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Multi-Systemic Therapy

A family therapy programme for children at risk of placement in either care or custody

Estimated impact on violent crime:

MODERATE

Evidence quality:

1 2 3 4 5

Cost:

1 2 3

Prevention Type

  • Secondary
  • Tertiary

Setting

  • Community
  • Home

Themes

  • A supportive home

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. Courts and other youth justice organisations will often refer children and their families to MST as a mandated intervention programme.

The programme pairs families with a therapist who will work with them intensively for three to five 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:

  • Strategic family therapy, where the family is encouraged to discuss previous social interactions with the aim of developing positive interactions in the future.
  • Structural family therapy, where the therapist and family explore habits, routines, or behaviours which might be hindering the child’s positive development.
  • Working with parents to develop practical strategies for supporting positive behaviour and managing challenging behaviour.
  • Cognitive-behavioural therapy, where the therapist helps children and their families to identify and challenge negative or unhelpful thought patterns.

Is it effective?

Overall, the research suggests that the impact of MST has been moderate.

Globally, and particularly in the USA, there is promising evidence of effectiveness. A review of the international research estimated that, on average, the programme reduces violence by 15% and crime by 25%.

However, the small amount of evidence from the UK is less promising. A smaller study in 2011 found an impact on non-violent offending. However a larger 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 international research.

The Youth Endowment Fund has commissioned an evaluation of MST-E, a version of MST designed for situations where there is risk or evidence of criminal or sexual exploitation. The programme is being overseen by the MST-UK and Ireland Network Partnership at the South London and Maudsley NHS Foundation Trust (SLaM), delivered by Birmingham Children’s Trust, Kirklees Council, Nottingham City Council and Sandwell Children’s Trust, and evaluated by the University of Warwick. The evaluation team are initially conducting a feasibility study in four local authority areas to inform a decision about proceeding to a full trial. The team plan to compete this feasibility study in September 2022.

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

A review of the international research estimated that, on average, the programme reduces violence by 15% and crime by 25%. However, the small amount of evidence from the UK is less promising.

How secure is the evidence?

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

The evidence rating is low for several reasons. We dropped one rating level because the violence estimate is only based on seven studies, one rating level because of our assessment of the methodology used by the review, and and one final level because there is a lot of variation in the estimates provided by these studies. Potential explanations for this variation are explored below. The findings from the large UK trial mentioned above add to our uncertainty.

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. The team that delivers MST in the UK estimates the current cost at £15,000 per family. It is an intensive intervention and requires a trained and licensed therapist delivered over a sustained period of time. The cost per participant will vary depending on whether the therapist works with individuals or a group.

Topic summary

  • Generally, the research on the impact of MST has suggested desirable impacts including on direct measures of violence. However, one recent RCT in the UK did not find a desirable impact.
  • MST was particularly successful when MST techniques and skills were generalised to wider contexts, including improved family relationships and recovering progress after set-backs.
  • 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.

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

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

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© 2021 The Youth Endowment Fund Charitable Trust. Registered Charity Number: 1185413.
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