentials are needed to become an MST Therapist?

MST professionals are Master’s-prepared (clinical degreed) professionals. The minimum license requirements to become an MST Therapist in Texas are: LPC-A, LPC, LCSW, and LMFT. An MST professional working actively under the supervision of LMSW may also be considered.

Are bilingual services available?

Yes! Each LMHA providing MST services has or is pending hire of a Spanish-speaking MST professional. In the event additional bilingual services are needed, each LMHA is equipped with access to obtain an interpreter.

What level of family involvement is required to participate in the MST program?

MST engages families by doing ‘whatever it takes’ and anticipates active participation by the primary caregiver(s) and other family members. The MST staff should contact the youth and family according to the frequency with which is necessary to achieve targeted weekly goals. Therapists are expected to go to great lengths to engage hard to reach families/caregivers and are trained to work and collaborate with families/caregivers who may have had previous involvement in the JJ system and/or other treatment services.

Where can I learn more about MST?
Are Qualified Mental Health Professionals eligible for hire?

Yes!  Master’s level QMHP’s are eligible for hire in Texas.  Bachelor’s level QMHP’s may also be considered.

What steps should I take to become a licensed mental health professional in Texas?

General steps to become a mental health professional in Texas are as follows:

  1. Complete a bachelor’s degree in a behavioral, social science, or psychology field.
  2. Earn a master’s degree in mental health counseling.
  3. Complete graduate and postgraduate internship experience for certification/licensure requirements.
  4. Pass any required counseling exams for licensure.
Where can I learn more about MST job openings?

Deidra Ewing
Project Director, Texas Project

Deidra Ewing is the Project Director for the Texas Project. She is the ongoing point person for EBA's goal of ensuring quality services to MST programs in Texas. She is a proud graduate of Sam Houston State University and Prairie View A&M University. Her professional career includes 17+ years of advocacy for at risk youth and families within the Harris County Juvenile Probation Department. Deidra's experience includes years of court, field, family therapy, sub-acute hospitalization facilitation, program management, supervisory leadership, authorship, and has been recognized in the Houston community as one of Houston's Women History Makers.

Lisa McCarthy
HR Recruiter

McCarthy has spent the last 15 years developing and overseeing national recruitment strategies for a variety of businesses, including healthcare and non-profit. She is currently a Senior Recruiter with EBA. She has a background in nursing, possesses several qualifications in sourcing and recruiting, and is a thought leader in the field of talent acquisition.