Nicola Hornsby Programme Manager MST Fife Carole Murphy Programme Manager MST Edinburgh 5 th November 2015 What is Multisystemic Therapy Community based family driven intervention to address antisocial and offending behaviour in 1217 year olds ID: 461849
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Slide1
Multisystemic Therapy: A Scottish Perspective
Nicola Hornsby, Programme Manager MST Fife
Carole Murphy, Programme Manager MST Edinburgh
5
th
November 2015Slide2
What is Multisystemic Therapy?
Community based, family driven intervention to address antisocial and offending behaviour in 12-17 year olds
Addresses risk factors across multiple systems and builds protective factors
Interventions are goal-orientated, problem-focused, and evidence-based e.g. behaviour therapy, cognitive behavioural therapy, pragmatic family therapies or parent management trainingSlide3
What is Multisystemic Therapy?
Short-term (3-5 months) but intensive intervention
24/7 on-call service
Weekly group supervision and consultation
Continuous quality improvement - individual, team and service levelSlide4
Why we chose Multisystemic Therapy?
MST offered aspects not already offered by existing local services
Meets key service priorities of reducing out of home placements
Successful implementation and outcomes elsewhere in UK
High levels of technical assistance for implementation
Robust evidence base
Cost effectiveness dataSlide5
MST Research Evidence
RCT’s by
programme
developers in US
e.g.
Borduin
(1999) - some criticisms
Littell
et al (2005)
Long term RCT follow up
–
e.g.
Sawyer &
Borduin
, 2011, 22
yrs
post MST 75% fewer violent arrests
Independent RCT’s in the US
e.g.
Timmons-Mitchell et al 2006
Independent RCT’s in Europe
(e.g. Norway -
Ogden & Hagen, 2006, Ogden and Halliday-Boykins (2004)
UK RCT
(Butler, Baruch, Hickey, &
Fonagy
, 2011) Compared MST directly with the use of Youth Offending Service statutory interventions. In the last 6 months of the study only 8% in the MST group against 34% in the YOS group had one or more further non- violent convictions Slide6
Independent support for the utility of MST
Blueprints EBP database rating of ‘Model Plus’
Recognised by United Nations Office on Drugs and Crime (2010)
Multimodal interventions, for example MST, are recommended in NICE guidelines for antisocial behaviour and conduct disorder (2013)Slide7
Cost effectiveness: UK studies
Every pound spent
on MST produces a return of £1.77
(Social Research Unit)
Costing report on implementation of NICE guidance indicates MST to be cost effective in the UK.Slide8
MST
Scotland
Year MST started: 2009 (2 teams), 2011 (1 further team), 2013 (2 further teams added)
Fife, Glasgow and Edinburgh outcomes combined (5 teams):
604 families (cases closed to date)
87% completed the intervention
89% youth at home
75% youth in school/working
65% youth no further charges
Slide9
Evidence linking CSE and Antisocial Behaviours
Ary
et al 1999, longitudinal study evidence for shared developmental pathway for antisocial behaviour, high risk sexual behaviour, academic failure and substance misuse
High family conflict and low positive family relationships led to poor parental monitoring 1 year later and the formation of a negative peer group, at 2 year follow up adolescents had developed the range of problems listed above
Similar risk factors identified in Barnardo’s studies (2006, 2014)Slide10
Using MST as Part of a Multiagency Approach to Reduce Risk of CSE
Young people do not always perceive themselves as exploited
Working systemically is a powerful way to address multiple risk factors quickly
Needs a “dual approach” alongside investigation and information sharing to pursue perpetrators prosecution
If families are provided with adequate support to reduce family conflict, improve relationships and monitoring and supervision and increase involvement in school/decrease association with antisocial peers then risk of CSE is reducedSlide11
Typical Pattern of Referral Behaviours for 12- 14 Year Olds
Going missing:
police reports for missing episodes
Verbal aggression at home:
can occur daily. Abusive towards parents when questioned about coming home late and going to school. Breakdown in parent/child relationship has resulted in parents demanding that child be taken into care
Alcohol use:
hospital admissions x 2 as a result of alcohol use
Posting naked images online:
reports has experienced cyberbullying from school peers as a result
Coming Home Late:
every night. Associating with an older peer group in local park
Non School Attendance:
frequent truancy including period truancySlide12
Top Clinical Concern: Going
Missing
“Pull and push” factors
Going Missing
Young person anxious about attending school: absconds to avoid school
No incentive to come home on time ( more rewarding to be out)
Mum
does not know what to do to
get her home. Mum has given up. Easier at home when child not in house – less conflict
No clear curfew : Mum negotiating with child about when she can stay out until
contacts
her Mum, while missing, thus Mum does not
reporting her
missing or take other action
Hanging around with unknown peers on local park who have late/no curfews
Antisocial influence contact her by text/online to encourage her out
It’s exciting to stay out
has money every day to go out from Mum
w
ants to make friends
School HolidaysSlide13
Example
Interventions
DRIVER
INTERVENTION
1.Mum does not know what to do to get
young person home
Safety
plan
: included supervision
and monitoring steps, 4W’s, check in’s. Identify additional family/friends support for Mum.
2.Hanging around with unknown peers on local park who have late/no curfews
Peer work:
obtaining contact details, encouraging pro-social relationships, getting to know peer group and parents, target “safe” houses,
3.
Antisocial influences contact girl online to tempt her out
Educate
Mum re supervision and monitoring on line. Restrict access and clear rules use. Submit IRD. Liaison with CPT and PPU
4. No incentive to come home on time (more rewarding to be out)
Increasing “pull” factors back home. Teach Mum communication & de-escalation skills.
Positive discipline strategies. Plan shared time together. Identify barriers to improving family relationships
5. Anxious about attending school: absconds to avoid school
Identifying appropriate school placement and supporting
back into education. Building links with
support staff in Education. Supporting positive home/school links and communicationSlide14
Continuous Review
Risk factors and interventions are reviewed on a weekly basis in order to give the family the necessary level of support required to successfully implement interventions
i.e. not a “one off plan” but weekly review and development of interventions in order to overcome barriers to successSlide15
Key messages from Practice
Introducing EBP’s into local service delivery can be an effective way of meeting service priorities
BUT:
Delivering expected outcomes requires organisational support and understanding of the programme
Clearly identify where the programme sits within a continuum of intervention/an effective referral pathway is essential
Local support networks are important. MSTUK Network Partnership, Scottish MST ConsultantSlide16
References
Blueprints for Healthy Youth Development:
http://blueprintsprograms.com
NICE guidelines CG158 (March 2013): Antisocial behaviour and conduct disorders in children and young people: recognition, intervention and management.
http://pathways.nice.org.uk/pathways/antisocial-behaviour-and-conduct-disorders-in-children-and-young-people
Antisocial behaviour and conduct disorders in children and young people: Costing Report – Implementing NICE guidance.
http://www.nice.org.uk/guidance/cg158/resources/cg158-conduct-disorders-in-children-and-young-people-costing-report2Slide17
References
United Nations Office on Drugs and Crime (2010): Compilation of Evidence-Based Family Skills Training Programmes.
http://www.unodc.org/docs/youthnet/compilation/10-50018 Ebook.pdf
Social Research Unit (2012b).
Investing in Children:
Youth Justice
1.1
.
Dartington
: SRU.