Multi-systemic Therapy (MST) is an intensive family and community-based intervention for children and young people aged between 11 and 17 at risk of out of home placement in either care or custody due to their offending, or who have severe behaviour problems.
Government-commissioned research by University College London (UCL) has suggested that MST is no more effective than other interventions for young people with challenging behaviour and at risk of being taken into care.
However, even on the basis of this research, MST is still the most effective programme available for commissioners and service planners seeking to meet the needs of highly vulnerable young people.
Action for Children began delivering MST in 2010 and currently provides it across four sites in England. Our interest arose because of the strength of international research on its effectiveness in avoiding custody.
We have delivered successful outcomes to hundreds of young people who were otherwise unsafe and at risk. These have been delivered at the sharpest edge of service provision, in the context of crime, truancy, violent and turbulent family relationships, homelessness, sexual exploitation and unsafe peer relationships.
Young people have been assisted to remain within their birth families when there appeared no hope of achieving this - and have done so safely (see table).
Achieving these improved outcomes has not been easy. They reflect hard work and dedication from professionals and commitment from the families. Nor is the model perfect - MST teams become more effective in their second year as therapists become familiar with the approach. Also, some young people and their families were unable to engage with the intensity or structure of the programme, while others needed admission into care for safety.
MST works for most young people and families for whom it is designed. No comparator services were single programme approaches and, therefore, none offered the same capacity to replicate delivery. Furthermore, MST in the UK has improved since 2012, the end point of the UCL research.
The findings need careful interpretation, but government and commissioners must not lose sight of the rich, positive research base and more recent results, not to mention the huge savings achieved through effective prevention.
MST is a complex intervention, but its simple message lies in the experiences of hundreds of young people enjoying improved family relationships, regular schooling and constructive friendships.
- David Derbyshire is director of practice improvement, Action for Children
- Multi-systemic therapy versus management as usual in the treatment of adolescent antisocial behaviour: a pragmatic, randomised controlled, superiority trial, was led by UCL and published in The Lancet Psychiatry