What is Multisystemic Therapy (MST)?
The Brandon Centre ran the first randomised controlled trial of Multisystemic Therapy (MST) in the UK in partnership with Camden and Haringey Youth Offending Services. The trial ended in 2010 and the Centre’s MST standard service is now commissioned by Haringey, Waltham Forest, Camden, Enfield, Islington, Ealing, and Lambeth.
What Is MST?
MST was developed by the Family Services Research Center at the Medical University of South Carolina. It was apparent that mental health services for serious young offenders were minimally effective at best, extremely expensive and not accountable for outcomes. They reviewed the research literature and looked for interventions with documented success in shaping good outcomes for anti-social young people. They also noted which interventions, some quite popular, have no empirical support. This process of discarding ineffective techniques while gleaning those most effective means that MST is really more an amalgam of best practices than a brand new method.
MST adopts a social-ecological approach to understanding anti-social behaviour or emotional problems. The underlying premise of MST is that young people’s difficulties are multi-causal; therefore, effective interventions would recognise this fact and address the multiple sources of influence. These sources are found not only in the young person (values and attitudes, social skills, biology, etc) but also in the young person’s social ecology: the family, school, peer group and neighbourhood. It is a key premise of MST that community-based treatment informed by an understanding of the young person’s ecology will be more effective than costlier residential treatment. Research has shown that treating the young person in isolation of the family, school, peer and neighbourhood systems means that any gains are quickly eroded upon return to the family, school or neighbourhood. Custody stays could also be counter-productive because an already troubled young person is immersed in a peer culture where antisocial values predominate.
MST uses the family-preservation model of service delivery in that it is home-based, goal-oriented and time-limited. It is present-focused and seeks to identify and extinguish behaviours that are of concern not only to referring agents, but also to the family itself. In fact the entire family is involved with MST, in contrast to the many interventions that define the young person as the “identified client.” MST involvement will typically be between three and five months.
Collaboration with community agencies is a crucial part of MST. The school is a key player and workers may be in daily contact with teachers and administrators. MST Therapists will also work in close partnership with referrers. The MST Team will work closely with youth justice officers, social workers or mental health workers to ensure that MST is implemented to maximum effect in the context of the requirements of the referring agency. There may be a need to involve the young person in substance abuse treatment or seek a psychiatric consultation about a parent, for example.
While the initial MST involvement may be intensive, perhaps daily, the ultimate goal is to empower the family to take responsibility for making and maintaining gains. An important part of this process is to foster in the parents the ability to be good advocates for their children and themselves with social service agencies and to seek out their own supports. In other words, parents are encouraged to develop the requisite skills to solve their own problems rather than rely on professionals.
MST is a flexible intervention tailored to each unique situation. There is no one recipe for success. Instead, there are nine guiding principles:
- The primary purpose of assessment is to understand the “fit” between the identified problems and their broader context
- Therapeutic contacts should emphasise the positive and should use systemic strengths as levers for change.
- Interventions should be designed to promote responsible behaviour and decrease irresponsible behaviour among family members.
- Interventions should be present-focused and action-oriented, targeting specific and well-defined problems.
- Interventions should target sequences of behaviour within or between multiple systems that maintain the identified problems.
- Interventions should be developmentally appropriate and fit the developmental needs of the young person.
- Interventions should be designed to require daily or weekly effort by family members.
- Intervention efficacy is evaluated continuously from multiple perspectives with providers assuming accountability for overcoming barriers to successful outcomes.
- Interventions should be designed to promote treatment generalisation and long-term maintenance of therapeutic change by empowering caregivers to address family members’ needs across multiple systemic contexts.
The MST-specific training augments the education and experience therapists bring from their chosen fields (usually psychology or clinical social work training).