Re-offending in troubled and aggressive young people can be significantly cut using a pioneering new mental health approach known as Multisystemic Therapy (full briefing at bottom of page), a UK conference was told. Reporting on the initial findings of the first UK evaluation pilot, researchers found in families with multiple problems that the use of Multisystemic Therapy or MST reduced the risk of re-offending, particularly among boys. The research was led by Dr Geoffrey Baruch, director of the Brandon Centre in Camden, North London and Dr Stephen Butler and his team from UCL (University College London).They found that lower re-offending behaviour was evident two years down the line compared to existing service approaches, and can be cost effective, because young people are kept out of custody or local authority care, and parents are encouraged to use the voluntary sector and local supports instead.
The approach, approved by NICE
(National Institute for Clinical Excellence) has been trialed across 10 sites
in England, having been successful in the USA and is supported jointly by the Department for Education, the Youth Justice Board and Department of
Health. First results of the evaluation at one UK site as well as the US
experience were presented at the conference.
Multisystemic Therapy revolves
around improving parenting capacity, increasing young people's engagement with
education and training, reducing their offending behaviour, and tackling
underlying health or mental health problems, including substance misuse. It is used
with children and young people aged 11-17 years and their families, where young
people are at risk of out of home placement in either care or custody, due to
delinquent and aggressive behaviour, and anti-social attitudes.
Care
Services Minister Paul Burstow said:
"We must do all we can to keep young people out of
the criminal justice system - these findings show encouraging results about how
we might do that.
"The research shows the key role mental
health staff and the voluntary sector can play in work with young people and
their families."
Children's Minister Tim Loughton said:
"We must make sure that young people with complex needs are
getting the help they need to get their lives back on track. Today's conference
is an excellent opportunity for local authorities to learn from each other and
build effective links, so they can develop and sustain programmes such as
MST."
Graham Robb,
Board Member of the Youth Justice Board said:
"The findings
of this evaluation are very encouraging. MST can turn around the lives of
children and families while also making overall savings to the public purse .
The YJB has a strong track record for exploring the potential of pioneering
evidence based programmes, and as such we are really keen to support MST."
Briefing on Multisystemic therapy
1. The government's
commitment to tackling social exclusion was outlined in Reaching Out: An Action Plan on Social Exclusion (September
2006). The action plan contains a
number of specific recommendations focused on young people, including the Early
Intervention in Personality Disorder Programme, which was established in order
to deliver Action 20: ‘The Government
will launch pilots to test different interventions for tackling mental health
problems in childhood, such as ‘Multi-systemic therapy'.... to prevent the onset
of problems later in life.'
In addition, the Care Matters: Time
for Change (2007) White paper identified that funding would be made
available for the development of Multisystemic Therapy (MST) as an effective
specialist intervention for young people on the edge of care.
2. MST is
a licensed and evidence based, community intervention for children and young
people aged 11-17 years and their families, where young people are at risk of
out of home placement in either care or custody and families have not engaged
with other services. The MST
team works with young people and
their families to increase parenting capacity, to increase young people's
engagement with education and training, to promote pro-social activities for
parent and child, to reduce young people's offending behaviour, increase family
cohesion and to tackle underlying
health or mental health problems in the young person or parent, including
substance misuse. Further information on the model and the evidence base is
available at www.mstservices.com
3. DH and Department for Education (DfE)
, in partnership with the YJB have brought these two initiatives together,
to establish ten pilot sites of Multisystemic therapy, with tapered funding
over four years. The main aim of the programme is to reduce numbers of young
people being placed away from home in care, custody or residential schooling.
The ten sites are: Barnsley, LB of Hackney, LB of Greenwich,
LB of Merton and Kingston, Leeds, Peterborough, Plymouth, Reading, Sheffield
and Trafford. All sites are partnerships between the local authority/
Children's Trust (including CAMHS), the PCT and the Youth Offending Service and
also collaborate with adult mental health and substance misuse services. All
sites have now been operational for a year and over 300 families have completed
the 3-5 month programme. Positive outcomes are being reported in terms of
reduced family conflict, reduced offending, reengagement of young people in
education and training, preventing young people coming into care or custody and
reducing the period of time young people remain in care if they have been
accommodated. 90% of families worked with have completed the programme and 89%
of young people are still living at home at the end of the programme.
