Multisystemic Therapy (MST) Overview

Transcription

1 Multisystemic Therapy (MST) Overview Prepared by MST Services

2 Key Points The Model Research & Endorsements Outcomes International Data Glasgow Implementation of MST Linkage between MST and Triple P Future Directions

3 The Model What is MST? Community-based, research and family-driven treatment for antisocial/delinquent behavior in youth Focus is on Empowering caregivers (parents) to solve current and future problems MST client is the entire ecology of the youth - family, peers, school, neighborhood Highly structured clinical supervision and quality assurance processes

4 Ecological Model Treatment Providers Community School Peers Family Child

5 MST Quality Assurance System Organizational Context Supervisor Therapist Youth/ Family Manualized Manualized Manualized Consultant Adherence Measure Manualized Consultant/ MST Expert Supervisory Adherence Measure Therapist Adherence Measure

6 MST: 30+ Years of Science 26 published outcome, transportability and benchmarking studies including 20 randomized trials 11 with serious juvenile offenders -7 independent studies 2 with substance abusing or dependent juvenile offenders 3 with juvenile sexual offenders 3 with youths presenting serious emotional disturbance 2 with maltreating families 3 with adolescents with chronic health care conditions Diabetes and obesity 2 large-scale transportability (dissemination) studies

7 Long-term Outcomes 14-year and 22-year post-treatment outcomes MST compared to Individual Treatment, (individuals treated ) 14 years post treatment (n= 165, 94% tracking success) 54% fewer arrests 59% fewer violent arrests 57%fewer days in adult confinement 43% fewer days on adult probation 22 years post treatment (n= 148, 84% tracking success) 36% fewer felony arrests 75% fewer violent felony arrests 33% fewer days in adult confinement 38% fewer issues with family instability (divorce, paternity, child support suits) 3% fewer financial problems (credit, contract, rent suits) *Complete research overview:

8 Overall outcomes include: Improved family relations Reductions in behavioural problems Reduced association with anti-social peers Increased attendance at school Increased social competence Reduced alcohol and substance misuse Reduced arrest rates (25%-70%) Lower rates of violent crime Reduced number out of home placements (47%-64%) Reduced number of days in custody (57%)

9 International Implementation Over 34 states in the U.S. Nationwide programmes in Norway & the Netherlands 9 site randomised control trial in England Expansion of 10 additional sites for England scheduled for 2012 Also being used in Australia, Canada, Denmark, N. Ireland, Sweden, Switzerland, Belgium, Iceland and New Zealand Scotland has 1 team based in Glasgow and 2 teams established in Fife

10 Ultimate Outcomes Review 20,869 youth March 2008 March 2009 Target Overall Averages U.S. Averages Int'l Averages % of youth living at home 90% 86.20% 85.80% 88.60% % of youth in school and/or working 90% 83.90% 86.20% 75.90% % of youth with no new arrests 90% 81.50% 81.70% 80.20%

11 Adherence & Case Closure Target Overall Average s U.S. Average s Int'l Average s Overall average adherence score % of youth completing treatment 85.0% 81.9% 81.6% 83.8% % of youth placed during treatment <10% 10.8% 11.3% 7.3% Average length of treatment

12 MST in Glasgow Multi-agency steering group formed Pilot site covering the North West Co-located in a children and families setting Clear referral route and feedback processes defined Evaluation framework developed

13 Glasgow Implementation 87 referrals to date, 64 cases accepted All at escalating risk of accommodation All displaying serious antisocial behaviour across more than 1 domain (home, school, community) Average of 8 calendar days from referral to 1 st visit 55 young people discharged to date Average length of treatment 133 days (19 weeks)

14 Ultimate outcomes to date 96% living at home 58% in education / vocational training or working 64% with no new arrests

15 MST and Triple P Positive, strength focused approach Support families to implement and adapt skills learned in situ Teach transference of skills learned to other systems (e.g. School) Build on the supportive aspects of group programme by enabling families to activate supports within their own ecology

16 Relationship Between MST & Triple P in Glasgow 8 families with prior exposure to Triple P Three major take away points: Expedited learning & skills acquisition curve Intensive support improves utilization Assist families in accessing community services appropriate to level of need

17 Planning for the Future Continue growth of current MST program by: Expanding referral base Enhancing effective collaborative working relationships with community stakeholders and partner agencies / organisations Increasing efforts to collaborate with schools and service providers to improve outcomes in relation to education and offending

18 Conclusions MST is effective in reducing anti-social and offending behaviour and in improving parenting skills and family relationships MST is an effective evidence based intervention that is successfully being implemented in Scotland Based on local short term outcomes and long term international outcomes, MST in Scotland is likely to have sustained long term benefits

19 Compatible services along a continuum of care can provide positive results for young people and their families Triple P can provide a foundation for improved parenting practices for families referred to MST

20 Contact Information Daniel Bachicha, Ph.D. MST Senior Expert ***************************************************** Sarah Gallacher, MST Programme Supervisor Chartered Forensic Psychologist NHS Greater Glasgow and Clyde