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Multisystemic Therapy for Child Abuse and Neglect

Multisystemic Therapy for Child Abuse and Neglect

Evidence rating
3
Cost rating
5
Review: September 2017

Note on provider involvement: This provider has agreed to EIF’s terms of reference, and the assessment has been conducted and published with the full cooperation of the programme provider.

Multi-systemic 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 6 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.

EIF Programme Assessment

Evidence rating
3

Multisystemic Therapy for Child Abuse and Neglect has evidence of a short-term positive impact on child outcomes from at least one rigorous evaluation.

What does the evidence rating mean?

Level 3 indicates evidence of efficacy. This means the programme can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome.

This programme does not receive a rating of 4 as it has not yet replicated its results in another rigorously conducted study, where at least one study indicates long-term impacts, and at least one uses measures independent of study participants. 

Cost rating
5

A rating of 5 indicates that a programme has a high cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of more than £2,000.

Child outcomes

According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:

Supporting children's mental health and wellbeing

based on
1.43 point improvement on the Administrative data from the Child Protective Services
Improvement index: +21
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 71% and worse outcomes than 29% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later
0.25 point improvement on the Trauma Symptom Checklist for Children
Improvement index: +25
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 75% and worse outcomes than 25% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later
based on
0.94 point improvement on the Trauma Symptom Checklist for Children
Improvement index: +27
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 77% and worse outcomes than 23% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later
based on
2.13 point improvement on The Child Behaviour Checklist (parent report)
Improvement index: +26
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 76% and worse outcomes than 24% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later

Preventing child maltreatment

based on
0.18 point improvement on the Conflict Tactic Scale (child report)
Improvement index: +31
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 81% and worse outcomes than 19% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later
0.04 point improvement on the Conflict Tactic Scale (parent report)
Improvement index: +11
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 61% and worse outcomes than 39% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later
based on
0.03 point improvement on the Conflict Tactic Scale (child report)
Improvement index: +8
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 58% and worse outcomes than 42% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later
based on
0.02 point improvement on the Conflict Tactic Scale (child report)
Improvement index: +6
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 56% and worse outcomes than 44% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later
based on
0.34 point improvement on the Conflict Tactic Scale (child report)
Improvement index: +21
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 71% and worse outcomes than 29% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later
0.15 point improvement on the Conflict Tactic Scale (parent report)
Improvement index: +22
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 72% and worse outcomes than 28% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later
based on
0.02 point improvement on the Conflict Tactic Scale (child report)
Improvement index: +8
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 58% and worse outcomes than 42% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later
0.04 point improvement on the Conflict Tactic Scale (parent report)
Improvement index: +22
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 72% and worse outcomes than 28% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later
based on
0.18 point improvement on the administrative data from the Child Protective Services
Improvement index: +8
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 58% and worse outcomes than 42% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later

Preventing crime, violence and antisocial behaviour

based on
3.50 point improvement on The Child Behaviour Checklist (parent report)
Improvement index: +30
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 80% and worse outcomes than 20% of their peers, if they had received the intervention.
Between the end of the intervention and 10 months later

This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.

Multisystemic Therapy for Child Abuse and Neglect

Key programme characteristics

Who is it for?

The best available evidence for this programme relates to the following age-groups:

  • Primary school
  • Preadolescents
  • Adolescents

How is it delivered?

The best available evidence for this programme relates to implementation through these delivery models:

  • Individual

Where is it delivered?

The best available evidence for this programme relates to its implementation in these settings:

  • Out-patient health setting

How is it targeted?

The best available evidence for this programme relates to its implementation as:

  • Targeted indicated

Where has it been implemented?

Australia, Netherlands, Norway, United Kingdom, United States

UK provision

This programme has been implemented in the UK.

UK evaluation

This programme’s best evidence does not include evaluation conducted in the UK.

Spotlight sets

EIF does not currently include this programme within any Spotlight set.

Multisystemic Therapy for Child Abuse and Neglect

About the programme

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 (eg 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?
  • The practitioner who delivers this programme is an MST-CAN therapist with QCF-6 level qualifications. 
What are the training requirements?
  • Practitioners have 104 total hours of programme training. Booster training of practitioners is recommended.
How are the practitioners supervised?
  • It is recommended that practitioners are supervised by one host-agency supervisors (qualified to QCF-7/8 level), with 120 hours of programme training. 
  • It is recommended that practitioners are supervised by one programme developer supervisors (qualified to QCF-7/8 level).
What are the systems for maintaining fidelity?

Programme fidelity is maintained through the following processes:

  • Training manual
  • Other printed material
  • Other online material
  • Video or DVD training
  • Face-to-face training
  • Fidelity monitoring.
Is there a licensing requirement?

Yes, there is a licence required to run this programme.

