Action for Children - Multisystemic therapy, Manchester

• Programme uses multisystemic therapy to work with children, their families and carers to improve relationships
• Intensive support is provided when young people aged 11 to 17 are at risk of being taken into care because of severe behaviour problems
• Evaluation has found using MST has significantly reduced the number of days children spend in residential care, as well as social care involvement

ACTION

Action for Children's multisystemic therapy (MST) is designed to support young people aged 11 to 17 on the edge of the care system, and their families. It is an intensive, home-based therapy programme provided for three to five months that focuses on problem solving and offers families access to a therapist round-the-clock.

It aims to improve family relationships and reduce youth criminal activity, antisocial behaviour and other issues.

Across the UK, there are 21 different MST providers from both the voluntary and statutory sectors delivering MST for 36 local authorities across 24 sites, with some applying MST principles to tackle specific problems or help groups of young people such as those returning home from care.

Sarah Tootell, children's services manager at Action for Children, heads up the Manchester MST, which has been running for more than two years. She explains that MST intervention has been successful in keeping young people at home, therefore preventing the need for care or custody.

"The MST services that I have management responsibility for have well-established referral panels, which means that there is a multiagency approach to identify which families should be supported through MST intervention," she says.

Tootell explains that MST has clear criteria on the type of referrals they can take. "We want to use resources in services responsibly, so it's important that the families we work with are those with young people who display willful misconduct.

"They must have two or more ‘referral behaviours' that indicate the young people who are referred are those most likely to end up in care or police custody," she says.

With the bar set high, the cases the MST team take on are typically those young people whose complex problem behaviours put them most at risk.

"Therapists work in the home and community and unlike other therapy types - where a child or young person is seen individually - in MST, therapists work with the parents or caregivers to increase their skills in dealing with the child or young person as well as increase parental confidence," she adds.

"It is highly intensive and families can expect visits at least three times per week with check-ins and telephone calls at other times, and 24 hours a day, seven days a week on call support provided by the service.

MST is designed to help parents and young people to build on their strengths and take responsibility for their actions. Targets are sequential and action-oriented, which helps build on progress and achievements gradually. Families are expected to plan, prepare, evaluate and review constantly throughout the treatment.

"MST addresses fundamental problems in the families' functioning and works on the ecology of the child," explains Tootell.

"It increases parental responsibility and works in a multi-systemic way - MST looks at the child, family, peers, school, neighbourhood, community and culture. MST focuses on overcoming the barriers to success, whatever it takes or whatever they may be."

To improve understanding of the child's and family's life, and the problems they face, therapists often speak with extended family, neighbours and key people in schools and other support agencies about treatment, how it is progressing and what it involves.

The MST team would usually take the clinical lead when there are other agencies involved with the family during treatment but are conscious of keeping other agencies informed.

"Once parents are better able to manage their child's behaviours, the therapist will work with them to plan for sustainability - making sure the parent has their own ‘toolkit' when treatment ends and are able to continue with implementing the strategies that they had when the therapist was involved," Tootell adds.

"When parents start to see that treatment is working their confidence increases and with the constant support of a therapist they are able to continue to implement strategies to manage the child's behaviour."

Tootell adds that MST supervisors come from a range of professions such as nursing, social work and psychology with qualifications at Masters level, and have experience of delivering a range of therapeutic work, including behaviour interventions, cognitive behaviour therapy and family therapy.

Therapists also come from a range of backgrounds including social work, youth offending and child or adult mental health.

IMPACT

Evaluation of the impact of MST in Manchester, published in June 2016, found for children that had taken part in the programme there was an increase in the number that had left care and returned home, while social care interventions with them had also reduced.

The report states: "In the period prior to MST there were very few cases de-escalated, indicating that children were staying at the same or increasing their level of need. In the period following completion of MST there is an increase in the number of cases that have been de-escalated within social care.

"In the three months pre-MST, children in the evaluation cohort who had been in care, spent a total of 129 days in residential care placements. This more than halved to 60 days in the three-month post-MST period, and further reduced in the three- to six-month post-MST period to 27 days."

Further analysis shows that in Wigan, around 90 per cent of young people who have been involved with MST remain at home 12 months post-treatment.

This practice example is part of CYP Now's special report on preventing care proceedings. Click here for more