MultifunC, Scandinavia: International Focus

Supporting adolescents with severe behavioural problems can be challenging. A young person’s behaviour may have resulted in a breakdown in family relationships, disruption to education and participation in criminal activity. Community-based interventions delivered by educational psychology, youth offending services and social work may not be effective due to the severity of the behaviour. In such instances, a young person can often end up in custody, whereas a secure residential care placement would be a better option for stabilising their behaviour in the short term and reducing their risk of reoffending in the long-term. However, finding a suitable secure care setting can be difficult. Then there is the issue of what happens once the young person leaves a placement – too often they are expected to slot back into life, when a gradual reintroduction to the community or home is needed.

An approach developed in Scandinavia aims to combine the intensive therapeutic support provided in secure residential care alongside developing long-term life skills that the young person will need to ensure their transition into the community is a success.

Multifunctional Treatment in Residential and Community Settings for young offenders (MultifunC) has had impressive results in Denmark, Sweden and Norway over the past 20 years, with elements of the approach reflected in the soon-to-be-established secure schools in England.

CULTURE AND SOCIETY

The MultifunC programme is targeted at young adolescents aged 14 to 17 who have severe behavioural problems.

The young people are characterised by high risks of offending and criminal behaviour. They often face the consequences of school drop-out, little educational attainment and low cognitive skills.

The adolescents’ problems typically appear in school, early employment, the family environment, or when socialising with peers. Difficulties will typically be so severe that neither a home-based treatment nor temporary placement in a professional foster family are considered sufficient.

In Scandinavia, residential treatments have been the most commonly used treatment intervention for young people involved in antisocial behaviour.

MultifunC aims to change the young person’s behaviour and a holistic approach is taken to targeting known risk factors for antisocial behaviour. Individual characteristics such as social skills, mental capacity, depression and anxiety are addressed. The programme also recognises that risk factors are found both within the individual and in his or her environment and so intervention is directed at external factors like the young person’s family, relations to peers, school and neighbourhood, based on their association to the young person’s behaviour in each case.

It is implemented through nine institutions – five in Norway, two in Sweden and two in Denmark.

THE INTERVENTION

The programme consists of around six to seven months in a residential home followed by an aftercare period, which often takes place in the family setting. The total intervention period for the individual young person is assessed on a case-by-case basis, but is usually around 10-12 months.

The residential home is an open unit closely connected to the community including local schools, leisure activities and peers. The units are home to eight young people at any one time. The team around each young person includes a psychologist, two social educators, a teacher from the pedagogical team and family therapist.

The young person’s participation in education, employment and in the local community is actively pursued. Community inclusion revolves around the involvement of family members and prosocial peers. Family members, notably parents, are part of the treatment process from the very start.

It regards participation of the young person (and their family) in all decisions about the treatment planning and process as indispensable in guaranteeing effective change

Major emphasis is placed on the young person attending school. In cases of prior school drop-out, a place in a school needs to be secured. This could be at a mainstream school or special schools that have a focus on inclusive education. School attendance is ensured through accompanying the young person by a team member.

As part of the programme, young people can undertake internships in private companies. In those internships, the supervisors can assume key roles in providing guidance at the work place as well as orientation in life.

PRACTICE

MultifunC uses cognitive behavioural theory and social learning theory. During the entire intervention there is a focus on changing the young persons’ behaviour across different spheres of life – school, work place, family and peer circles.

When entering the programme, an action plan gets drafted in collaboration with the family and young person. The treatment plan for each young person is established with a focus on risk factors, assessing the young person’s social skills, cognitive capacity, educational attainment, mental health status and general wellbeing.

A weekly schedule gives comprehensive guidance on what the young person has to do each day, with staff on hand to monitor progress and provide constant feedback. Compliance with the schedule in combination with positive behaviour becomes rewarded through a point system with progression elements.

The activities in the programme develop key social skills that young people need to master, including controlling temper and aggression, emotional self-regulation and motivation. Behavioural training is combined with guided reflections about personal values and behavioural ethics.

MultifunC is particularly tailored towards troubled families with multiple needs. The therapy approaches seek to improve the relationship and communication between the child and parents. For that, parents are involved in treatment planning and receive continuous support.

Each MultifunC programme has one leader who is responsible for the programme as a whole. In addition, there is one assessment team, one treatment team, one pedagogical team, and one family and aftercare team.

The assessment team is responsible for the assessment of the young person, the creation of the treatment plan, and the treatment progress. The team is also responsible for guidance to other teams during the treatment process.

The MultifunC assessment team assesses the young person’s needs as well as the family’s. Individual progress is measured based on the initial needs assessment which shapes the treatment targets. The assessment is based on recognised methods and standardised instruments.

The treatment team is responsible for the daily treatment of the young person in the residential setting. This includes therapies, management of risk situations, anti-aggression training, and the organisation of leisure activities.

The pedagogical team is responsible for the educational assessment and the educational support to each young person. This includes co-operation with schools and the relevant authorities.

The family and aftercare team is responsible for treatment and support to the parents during the young person’s phase of home care and after the young person’s return to the family. This includes involving the parents in decisions, providing them with training and support in the family home.

IMPACT

The Swedish National Board of Health and Welfare funded a study of 80 young people aged 15-17 with medium and high risk of offending. Half of the group participants received MultifunC, and half treatment as usual (TAU). Although non-randomised, the two groups were found to be equivalent on important background variables.

The results, published in May 2019, found that after 24 months, young people participating in MultifunC had a reduced need for residential care in a “locked setting” as well as out-of-home placement in general compared to young people in the TAU group.

The economic analysis found MultifunC to be a cost-effective alternative to TAU due to the reduced need of residential care in locked settings. There were no significant effects on reoffending or psychiatric care.

A 2013 study of MultifunC in Norway reported improvements in the behaviour of young people. It found that 70 per cent completed the whole treatment programme including the integrated aftercare, with a success rate of 60-70 per cent based on recording a positive change in school or work and family function, the absence of reoffending behaviour and no further placements.

FACTFILE

• MultifunC is a programme that aims to help young people address offending or antisocial behaviour
• It includes a period in residential care followed by intensive support in the community
• The approach has been used in Scandinavia for 20 years as an alternative to placing adolescents in custody
• A therapeutic team work with the young person and their family to tackle the causes of the problem behaviour
• Ensuring young people are engaged in education, training and their communities is crucial to its success
• Studies have shown positive outcomes for around two-thirds of young people that participate in MultifunC
  
  

EXPERT VIEW
Learning from MultifunC

MultifunC sits outside of the youth justice system as we would define it in England and Wales and is not directly comparable to secure settings, however, there are interesting similarities between some elements of the model and our approach to youth justice.

It’s clear that MultifunC, like child first principles here, builds on evidence that we should reduce a child’s contact with the criminal justice system wherever possible and respond to the child’s needs. Co-production is also evident, building on the understanding that children and their families should be actively involved in forming their plans and their activity.

The multidisciplinary working that has been the backbone of success in developing youth offending teams in England and Wales is also shown to be a fundamental of MultifunC.

There are also some comparisons in the approaches of MultifunC and secure schools. Both have a clear focus on education – reflecting education, training and employment as protective factors in relation to desistance from crime. Both also recognise the importance of involving the local community.

Perhaps the most important comparison to draw is around the transition from the residential setting back to their home. Crucially, with a MultifunC model, intensive transitional support is provided both to a child and their family. To make a real difference in the lives of children being released from custody into the community in England and Wales we could learn from this and find a way to provide a similar level of support.

By Charlie Taylor, chair, Youth Justice Board