Multi-Systemic Therapy (MST) Katherine Mackay / Debbie Thorp 12 August 2010

1. Multi-Systemic Therapy (MST) Katherine Mackay / Debbie Thorp 12 August 2010 1

2. 2/5 (two fifths) of children diagnosed with a behaviour disorder still have the same diagnosis 3 years later 2

3. Programme Description MST is an intensive family and community based intervention which targets the multiple causes of serious anti-social behaviour in young people. It is aimed at preventing anti-social and offending behaviour and resultant out of home placements 3

4. Programme Aims • Enable young people to remain at home with their family • Re-engage young people in an educational or vocational placement • Enable young people to avoid offending behaviour and involvement with the Youth Justice System • Reduce behavioural difficulties • Increase the family’s ability to manage independently and reduce families involvement with multiple and costly intensive services • Return young people to pro-social activities 4

5. Target Group • Young people, 11 (secondary school age) to 17 years old, at imminent risk of out-of-home placement (in care, residential school or secure setting) due to anti-social or offending behaviours. • Young People with behavioural difficulties who have complex social, educational and clinical needs • Young people known to two services – CAMHS, Social Care, YOS, EWO 5

6. Typical Referral Behaviours • Truancy or school exclusion • Verbal aggression and threats of harm • Physical aggression (violence, fighting, property destruction) • Offending behaviour • Drug and alcohol problems • Serious risk taking behaviour • Association with anti-social peers 6

7. Income Grant for MST • Year 1 - £345,000 • Year 2 - £287,000 • Year 3 - £222,000 • Year 4 - £150,000 7

8. Research Evidence Based In comparison with control groups, MST: • Higher consumer satisfaction • Decreased long-term rates of re-arrest 25% to 70% • 47% to 64% decreases in long-term rates of days in out-of-home placements • Improved family relations and functioning • Increased mainstream school attendance • Decreased adolescent psychiatric symptoms • Decreased adolescent substance use • Cost effective compared to out-of-home placement 8

9. Cost Comparisons UK 9

10. Lessons Learnt So Far • It takes time to develop a new service • Initial referrals were the most complex in Trafford and this impacted on staff who were newly trained • There was confusion for referrers with many similar new projects starting at the same time. • There needs to be more work with schools. • We needed to develop a system to improve through put and reduce assessment time. 10

11. MST in Trafford Progress: a developing service 11

12. Cases seen by new serviceJune 08-August 10 Length of stay – 100-140 days 12

13. 6 months follow up : Trafford's first 8 ( T2) (T1 = at start of MST) 5 completed treatment • 2 young people placed in care • DM – transferred to Me2 • KB - going through Care Proceedings • One went to custody for offense committed in first month of MST 13

14. Positive Outcomes for Young People Number of Identified Issues 14

15. Cost Savings Number of Professionals / Services involved 6 months pre / post MST 15

16. Costs of Services per week • MST costs - £250.00 • Placement in Trafford Children’s Home - £2,400.00 • Hospital care - £2,400.00 • Secure placement - £5,000.00 16

17. Cost Savings Average Number of Professional Meetings 17

18. Cost Savings to Trafford Number of Services Young Person is known to 18

19. Cost Savings Number of home visits 6 months pre / post MST 19

20. Qualitative Data What Service Users Say… • My behaviour towards them (the family) has improved. I’m calmer now – not losing it. MST helped us to look at ourselves. The school contracts are very good. We needed a referee, a co-ordinator – that referee was MST, [therapist] always remained neutral and very calm • Got us communicating • Just FAB. Couldn’t ask for anyone better • Seemed to go on for a long time at the start. I’m more aware of how I feel – moods • Changed my way of thought, made me stronger as a parent. MST has made me think of alternative ways of dealing with confrontations, demands which have been unreasonable, bad behaviour etc 20

21. Successes • Outcomes are improving with each ‘round’ of cases • New protocols have been developed to improve efficiency • Customer (referrers and families) satisfaction is extremely high • Team adherence (our measure of effectively implemented MST) is increasing well above the threshold • Preparing to go into the research phase • Good staff retention throughout the project so far • Team up to capacity caseload • Completion of work within specified time limit 3-5 months • Trafford has an internationally recognised ‘Gold Standard’ intensive intervention in MST 21

22. Current Focus • Established a Multi Agency MST Referral Panel • Clearer referral pathway • Completion of National Research • Ongoing measurement of local statistics • Wider Systemic change in the community • Further promotion of MST • Provisional Licensure replaced by full Licence ensuring effective service deliverance 22

23. Improving Outcomes for Young People Number of Offending (all) prior to MST / 6 months post MST 23

24. Outcomes Nationally Cost effectiveness research on MST from Washington State Institute for Public Policy suggests that £5 is saved for every £1 invested in the programme. In the UK young people with conduct disorder currently cost public services 28 x the costs of young people without conduct disorder between the ages of 10 and 28 years (Scott and Knapp 2001) 24