4. Many
of the sites are looking at how MST fits with other evidence-based
interventions within their authority and using MST as a case example of how to
commission across agencies within the Children's Trust. Two sites are running the
Multi-dimensional Treatment Foster Care programme as well as MST (Reading &
Trafford) and have looked at issues across the pilots, including how to
effectively provide a 24 hour on call service for families & carers. Reading
has also started to include role-play tasks within their social work
interviews, having seen the success of these within the structure fro MST
interviews.
5. These
new sites are building on the experience of MST teams in Cambridgeshire and at
the Brandon Centre in North London, which have been in place for over 5 years.
The Brandon Centre has also been the subject of a research trial. Early
findings from this trial indicate positive outcomes for MST in relation to
reducing young people's offending, including violent offending and improving family relationships.
6. In
order to establish whether MST is an effective intervention for our families
and communities here in England and to test which young people and families it
is most effective for, a national research programme, including a Randomised
Control Trial, has been commissioned to monitor outcomes for young people and
families and the cost-effectiveness of the programme. The research team is led by
Professor Peter Fonagy of UCL. This research trial has been granted national ethical
approval and is now underway in 4 sites, with the
remaining 6 sites joining the trial during 2010.
7.In
addition to the 10 standard MST
sites, Cambridgeshire County Council in partnership with the PCT, has been
funded to set up an MST Child Abuse and Neglect programme which targets
families with children aged 6-17 years, where child physical abuse and/or
neglect is a key feature. This programme was launched in July 2009, is now
fully operational and will run for two further years.
8. DH,
YJB & DfE are also funding one pilot site of MST for Problem Sexual Behaviour
at the Brandon Centre in North London, this programme will target young people with
problem sexual behaviour aged 10-17 years who have committed sexual offences and
run for three years. This service launched in January 2010 and is currently
taking referrals from Youth Offending Teams, Children's services and CAMHS in
five inner London boroughs. Intensive work is undertaken with young people and
their families and aims to maintain the young person safely within the community,
reduce offending, including sexual offending and reduce the need for placement
in care or custody. This programme is based on strong research evidence from
the USA of the effectiveness of MST PSB in reducing both sexual offending and
non-sexual offending in young people and in improving family relationships.
Further information can be found at www.mstpsb.com and www.brandon-centre.org.uk
Case example
Lisa is a 13 yr old white British female who lives
at home with her mother. The family
had Social Care involvement since Lisa
was aged 10 due to mother's substance misuse and Lisa challenging behaviour.
Lisa had previously been in a foster care placement for six months. Local CAMHS
and the police had also been involved with the family
At the time of referral,
Lisa was placing herself at risk of child sexual exploitation due to her
running away and staying out overnight and her association with anti-social
peers and older men. She was also using drugs and alcohol, self -harming, had
poor school attendance and was aggressive to peers and mother. She had also had
a conviction for shoplifting. As a result she was at risk of coming back into
care.
Both Lisa and her
Mum wanted her to remain at home if possible but Mum stated that this could
only happen if Lisa stopped running away and reduced her aggressive behaviour.
MST worked with the family (including extended family members), school and
police to help Mum provide a clearer structure for Lisa and to help Lisa and
Mum to develop strategies to reduce conflict at home.
Following four
months in the programme outcomes were:
Lisa was:
•
Attending
mainstream school full-time (increased from 56% attendance)
•
No
evidence of offending for 4 weeks
•
Not run
away for 14 weeks
•
Living
at home with family
•
No
physical aggression in home or community or self harm
•
Fewer
services involved with the family- YOS, CAMHS, Social Services all ended
involvement
Mother
•
Reduction
of Mum's drug use
•
Increase
in her social supports in the community
At 6 months follow
up, Lisa and Mum had maintained progress in all these areas.
