1. Multi Systemic Therapy
Overview
Breaking the cycle of problematic behaviour
by keeping young people at home, in school and out of trouble

2. Overview
What is MST?
How does MST work in practice?
MST Newcastle

3. What is MST?
Community-based, intensive, family driven approach for young people who are at risk of custody or being placed into Local Authority Care due to their OWN behaviour.
The MST ‘client’ is the entire ecology of the young person: family, peers, school, local community.
Focus is on empowering the caregivers to solve current and future problems.

4. Ultimate MST Outcomes
To keep families together when the young person is at risk of entering care or custody.
For the young person to be engaged in education / training.
For there to be a reduction in antisocial behaviour and charges brought against the young person.

5. Instrumental Outcomes
Improved parenting skills
Improved family relations
Improved access to supports
Success in education and training
Improved involvement with pro social peers and activities
Changes sustained for 3-4 weeks

6. Theoretical underpinnings
Social Ecological approach
Young people live in a social ecology of interconnected systems.
Behaviour is influenced across a number of different systems.
In order to change behaviour we need to target factors at an individual, family, school, peer and community level.
Based on social ecological theory of Uri Bronfenbrenner;
Children and YP live in a social ecology of interconnected system that impact their behaviours inn direct and indirect ways. These influences act in both directions

7. Social Ecological Model

8. MST theory of change Key MST assumptions;
Children’s behaviour is strongly influenced by their families, friends and communities
Families and communities are central and essential partners and collaborators in MST treatment
Caregivers and parents want the best for their children
Families can live successfully without formal services
Professional treatment providers should be accountable for achieving outcomes

9. Research led models of intervention
We bring together some intensively researched and evidence based interventions to enable families to build on their strengths and resources to make changes:
Structural Family Therapy
Strategic Family Therapy
Behavioural Parent Training
Cognitive Behavioural Therapy

10. Evidence Base Strong research base showing that MST is effective
Evidence shows that MST is successful as it;
Targets the known causes of problematic behaviours; family and peer relations, school and community factors
Is family driven and takes place at home
Providers are accountable for outcomes
Continuous quality improvement occurs at all levels
Transportability study;
45 MST programmes in 12 states and Canada, 453 clinicians, 1979 YP
1 year post treatment reductions in YP’s probelmatic behaviours and functioning
Over 2 year post treatment reductions in criminal activity
Increased worker adherence to the model results in improved outcomes; more significant decreases in criminal activity and arrest rates

11. How Does MST work in Practice?

12. How does it work in practice?
Single worker working intensively with 4 to 6 families at a time.
Negotiate outcomes with the family and key participants.
Work is done in the home, school and local community.
24 hour / 7 days a week team availability: ‘on call’ system.
Typical intervention lasts 3-5 months.
MST worker will take the lead on delivering interventions to address referral behaviours. What does this mean in practice?

13. MST workers work primarily with parents to help them:
Increase their parenting skills
Improve family relations
Involve the young person with more pro social peers and activities
Improve school attendance
Create family support networks

14. Core elements of MST MST treatment principles MST analytical process
MST quality assurance system
Quality assurance system includes weekly group supervision and consultation with an MST expert; ongoing training; monitoring of sessions via field visits and tape Recording; feedback from professionals to improve performance; feedback from families re their experiences of MST
QA; weekly group supervision, weekly consultation, families feedback on workers, workers feedback on manager, all feedback on consultant

15. MST Principles 1. Find the fit 2. Positive and strength focussed
3. Increased responsibility
4. Present focussed, action oriented, well defined
5. Targeting sequences
6. Developmentally appropriate
7. Continuous effort
8. Evaluation and accountability
9. Generalisation
Principles used in developing intervention and carrying out interventions. Guide us in every aspect

17. Finding the Fit; Sample Fit circle

18. MST Newcastle

19. Why Newcastle?
Newcastle has a high number of young people being placed in Local Authority Care for short periods of time, suggesting that they may not need to enter care at all if an appropriate family intervention can be provided.
Research has shown MST to:
Reduce re-arrest rates by up to 70%
Reduce out-of-home placements by up to 64%

20. Referral Criteria
Young Person must be aged between 12 and 17 years (or 11yrs if in year 7)
AND
The young person must be at risk of entering care or custody due to THEIR OWN problematic behaviour, such as offending and substance misuse.

21. Exclusionary criteria
Young people living independently or already in care or custody or for whom a caregiver can’t be located.
Young people who mainly present with a serious mental health problem or developmental disorder, e.g. Autism.
Young people who mainly present with concerns around suicide, homicide or psychotic behaviour.
When the concern is mainly around the behaviour of the parent rather than the young person.

22. Typical referral behaviours
Verbal and physical aggression at home/ school/ community
Low/ no school attendance
Offending behaviour
Drug and alcohol use
Association with anti-social peers
Missing behaviours
Poor family relations

23. Newcastle to date Started taking referrals in May 2012
Worked with 39 families so far
Closed 32 families
27 cases closed due to successfully addressing referral behaviours,
2 cases discharged due to Team’s inability to sustain engagement
2 YP accommodated,
1 YP moved out of area

24. Ultimate Outcomes: May 2012 to May 2013 for 32 Closed Cases
Percentage of YP living at home = 90.9% (30 out of 32 YP)
Percentage of YP in school or working = 81.8% (26 out of 32 YP)
Percentage of YP with no new charges during MST = 66.7% (21 out of 32 YP)

25. Instrumental Outcomes: May 2012 to May 2013 for 32 Closed Cases
Percentage of families with parenting skills necessary to handle future problems = 78.8% (25 out of 32 families)
Percentage of families with improved family relations = 78.8% (25 out of 32 families)
Percentage of families with improved network of supports = 66.7% (21 out of 32 families)
Percentage of YP with success in education or training = 78.8% (25 out of 32 families)

26. Instrumental Outcomes: May 2012 to May 2013 for 32 Closed Cases
Percentage of YP involved with pro social peers/activities = 48.5 (15 out of 32 young people)
Percentage of cases where positive change has been sustained = 78.8% (25 out of 32 families)
All Outcomes are based on families self reporting and worker assessment

27. Some feedback on MST Newcastle From Families
Our worker never gave up on our moods and she had ideas about resolving each problem
Very determined to help the family as much as they could. Very friendly
I am very grateful to have received the service
The call service is great as I really needed this
I would like to say thank you to MST, especially my worker. She has made my relationship with my son better
How is MST different?;
The intense 3 days a week contact and phone contact the whole time

28. Newcastle’s MST Team Supervisor: Sarah Ritson
Abby Waites (Maternity Leave)
MST Team:
Ashley Robson
Philip Sammut- Smith
Warren Petitjean
New Worker hired but not yet in post

29. For more information… Visit www.mstservices.com
Telephone:
Cookery Block - Heaton Complex
Trewhitt Road, Heaton
NE6 5DY

30. Any Questions?