There are several evidence-based practices that have been shown to be effective for developing multi-level interventions for at-risk youth. Multi-level interventions are important because they address risk and protective factors at different levels, including the individual, family, school, peer, and community levels. Addressing risk factors at multiple levels simultaneously is thought to have a stronger impact on preventing maladaptive outcomes compared to single-level interventions.

One approach that has shown success is multi-systemic therapy (MST). MST aims to promote behavioral change in the youth’s natural environment using a collaborative, team-based approach. MST therapists work with the family and other systems in the youth’s life, such as school, peers, and neighborhood. Therapists provide interventions that empower caretakers with the skills and resources needed to deal effectively with the behavioral problems. MST focuses on addressing influences on antisocial behavior within the youth’s social networks and developing coping strategies. Randomized controlled trials have found MST to be effective at reducing antisocial behavior, substance use, and out-of-home placements compared to usual care.

Another evidence-based multi-level intervention is the Communities That Care (CTC) prevention system. The CTC system involves assessing community risk and protective factors, building collaboration between community members and organizations, and implementing programs and strategies that target modifiable risk factors. Community coalitions develop plans to implement programs across the different levels, such as parent training, social development strategies in schools, and policies in local government/law enforcement. Longitudinal studies have found that communities using the CTC system demonstrate reductions in rates of substance abuse, delinquency, and other problem behaviors compared to control communities.

At the school-level, positive behavior intervention and support (PBIS) is an evidence-based framework for preventing problem behaviors. PBIS involves teaching prosocial expectations across all school settings, using a system of positive reinforcement, and intervening early for students not responding to Tier 1 supports. School staff are trained to define, teach, model, and reinforce appropriate student behaviors. The universal supports are supplemented with more intensive, individualized supports (Tier 2 and 3) for students needing extra help. Numerous studies show PBIS is associated with reductions in office discipline referrals, suspensions, improvements in academic achievement and school climate over time.

Targeting protective factors through mentoring programs is another effective multi-level intervention for youth. Community-based mentoring matches at-risk youth with caring, supportive adults in their communities. High-quality programs provide ongoing training to mentors, structured activities for mentor-mentee matched, and aim to establish long-lasting relationships. Research indicates community-based mentoring programs can improve outcomes such as academic achievement and performance, self-esteem, social competencies and relationships, as well as decrease rates of risky behaviors like violence, substance use and skipping school.

Family-focused interventions are also important as part of multi-level programs. Parent management training aims to teach parents positive reinforcement techniques, effective discipline strategies, and how to help their child develop important social and emotional skills. Improving parenting skills and the parent-child relationship strengthens a protective factor. Multisystemic family therapy similarly addresses risk factors in youth and their families by changing family dynamics and empowering caretakers. Outcome studies demonstrate reduced antisocial behavior, criminal activity, and mental health issues through family-focused interventions.

Developing multi-level interventions by implementing evidence-based programs across individual, family, school, peer and community domains is an effective approach for at-risk youth populations. Addressing multiple risk and protective factors simultaneously through collaborative, team-based strategies has been shown to produce stronger effects than single-level programs alone. Programs should be matched to the specific needs of the population through an assessment process and involve stakeholder engagement at all levels for sustainability.