Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) is an intensive treatment for families who have recently been reported to Child Protection Services for physically abusing and/or neglecting a child between the ages of six and 17. MST-CAN therapists provide the family with tailored individual and family support and therapy over a six- to nine-month period with the aim of helping parents learn how to parent their child in a way that is not abusive or neglectful.
MST-CAN has initial evidence of reducing parents’ maltreating behaviour and out-of-home placements.
How it works (Theory of change)
- MST-CAN is informed by ecological theory that suggests that child maltreatment is multiply determined by risks occurring at the level of the child, family, school and community.
- MST-CAN therapists help families identify strengths within each ecological level that will help them overcome the risks contributing to the maltreating behaviours.
- Parents also learn strategies that are specific to their identified strengths to overcome the risks they are experiencing.
- In the short term, parent and child behaviours improve; families experience greater cohesion and improved relationships with their child’s schools and wider support systems.
- In the long term, the risk of child maltreatment decreases, children are at less risk of behavioural problems, and there is less likelihood that the child will need to go into care.
What happens during delivery?
How is it delivered?
- MST-CAN is delivered by a therapist individually to families in their homes.
- Therapists are available 24/7 to the family and carry a caseload of three to four families at a time.
- Therapy sessions typically last between 50 minutes and two hours.
- The frequency of the sessions vary depending on the needs of the family and the stage of the treatment, typically ranging from three days a week to daily. Therapists work with individual families for an average of six to nine months.
What happens during the intervention?
- The MST-CAN therapist works closely with his or her MST-CAN expert, supervisor and family to find a good ‘fit’ between the family’s issues and tailored strategies. This includes identifying barriers to the success of the programme (e.g. parental substance misuse or mental health problems) and developing methods for removing these barriers.
- A key aim of the intervention is to help families assume greater responsibility for their behaviours and actively work to resolve serious family issues.
What are the implementation requirements?
Who can deliver it?
- Practitioners should ideally have a QCF Level 7 or 8, although in some cases a Level 6 may be sufficient.
- Therapists can be from a variety of professional backgrounds such as social work, probation, clinical psychology and systemic family therapy.
- However, MST-CAN therapists should have an understanding of child development and family violence and have skills in engaging families reluctant to participate.
- MST-CAN therapists should also have experience in crisis intervention where homicidal or suicidal risk is present and have knowledge of the Child Protection system.
What are the training requirements?
- All MST-CAN personnel must attend the five day core MST training course where they learn the theoretical principles underpinning MST, methods for delivering the programme and opportunities to receive feedback through role play.
- Once initial training is completed, all MST-CAN personnel must attend four additional training days covering principles specific to the MST-CAN version of the programme.
- All MST-CAN personnel must then attend an additional four day training course covering issues involved in trauma treatment.
- Training continues once MST-CAN personnel start to work with families. This training includes weekly telephone consultations with the MST-CAN expert and quarterly one-and-a-half-day booster training sessions.
How are the practitioners supervised?
Supervision is provided on multiple levels:
- The MST-CAN team meets weekly with the onsite MST-CAN supervisor.
- Site supervisors attend two additional days of MST training and supervisor workshops.
- The MST-CAN team discusses their cases with an MST-CAN expert once a week by phone to obtain additional feedback and direction as needed.
What are the systems for maintaining fidelity?
Programme fidelity is maintained through MST’s Quality Assurance/Quality Improvement (QA/AI) system, which includes the following components:
- Manuals for therapists, supervisors, consultants and organisations
- Training and quarterly booster training for therapists, crisis caseworkers and supervisors
- Weekly consultation (via phone) with the trainer/MST expert assigned to the team/programme
- Onsite clinical supervision for therapists and the crisis caseworkers
- Expert consultation for therapists, crisis caseworkers and supervisors
- Programme development and support for the organisation operating the MST-CAN programme
- Validated measures of implementation adherence for therapists, supervisors and consultants
- A web-based implementation tracking and feedback system provided through the MST Institute
- Bi-annual Programme Implementation reviews to assess programme fidelity and drift across a number of clinical, operational, organisational and system-level processes.
Projected Costs and Benefits
This information is not yet available.
MST-CAN has initial evidence of reducing the risks of child maltreatment and the need for going into care from a single randomised controlled trial.
Swenson, C.C., Schaeffer, C.M., Henggeler, S.W., Faldowski, R., & Mayhew, A. (2010). Multisystemic therapy for child abuse and neglect: A randomized effectiveness trial. Journal of Family Psychology, 24 , 497 – 507.
- Improvements in young people’s mental health problems (child self-reports)
- Improvements in parents’ mental health problems (parent self-reports)
- Improvements in parenting practices (parent self-report)
- Reductions in abusive and neglectful parenting behaviours (parent self-report)
- Increases in families’ natural support networks (parent self-report)
- Reductions in out-of-home placements (social service records).