Usability

Core Components

Multisystemic Therapy (MST) is an evidence-based, family and community intervention delivered to young people (10-17years) and their families with social, emotional and behavioural problems, who are at risk of out of home placement and other serious negative outcomes, for example school exclusion.   The primary goal of this intensive, multi-faceted intervention is to end the repetitive pattern of problem behaviour by helping young people remain safely in school and home, and out of conflict with the law. At its core, MST focuses mainly on enhancing family functioning, with improvements expected to translate to other systems in which the young person is embedded (including peer relationships, school and community).  

MST incorporates an MST analytic process and nine treatment principles. The MST treatment model/ analytic process facilitates individualised ‘fit’ assessments and enables the provision of individualised intervention processes which address the range of risk factors that drive adolescent antisocial/problem behaviours. The individualised ‘fit’ assessment identifies current problems, assesses the role of these problems in the context of the young person’s multiple systems, and provides guidance to the treatment process.

The change-process is driven by caregivers; hence MST therapists work with parents/caregivers to strengthen their capacity to address family needs for the purpose of achieving long-term success. Key MST aims include empowering parents(s)/caregivers with strategies to manage behaviours in young people; promoting commitment to education; increasing participation in positive activities (for parent/ carer and young people); reducing antisocial behaviours; bettering family relationships; and managing existing, underlying problems like substance use and mental health difficulties.

MST targets young people’s substance use through engaging caregivers, helping them identify signs of use, improving caregivers discipline strategies, reducing access to substances, changing the young person’s peer and community ecology and increasing supervision and monitoring at home, in the community and in school. MST also works to increase the young person’s attendance and engagement with education and pro-social activities and implements individual cognitive and behavioural intervention to alter core beliefs where necessary and increase peer refusal skills.

Where substance use is assessed as being particularly prevalent and problematic, therapists can also implement Contingency Management (CM), a compatible and standalone evidenced based intervention. Components of CM can be utilised, or it can be delivered whole cloth.

MST is delivered by MST therapists to young people and their families. It is delivered over three to five months, in multiple weekly sessions (offered daily or up to three times weekly) that last about 50 - 120 minutes. MST therapists make themselves available to young people and their families all day (24 hours a day) and all week (seven days a week) throughout the period of therapy via an MST on-call system. This means families can access support whenever it is needed.

Fidelity

Fidelity to the MST model is provided through a Quality Assurance/Quality Improvement Process.

• Training and ongoing support (initial orientation training, quarterly team booster training, weekly expert consultation, weekly supervision and frequent team and individual development planning)
• Organisational support for MST programmes
• Implementation monitoring (measures adherence and outcomes, work sample reviews*)
• Regular programme impact and implementation evaluations.

*Throughout treatment, several clearly defined adherence measures are tracked. The primary caregiver of the family reports how well the MST Therapist is adhering to MST’s treatment principles. In addition, the therapists on the MST team report how well the Supervisor, and Consultant are adhering to the treatment model using the Therapist Adherence Measure (TAM) which can be found at https://msti.org/tam. Model fidelity is critically important as research demonstrates that proper adherence and supervision results in improvements in youth outcomes (1)

MST providers use a website (MSTI.org) to track case level outcome data. At the time of discharge. MST measures three ultimate outcomes for each youth receiving treatment: 1) is the youth at home 2) is the youth in school or working and 3) was the youth arrested during MST treatment. Teams are also able to collect follow up data through the UK database.

Modifiable Components

In addition to the standard MST, adaptions for different populations have been developed to extend beyond working with young people with antisocial behaviour some of these adaptions are:

1) MST for Child Abuse and Neglect (MST-CAN) for families of children (aged 6-12 years) experiencing physical abuse and/or neglect; 2) MST-Building Stronger Families (MST-BSF) a programme for families experiencing child maltreatment and serious parent substance misuse 3) MST Family Integrated Transitions (MST-FIT) to facilitate successful reunification and home return of young people (11-17 years) who are in out of home placements; and 4) MST Problem Sexual Behaviour (MST -PSB) for young people (aged 10-18 years) who have sexually offended/ assaulted a family member.

Throughout 2020/2021, MST continued to provide treatment to young people and their families and quickly adapted to online and blended delivery. All workforce training and support was adapted to online delivery and outcome measures and evaluations evidenced the continued successful implementation of MST. Many key learning points have been gained throughout this process, including the potential to deliver MST to remote, rural communities.

MST is being delivered across a number of continents, including North and South America, Europe and Australasia. Within Europe teams are implementing MST in Belgium, England, France, Germany, Iceland, Ireland, Netherlands, Norway, Scotland, Sweden, Switzerland and Wales.