An internationally recognized treatment aimed at preventing the most troubled juvenile offenders from spiraling into lives of crime has gained traction throughout the country but remains mostly unavailable in South Carolina, the state where it was developed.
Supporters say Multisystemic Therapy, first researched at MUSC beginning in 1992, is more effective and less costly than putting juvenile criminals in traditional programs, which include wilderness camps and group homes.
The treatment, which caters to repeat offenders between the ages of 12 and 17, relies on trained therapists providing intensive guidance to children and their families at their own homes several days a week for up to five months.
Therapists address underlying factors contributing to children's misbehavior, including substance abuse, poverty and domestic violence. They have small caseloads -- usually around five families at once -- and are on call to intervene 24 hours a day.
The program is available in 31 states and a dozen countries and is widely used in North Carolina, Florida, Connecticut and Pennsylvania. A group of Japanese officials recently were trained in Charleston.
But only five counties in South Carolina offer the treatment, and supporters say it remains unavailable in the urban areas that need it most, including Charleston, which is "in dire need of a team," according to the children and family services director of the S.C. Department of Mental Health.
Advocates charge that the state lacks the political will to divert money from traditional programs and is too broke to fund the new treatment otherwise.
"Politicians aren't interested in saving money in a budget 10 years from now," said Marshall Swenson, a program director for the treatment in Mount Pleasant. "They're focused on who's getting re-elected in November. The people who championed the research here in the early '90s are long gone."
State legislators holding the purse strings say no one has publicly advocated spreading the treatment statewide, which is the most likely reason its growth here has halted, they said. Some key legislators, including State Sen. Robert Ford, D-Charleston, who sits on the Senate Committee on Corrections and Penology and the Judiciary Committee, have never even heard of it.
"They've kept it a secret," Ford said. "I don't know about it, and I deal with these issues every day, and MUSC is in my district. If they've got something proven to work, to help raise a young person to be a productive citizen, we need to jump on it. It's better to pay for it now than pay for jail later."
Supporters of Multisystemic Therapy, who include high-ranking officials in the South Carolina Department of Juvenile Justice, the state Department of Mental Health and the U.S. Surgeon General, said the treatment has been scientifically proven to reduce the rates of recidivism among youthful offenders.
They said other programs available in South Carolina for repeat juvenile offenders, including wilderness camps or group homes, have no data proving they are effective, and may even compound children's problems.
Marshall Swenson, vice president of MST Services in Mount Pleasant, a private firm that receives government contracts to train therapists, said delinquents are vulnerable to gangs and become more criminally savvy during long-term stays at camps and group homes.
"If you put a bunch of bad kids together, they will learn from each other," Swenson said. "Judges like camps because they feel it's something positive for the kids. But you're taking them away from their families and putting them with other antisocial kids."
The therapy is different from existing alternative programs because it keeps children in their own homes and their own schools -- the very places that are likely contributing to their misbehavior. Trained therapists require caregivers to confront their own problems and to become more involved in their children's lives.
Therapists, who see one family up to five times a week, accompany parents to school meetings and teach them how to discipline.
"Families are usually skeptical," Swenson said. "Sometimes they would rather get rid of the problem child and have someone else try to fix them at camp. But what happens when camp's over? We're usually the last best chance for setting their kid straight."
Dale Carter, who has helped implement the treatment in North Carolina, said that state started closing group homes in July 2009 because officials there "saw evidence they did more harm than good."
State funds then began to flow toward expanding the therapy program in North Carolina, which now has 52 treatment groups, up from 18 last June, Carter said. "They recognized MST had better long-term outcomes at a lower cost," he said.
"It's a big head scratcher," Carter said. "It originated (at MUSC). People come to South Carolina from around the world for training in MST. It's disappointing to tell people we're not bigger here."
Swenson said his group is "overwhelmed" keeping up with demand for training in other states, where interest and state funding have grown rapidly in recent years. "So few people are interested here where it started," he said. "That's the irony of it all."
In South Carolina, the treatment is funded by Medicaid and the Department of Mental Health and is available in Florence, Greenville, Lexington, Orangeburg and Rock Hill counties. Each team has four therapists and treats about 60 families per year.
The treatment costs $59 per family per day, according to data provided by the state Department of Mental Health.
By comparison, placement in foster care costs between $70 and $142 a day per child; wilderness camps cost an average of $100 a day; group homes cost an average of $177 a day; and secure lock-up costs $300 a day, according to figures provided by the state.
While the treatment lasts up to five months, other placements can be a year or longer, officials said.
Louise Johnson, director of children and family services for the S.C. Department of Mental Health, said she has advocated making the program a statewide approach to dealing with juvenile offenders for four years.
"We can save money by serving those kids in their homes and do a better job of setting them straight," Johnson said. Sending children to group homes and camps "is like throwing money down a black hole," she said.
But expanding MST requires spending money up-front, and securing additional funding is difficult when state agencies already are coping with budget shortfalls, furloughs and hiring and wage freezes, said William Byars, director of the state Department of Juvenile Justice.
Byars, a former family court judge in the 5th Judicial Circuit, said the program saves money over the long-term by keeping children out of expensive residential programs and adult jail and, by training parents, sets a good example for younger siblings.
"I know that MST works," Byars said. "It's a program I would like to do more of. It needs to cover the whole state to be truly successful."
Money is the issue, he said.
"It's a Cadillac program, but we're just trying to keep the car running right now," Byars said. "MST will pay out in the next few years, but what am I going to do in the next few months?"
Byars said he has overseen an effort to expand what he called the "next best option" -- providing children with Department of Juvenile Justice supervision after leaving lock-ups, group homes or camps.
The supervision program, which has been in effect since shortly after Byars took over the department more than seven years ago, has contributed to a nearly 30 percent drop in the caseload for juvenile offenders during that time, he said.
Byars said he hopes MST will become more widespread in the state once the economy rebounds.
"We don't need to rebuild the system back to exactly what was there before budget cuts," he said. "We can rebuild it back better."
Scott Henggeler, the director of the Family Services Research Center at MUSC who began the MST research there in the early 1990s, said beyond the question of funding, barriers to the treatment's spread remain in South Carolina, including public and political support.
"There is not a lot of public sympathy or support for juvenile offenders," Henggeler said. "They don't have a lobbying group. Most people would prefer to see them locked up, but in reality, that can make the situation worse. We must deal with causes of their behavior, but that doesn't sit as well as sending them off to camp. Politicians in general would rather appear tough on crime."
But several influential state legislators said last week they would like to learn more about the treatment in the coming months.
State Sen. President Pro Tempore Glenn McConnell, who is chairman of the Senate Judiciary Committee, said the program's ultimate cost savings is aligned with his intention of "doing more with less."
"We've got to look at the things that work and get rid of the things that don't," McConnell said. "We need programs with measured results and long-term savings."
State Sen. Michael Fair, R-Greenville, who is chairman of the Senate Committee on Corrections and Penology, said he would be interested in hearing testimony from the program's supporters at an October meeting of a separate committee he's on, the Joint Citizens and Legislative Committee on Children.
"It's an ideal topic for us," Fair said. "I'd love for them to address our concerns. I'm all for pursuing it and seeing if money is available. Everything I know about the program is good."