Guidebook

Multisystemic Therapy (MST)

Multisystemic Therapy (MST) is for families of young people between the ages of 12 to 17 who have exhibited serious antisocial and delinquent behaviour. MST therapists provide the young person and their parents with individual and family therapy over a four to six month period with the aim of doing ‘whatever it takes’ to improve the family’s functioning and the young person’s behaviour.

MST has established evidence of improving family functioning and reducing youth offending and out-of-home placements.

Please click here to download a PDF version of full programme description

How it works (Theory of change)

  • MST is informed by ecological theory that assumes that a young person’s behavioural problems are multi-determined by risks that occur at the level of the child, family, school and community.
  • MST- therapists help families identify strengths within each ecological level that will help them overcome the risks that contribute to the child’s behavioural problems.
  • Families also develop strategies specific to their risks to improve family functioning and reduce behavioural problems.
  • Parenting behaviours improve, family communication improves, the family’s links to external support improves, the young person’s behaviour improves and his or her relationship to the school and community improves.
  • Improvements in schools, reductions in offending rates and a reduced need to go into prison or out-of-home care.

What happens during delivery?

How is it delivered?

  • MST is delivered by a therapist individually to families in their homes.
  • Therapists are available to the family 24/7 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 four to six months.

 

What happens during the intervention?

  • The MST model views the parents as the primary agents of change. Each family’s treatment plan therefore includes a variety of strategies to improve the parents’ effectiveness and the quality of their relationship with their child.
  • It is essential that these strategies ‘fit’ with each family’s unique set of strengths and weaknesses. A key aim of the therapy is determine this fit by identifying strategies that ‘work’.
  • A second aim of the intervention is to help families assume greater responsibility for their behaviours and generate solutions for solving their family problems.

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, clinical psychology and systemic family therapy.

  • MST therapists should have experience of working with challenging families and willing to adopt a flexible approach.

 

What are the training requirements?

  • All MST personnel should 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.
  • Training continues once therapists start to work with families. This training includes weekly telephone consultations with the MST consultant and quarterly one-and-a-half-day booster training sessions.

 

How are the practitioners supervised?

  • The MST team meets weekly with the onsite MST supervisor.
  • Site supervisors attend two additional days of MST training and Advisor Supervisor workshops.
  • The MST team discusses their cases with an MST expert consultant 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 and supervisors
  • Weekly consultation (via phone) with the trainer/MST Expert assigned to the team/programme
  • Onsite clinical supervision for therapists
  • Expert consultation for therapists and supervisors
  • Programme development and support for the organisation operating the MST 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

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Evidence

MST has established short and long term evidence of improving family functioning, decreasing antisocial behaviour and reoffending rates, the need for imprisonment and the need for out-of-home care from over 20 international studies. Three are described here:

 

Butler, S., Baruch, G., Hickey, N., & Fonagy, P. (2011). A randomized controlled trial of multisystemic therapy and a statutory  therapeutic intervention for young offenders. Journal of the American Academy of Child & Adolescent Psychiatry, 50, 1 220 – 1235.

  • Reduced offending and antisocial behaviour (parent and young person reported)
  • Reduction in nonviolent offenses (police reported).

 

Ogden, T.H., Kristine Amlund (2006). Multisystemic Treatment of Serious Behaviour Problems in Youth: Sustainability of Effectiveness Two Years after Intake. Child and Adolescent Mental Health, 11, 142 – 149.

  • Reduced criminal activity (parent report)
  • Reduced out-of-home placement (parent report)
  • Reduced externalizing and internalizing symptoms (adolescent self-report)
  • Improved family functioning (parent report)
  • Improved mental wellbeing (adolescent self-report).

 

Sawyer, A.M. and Borduin, C.M. (2011). Effects of Multi-systemic Therapy through midlife: A 9-year follow-up to a randomized clinical trial with serious and violent juvenile offenders. Journal of Consulting and Clinical Psychology, 79, 643 – 652.

  • Reductions in felonies (re-offending rates)
  • Reductions in misdemeanours (re-offending rates)
  • Reductions in family civil suits (court records).
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