Multisystemic Therapy (MST) A family and systems approach to supporting young people. Central and North West London NHS Foundation Trust

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1 1 Multisystemic Therapy Team (MST) Child and Adolecent Mental Health Services Central and North West London NHS Foundation Trust Multisystemic Therapy (MST) A family and systems approach to supporting young people

2 We felt that MST was extremely supportive to this family and did make massive changes to the family as a whole. [The Therapist] kept us informed at all times and was very polite and constructive. The School

3 Multisystemic Therapy Team (MST) 3 Overview Multisystemic Therapy (MST) is an intensive way of working with families when they are struggling to manage the behaviour of their child. It is aimed at the parents/carers of young people who are in secondary school aged where: There is current involvement with Children and Families Services and/or the Youth Offending Team (YOT) The offending and/or anti-social behaviour of the young person is putting them at risk of being placed out of the home into care or custody The young person has received a short period of care as a result of their anti-social behaviour, and their care plan includes rehabilitation home. MST provides practical guidance to families using cognitive, behavioural and family therapy models of psychology. The caregiver is provided with strategies for effectively managing their child s problematic behaviours and for engaging effectively with their key systems such as school and other agencies. The aim of MST s work with families is to keep families together. MST is not appropriate when the young person: Has a care plan that involves living independently, such as in a children s home, foster placement or other placement that is not a family home Is actively psychotic or displays homicidal or suicidal ideation Has committed sexual offences Has a pervasive developmental delay such as autism or Asperger s Syndrome. Or where: Existing agency involvement would interfere with MST (i.e. a custodial sentence is highly likely prior to completion of the three to five month programme) The care plan states that permanent care outside the family is essential.

4 wider society family school and local community influences thoughts and behaviours influences factors emotional values, b eliefs, skills etc.organic internal factors school policies, availability of mentors, support services etc. family values, norms, expectations etc. external factors culture, media, global economic conditions etc.

5 Multisystemic Therapy Team (MST) 5 Benefits A single, dedicated practitioner will work directly with the family and the professional network helping to coordinate the plan of work. MST will meet with family members, agencies and other key supports to set clear goals for the work. MST will help the parent/caregiver understand and work with the entire world of the young person. This includes the home, their extended family, their school life, their friends, their local area, as well as their interactions in cyberspace. MST aims to help parents understand their child s world and to develop strategies to make effective changes across the different aspects of their life. Support is available from the MST Team 24 hours a day, seven days a week at times of crisis. The MST Team will work with the family, offering present-focused cognitive, behavioural and family therapy interventions in the home or community. Sessions offered to families are at times that suit them, such as in the evenings, before or after work or on weekends. All sessions take place in the family home. MST focuses on goals, strengths and barriers to monitor progress weekly throughout treatment. The MST Team provided hope, support, guidance and practical techniques to help me with my teenager. I wish I d received this type of help sooner.

6 6 Multisystemic Therapy Team (MST) Outcomes Evidence shows that MST can help: Keep families together Reduce anti-social behaviour and re-offending Improve school attendance and educational attainment Improve relationships between young person and parents Increase positive social behaviours with positive peer groups. There are 30 places a year for year olds at risk of being placed out of home, in care or custody, or who can be successfully rehabilitated back into the family home, following short periods of care. I have found the experience of working with MST to be very beneficial to the family. They helped develop the strengths of the family and implement new strategies that the family could use. It was a different approach to working with the family that worked well. It is a very practical intervention and the improvements can be seen within the family home. Social worker

7 Multisystemic Therapy Team (MST) 7

8 8 Multisystemic Therapy Team (MST) Case study *Michael was referred to MST by YOT when he was 15 years old. At this time he was subject to a referral order for stabbing a young woman and there were concerns about his anti-social behaviour in the community (loitering and unruly behaviour) which was placing his family s housing tenancy at risk. There were also concerns regarding aggression at home and at school. Michael s parents reported that he was having regular physical fights with his 17 year old brother (who was also known to the YOT). There had also been a number of aggressive incidents at school ranging from throwing furniture to assaulting students and members of staff, which had resulted in three school exclusions. At the start of the work with MST, Michael was not in any form of education. MST helped to turn Michael s life around. The team worked with Michael s family to reduce his aggression at home and in the community; ensure he was in full time education; prevent further offending in the community and support the successful completion of his YOT order. His MST worker placed control over his behaviour back in the hands of his parents and helped the family to find a parenting approach that was effective in managing Michael s behaviour. This completely changed the family dynamics within the home so that there was less conflict between the parents, between the siblings and between the parents and Michael, which significantly reduced the aggression within the home. The parents were also supported in devising and implementing rules and boundaries around Michael s coming home time and reducing the opportunities for him to spend time with anti-social peers. Work with the family also focused on finding an appropriate college course for Michael and improving the homeeducation placement link so that they could be very much involved in their son s education and progress. Michael s parents supported him to return to education and also worked to think about potential setbacks and how they would deal with these. The family and the MST worker put together a safety plan to reduce his access to knives and to check for them on his person on a regular basis. Michael was also brought into sessions so that his preconceptions

9 Multisystemic Therapy Team (MST) 9 about personal safety could be challenged. His parents were provided with strategies to increase Michael s problem solving skills and help him to devise ways to de-escalate his behaviour and make safer choices in the future. By the end of MST, Michael successfully completed his YOT order with no further arrests. Aggressive incidents had significantly reduced within the home with no reports of aggression in the community. Michael also successfully obtained a full time place on an Information and Technology course within a mainstream college. He was also acting as a mentor for younger children. As a result of the improvements the family s tenancy was no longer at risk and the parents reported a happier, calmer home environment. *Please note the name used in this case study has been changed to protect the identity of the service user. We are not afraid of getting our hands dirty : we will be there when your child is being aggressive, we will be in your home to help you think about how to manage this behaviour now and when it happens again. We know how bad things can get before they get better. We want to support you in helping your son or daughter s behaviour improve. We know this act of being there and getting through the worst of it means so much to families. MST therapist

10 10 Multisystemic Therapy referral Team (MST) process Social worker/yot worker discusses referral with team manager. Telephone call to MST Team by referrer (Social Care or YOT) Submit MST referral form to Suitable Not suitable Case presented at appropriate care/ resource panel (LBHF, RBKC or WCC) Services as usual MST intervention agreed MST intervention not agreed MST supervisor/ therapist arrange date for panel agree alternative intervention joint home visit with referrer to obtain written consent from family. Consent: The MST therapist meets with professional network to agree how they will be involved and review work. Work begins with family. Care/resource panel agree alternative intervention No consent. MST Supervisor writes to referrer and panel * Access is fortnightly. Where an urgent decision is required the chair of the appropriate panel should be contacted

11 Multisystemic Therapy Team (MST) 11 The team not only helped the family to improve their relationship and prevented their son coming into care but also worked brilliantly with the rest of the professional network, and improved the family s relationship with professionals. Withouth MST involved, the family would likely have disenaged from all professionals.

12 Referrals If you are aware of a family who might benefit from MST, please contact the MST Team Supervisor for an informal discussion around referrals at any time. mstsupervisor.cnwl@nhs.net Multisystemic Therapy Team (MST) Malton Road Hub 2-4 Malton Road London W10 5UP Tel: Web: Malton Road Ladbroke Grove Westway A40 St. Marks Rd Bramley Rd Kingsdown Close Latimer Road (Hammersmith and City) Central and North West London NHS Foundation Trust August _JUNE2014