NICE guidance and Multisystemic Therapy for Young People

1. NICE guidance and Multisystemic Therapy for Young People Dr. Jenny TaylorConsultant Clinical Psychologist & MST Team Manager Hackney Vina Bramble Parent, Hackney Cathy James Children, Young people & Families lead Personality Disorder Team, Department of Health

2. Aim of presentation • Relevance of NICE guidance for young people and families • Introduction to the Multisystemic Therapy programme in England • Parent and professional experience of MST in London borough of Hackney

3. NICE guidance 77 • Guidance on Anti-social Personality Disorder published in January 2009 • Includes prevention and interventions for children & young people and families(1) • For younger children, group parenting programmes are effective but for adolescents with more severe problems individualised programmes, including Multisystemic Therapy are most effective

4. Conduct Disorder & Antisocial Personality Disorder • Significant chronic antisocial behaviour in teenage years – ‘conduct disorder’ • Approx a third of kids who meet criteria for conduct disorder go on to meet criteria for ‘Antisocial Personality Disorder’ in adulthood

5. Recognition of developmental context People with ASPD have often grown up in fractured families in which parental conflict is typical and parenting is harsh and inconsistent. As a result of parental inadequacies and/or the child’s difficult behaviour, the child’s care is often interrupted and transferred to agencies outside the family. This in turn often leads to truancy, having delinquent associates and substance misuse, which frequently result in increased rates of unemployment, poor and unstable housing situations, and inconsistency in relationships in adulthood. Many people with ASPD have a criminal conviction and are imprisoned or die prematurely as a result of reckless behaviour. NICE clinical guideline 77

6. What is Multisystemic Therapy? • An intervention program for young people at risk of care or custody due to significant anti-social behaviour • Developed in the USA • Currently being researched here to compare its efficacy against standard ‘treatments’

7. Multisystemic Therapy in England • 2008 Ten pilot sites of MST were established as part of a national research programme into effectiveness of the model in England: Barnsley, Greenwich, Hackney, Leeds, Merton & Kingston, Peterborough, Plymouth, Reading, Sheffield & Trafford • Building on the experience of the two existing licensed MST sites in England (Cambridgeshire & Brandon Centre in North London) and of programmes in Northern European • Sites are funded over four years by Department of Health, Department for Children Schools and Families and Youth Justice Board

8. MST in Hackney Service opened in October 2008 Staff team: • MST Supervisor/Manager (plus 2x backup supervisors) • 4 x MST Therapists • MST Administrator

9. MST: the intervention What does it actually involve?

10. The ecological model Neighborhood School Peers Family Child

11. How does MST differ from other available interventions? • Prioritising evidence-based interventions • Delivered in a way that engages families • Focus and quality control • Emphasis on long term sustainability

12. Referrals from 1/10/08 – 1/10/09 • 58 referrals • 33 families worked with

13. Families worked with over the last year Of the 33 who went on to treatment: • 16 closed and completed • 5 closed without completion • 12 in progress

14. And what about the outcomes..?

15. Outcomes in terms of family satisfaction • ‘I loved MST, it’s a really great service and it helped my family loads. It taught me the techniques of doing the fit circles and things to do in different situations and this has really helped, I’m missing MST’ • ‘You are the only thing (Service) we’ve ever stuck with’ • ‘MST – Support when no one else did, made a difference when nothing else did.’

16. Outcomes in terms of living at home

17. Outcomes in terms of education

18. Outcomes in terms of offending