Multi-Systemic Therapy

What is it?

Multi-Systemic Therapy (MST) is a family therapy programme which works with children aged 10-17 and their families when the children are at risk of being placed in custody or care. The programme focuses on the ‘whole world’ of the child, including their homes and families, schools and teachers, and neighbourhoods and friends. It aims to promote positive family relationships, support the child to engage in education and training, tackle problems like substance use, and protect the child against involvement in crime and violence. In some countries, courts and other youth justice organisations will often refer children and their families to MST as a mandated intervention programme though it is generally not mandated in the UK.

The programme pairs families with a therapist who will work with them intensively for three to six months. The therapist is ‘on call’ to help families 24 hours a day, seven days a week. The therapy will consider multiple aspects of the child’s life, including their family, school, local area and friends. It aims to identify and address issues in each of these areas which may be acting as barriers to positive behaviour.

The therapy can take a range of different forms and is customized to the child’s needs and setting:

• Encouraging the family to discuss previous sources of conflict with the aim of developing positive interactions in the future.
• Helping the family to explore habits, routines, or behaviours that may hinder the child’s positive development.
• Working with parents to develop practical strategies for supporting positive behaviour and managing challenging behaviour.
• Cognitive-behavioural therapy (CBT), where the therapist helps children and their families to identify and challenge negative or unhelpful thought patterns.

Is it effective?

On average, based on a review including eight studies from the USA, the international research suggests that MST is likely to have a moderate impact on violent crime.

Four non-US studies included in the review, three from the UK and one from Canada, suggest that MST is likely to have a low impact on violent crime.

A large UK study published in 2018 found that MST was not more effective when compared to usual practice. Usual practice involved children working with a case worker through a support and counselling model, with services to match their needs provided through Child and Adolescent Mental Health (CAMHS) services and social care. It is possible that the usual practice conditions that the control group experienced are more effective in the UK than elsewhere, which may explain the difference in results between the UK and the USA. There may also be differences in the experience of therapists and implementation fidelity.

Based on international studies, the review estimates that MST reduces violence by 16% and offending by 17%.

The international research suggests that MST is more effective for children under the age of 15 and with children who have previously been arrested.

How secure is the evidence?

We have moderate confidence in our estimate of the impact on violence.

The evidence rating is moderate for two reasons. We dropped one rating level because the violence estimate is only based on eight studies and one level because there is a lot of variation in the estimates provided by these studies, particularly between the USA and elsewhere.

How can you implement it well?

We did not find a systematic review which synthesised research about the implementation of MST. The YEF evidence and gap map contains one UK study which examined participants’ trajectories through the programme. This study is not strictly focused on implementation issues but does provide useful insights.

Participants reported that there were different trajectories of change following participation in the programme, with some continuing to improve, and others finding it difficult to maintain desirable changes or not seeing any change at all. It was particularly successful when MST techniques and skills were continued and generalised to wider contexts, including improved family relationships and recovering progress after set-backs.

Families reported several factors as responsible for initial changes due to MST. These included motivations to change, the relationship with the therapist, learning better communication and seeing initial results.

What programmes are available?

Below is a list of programmes found in the Early Intervention Foundation’s (EIF) Guidebook. The Guidebook summarises the research on programmes that aim to improve outcomes for children and young people.

How much does it cost?

The cost of MST is likely to be high.

A 2013 study in North London estimated the cost at £2,285 per participant. It is an intensive intervention and requires a trained and licensed therapist delivered over a sustained period of time.

Topic summary

• MST is a family therapy programme for children at risk of placement in either care or custody.
• International studies suggest that MST has a moderate impact on reducing violence. Research outside the US suggests there may be a low impact of MST on violence.
• MST appears more successful when the techniques and skills were used longer term, and as part of managing family relationships after the programmes ended.
• MST was found to be more effective with children under the age of 15. Studies with higher proportions of children who had previously been arrested also showed higher levels of reductions in reoffending.
• Further research evidence is required from settings in England and Wales.

Take away messages

• Invest in clinically-led provision and increase access for children at risk of being placed in custody or care, particularly those under the age of 15.  
• Ensure referrals and needs assessments take place quickly.  
• Check that MST support will enhance usual practice beyond CAMHS and social care.  
• Put strategies in place to reach children and families from racially minoritised communities and to keep them engaged throughout the intervention.  
• Put in place rigorous monitoring processes to check the strength of the relationship between the therapist and the child, and to ensure that the intervention is embedding skills that families can use beyond the programme.  

YEF projects and evaluations

YEF funded a feasibility study of the RESET programme. RESET is an adapted version of Multi Systemic Therapy designed and delivered to suit families where a 10–17-year-old child is at risk from child criminal exploitation (CCE). The 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.

External links

Find out more about delivering MST in the UK and Ireland.

A blog post written by an MST therapist on the importance of recognising cultural experiences in families in practice.

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