What does this project involve?
Multisystemic Therapy (MST) is an intensive family-based intervention designed to support young people with antisocial behaviours. It aims to improve family functioning, and focuses on the ‘whole world’ of the child, including their homes and families, schools and teachers, and neighbourhoods and friends. The therapy may use a variety of techniques, including providing practical tips for care givers to improve children’s behaviour, social skills training, building better community social support, and aspects of Cognitive Behavioural Therapy. The specific approach is determined by the child and family’s needs. As part of this project, an augmented version of MST was designed and delivered to suit families where a 10-17 year old child was at risk from child criminal exploitation (CCE). This MST programme was delivered over 4-6 months to families by MST UK and Ireland, with face-to-face sessions with the young person and/or their caregiver provided three times per week.
Why did YEF fund this project?
Child criminal exploitation (CCE) is said to occur when ‘an individual or group takes advantage of an imbalance of power to coerce, control, manipulate, or deceive a child or young person under the age of 18 into any criminal activity in exchange for something the victim needs or wants, for the financial or other advantage of the perpetrator or facilitator, or through violence or the threat of violence’ (Home Office, 2019) Safeguarding children and young people at risk of CCE, or gang involvement, is fundamental to protect the welfare, wellbeing, and safety of children. However, there are few well developed interventions to support this specific group. This evaluation aimed to explore whether MST could fulfil this role, an provide a well-evidenced programme to prevent involvement in CCE.
As the YEF Toolkit explains, MST is associated with a moderate average impact on violent crime, and we have a moderate level of confidence in this impact. However, we have more limited evidence on the use of MST in an English and Welsh context, and we lack evidence on the impact that MST may have specifically on children at risk of child criminal exploitation.
YEF funded a feasibility evaluation of this augmented, CCE-focused version of MST (MST E). The study began by refining the logic model to define the causal processes through which the intervention aims to reduce crime and offending. Careful thought was also given to how to adapt standard MST to suit families where children were at risk from CCE. In addition, the evaluator conducted interviews with nine MST practitioners, six primary caregivers and one young person to explore how to refine MST tools for the evaluation of this intervention.
In total, 258 families received MSTE, and 41 signed up to participate in the evaluation across four locations in England (Sandwell, Kirklees, Nottingham, and Birmingham). Regarding the child in the 258 families involved, 42% identified as White, 11% as Mixed, 4% as Black, 3% as Asian, and 31% as ‘Other’. 9% declined to provide data on their ethnicity.
The evaluator aimed to ascertain the acceptability and feasibility of MST E for stakeholders, family and clinician satisfaction with the intervention, the appropriateness of selected outcome measures, the willingness of teams to recruit participants, and the therapy completion rate. Enrolled families were asked to complete outcome questionnaires (featuring a range of outcomes including self-reported offending, empathy, behavioural difficulties, parenting, family functioning, and gang affiliation), and the evaluator collected various demographic and treatment data. Further interviews were conducted with two MST E consultants, four supervisors, eight therapists, nine primary carers and five young people to explore delivery, and the factors that may have facilitated or hindered implementation.
The evaluation ran from winter 2020 to autumn 2022, and was therefore impacted by the COVID-19 pandemic, requiring both the delivery team and evaluator to adapt to challenging circumstances.
|There was evidence that delivering the intervention to families was feasible, and that families found the intervention acceptable. However, there were significant evaluation challenges. COVID-19 hampered recruitment, participant retention was challenging, and young people expressed some mistrust of researchers. Collecting outcome data from sufficient numbers of young people was also not proved to be feasible.|
|Parents and carers did indicate that they were willing to take part in research to help others, and families reported that randomisation in a future larger study would be acceptable to them. The evaluator recommends considering the use of larger incentives to engage young people, and collecting the primary outcome from caregivers, rather than young people.|
|The evaluator noted that, in practice, it was difficult to clearly define the difference between standard MST and the augmented version. MST UK and Ireland reported that 195 of the 258 families that received the adapted MST completed the intervention during the study.|
|Implementation was facilitated by therapists’ ability to form therapeutic relationships with families, the intensity of the intervention, collaboration with other services, the engagement of caregivers and young people, and the focus on upskilling caregivers.|
|Implementation was hindered by the lack of engagement from one caregiver in a family, changing therapists, the intensity and intrusiveness of the intervention for some, challenges with exploitation occurring online, difficulties with collaboration with schools, changing peer groups, and lack of engagement with other agencies.|
What will YEF do next?
Given the challenges noted in this evaluation, YEF does not currently plan to fund a larger evaluation of CCE-focused MST.