How does it work? (Theory of Change)

How does it work?
  • 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.
Intended outcomes

Preventing child maltreatment

Contact details

Multisystemic Therapy for Child Abuse and Neglect

About the evidence

The most rigorous evidence for MST-CAN comes from an RCT, which was conducted in the USA. This is a rigorously conducted (level 3) study, which has identified a statistically significant positive impact on a number of child and parent outcomes. A programme receives the same rating as its most robust study, and so MST-CAN receives a level 3 rating overall. 

Study 1

Citation: Swenson et al., 2010
Design: RCT
Country: United States
Sample: 90 parent-child dyads in families with a child between the ages of 6-17
Timing: Baseline; 2 months post-baseline; 4 months post-baseline; 10 months post-baseline; 16 months post-baseline
Child outcomes: Reduced symptoms of child PTSD
Reduced child dissociative symptoms
Reduced internalising symptoms
Reduced neglect
Reduced psychological aggression
Reduced minor assault
Reduced severe assault
Reduced non-violent discipline
Increased placement stability
Reduced total problem behaviours
Other outcomes: Reduced psychological distress
Improved social support
Reduced violent parenting behaviours
Study rating: 3

Swenson, C. C., Schaeffer, C. M., Henggeler, S. W., Faldowski, R., & Mayhew, A. M. (2010). Multisystemic Therapy for Child Abuse and Neglect: a randomized effectiveness trial. Journal of Family Psychology, 24(4), 497.

Available at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928578/

Study Design and Sample 

The first study is a rigorously conducted RCT. 

This study involved random assignment of 90 children to a MST-CAN group (n=45), or Enhanced outpatient treatment (n=45).

This study was conducted in the USA (Charleston, South Carolina), with a sample of families who were known to child protection services. Families were eligible if there was a reported incident of abuse or neglect in the past 90 days and they had a child between the ages of 10 and 17 years.

Measures

Participants completed a battery of validated parent and child measures at baseline (pre-treatment) and then 2, 4, 10, and 16 months post-baseline:

  • Youth behavioural and emotional functioning was measured using The Child Behaviour Checklist (CBCL) (parent report), the Trauma Symptom Checklist for Children (TSCC) (child self-report), and the Social Skills Rating System (child self-report).
  • Psychiatric distress in parents was measured using the Global Severity Index (GSI) of the Brief Symptom Inventory (parent-report).
  • The number of psychiatric symptoms was measured using the BSI Positive Symptom Total Scale (PST) (parent report).
  • Parenting behaviour was measured using the Conflict Tactics Scale (CTS) (parent and child repot).
  • Social Support for the parents was measured using the 40-item Interpersonal Support Evaluation List (ISEL).
  • Maltreatment (re-abuse) and youth out-of-home placement was measured using data obtained from CPS records. Re-abuse was defined as a new report of abuse of the target child, abuse of any child by the target parent. With regards to out-of-home placements; this referred to whether children were placed, for how many days they were placed, and whether there were any placement changes.

Findings

This study identified statistically significant positive impact on a number of child and parent outcomes. This includes:

  • Reduced internalising behaviour (CBCL),
  • Reduced total behaviours (CBCL),
  • Reduced PTSD (CBCL, TSCC),
  • Reduced dissociative symptoms (TSCC).
  • Reduced neglect (parent and child report),
  • Reduced psychological aggression (child report),
  • Reduced minor assault (child report),
  • Reduced severe assault (parent and child report),
  • Reduced non-violent discipline (parent and child report). 
  • Improved parental psychiatric distress (GSI),
  • Improved social support.
More Less about study 1

Other studies

The following studies were identified for this programme but did not count towards the programme's overall evidence rating. A programme receives the same rating as its most robust study or studies.

Brunk, M. A., Henggeler, S. W., & Whelan, J. P. (1987). Comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect. Journal of Consulting and Clinical Psychology, 55(2), 171-178. http://dx.doi.org/10.1037/0022-006X.55.2.171 - This reference refers to a randomised control trial, conducted in the USA.

Schaeffer, C.M., Swenson, C.C., Tuerk, E.H., & Henggeler, S.W. (2013). Comprehensive treatment for co-occuring child maltreatment and parental substance abuse: Outcomes from a 24-month pilot study of the MST-Building Stronger Families programme. Child abuse & neglect, 37(8), 596-607 - This reference refers to a pre-post study, conducted in the USA.

Swenson, C.C., Schaeffer, C.M., Tuerk, E.H., Henggeler, S.W., Tuten, M., Panzarella, P., Lau, C., Remmele, L., Foley, T., Cannata, E., & Albert Guillorn, A. 2009. Adapting Multisystemic Therapy for Co-Occurring Child Maltreatment and Parental Substance Abuse: The Building Stronger Families Project.

Stallman, H.M., Walmsley, K.E., Bor, W., Collerson, M.E., Swenson, C.C., McDermott., B. 2010. New directions in treatment of child physical abuse and neglect in Australia: MST CAN: A case study - This reference refers to a case study design, conducted in Australia.

Published April 2024

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