MST in the UK & Ireland



Multisystemic Therapy (MST)

MST Research Papers

  • Evaluation of The Bail Supervision Scheme for Children (Pilot Scheme). December 2019
    The Department of Children and Youth Affairs (DCYA) designed a Bail Supervision Scheme (BSS) to provide the courts with an alternative for young people who were at high risk of bail denial. The BSS incorporates the evidence-based Multisystemic Therapy (MST) model within the normal court processes (for example, supports provided by court services, Young Persons Probation and An Garda Síochána).
    By tackling barriers to positive change within the young person’s home and community environment and facilitating the caregiver to challenge the young person’s problematic behavior, the BSS aims to facilitate sustainable pro-social change in the young person’s behavior. Following a tender process in 2016, DCYA commissioned Extern to provide a pilot BSS for young people attending the Children Court (Court 55) in Smithfield, Dublin. Following an implementation period, DCYA commissioned the School of Law in the University of Limerick to evaluate the BSS. The evaluation combined multiple methodologies including a quasi-experimental design and incorporated multiple data sources to test a theory of change.6 It investigated whether the BSS worked (outcomes) and sought to identify the conditions that facilitated the observed outcomes (process). The report presents these findings.
  • A grounded theory of multisystemic therapist roles in achieving positive outcomes for young people and families. Journal of Family Therapy (2019)
    Research on the application of multisystemic therapy (MST) has focused on the experiences of caregivers, families, and youth with behavioral conduct difficulties for whom MST has been established as an effective intervention. Perspectives of MST therapists are lacking, yet hold relevance for MST model adherence and services. Using a social constructivist grounded theory approach, eight MST therapists in the United Kingdom took part in a semi‐structured interview designed to explore the requirements of the role. Data revealed four categories: two of explicit roles that included establishing rapport, engaging with families, defining the drivers to a young person’s behavior, and doing ‘whatever it takes’ to overcome challenges; while underpinning these were two categories of implicit roles related to coping with the organizational environment and interpersonal skill demands of the role. This study widens the understanding of both individual and organizational factors/climate and its impact on therapist performance in MST practice.
  • Multisystemic Therapy in families of adopted young people referred for antisocial behaviour problems. Journal of Adoption & Fostering (2018)
    Multisystemic Therapy (MST) is an intervention offered to adopted young people presenting with antisocial behavior. Despite the substantial evidence base for MST in non-adoptive populations, a review of the literature identified that there has been no evaluation of its effectiveness in adoptive populations. This qualitative study aimed to provide the first exploration of adoptive parents’ lived experiences of standard MST in relation to their context as an adoptive family, focusing on aspects of the intervention that promoted or limited change. Ten semi-structured interviews were carried out with 11 adoptive parents. Thematic analysis identified five major themes that were service user validated: situation prior to MST; enablers to change; barriers to change; outcomes of MST; and developing MST to better meet the needs of adoptive families. Findings suggest potential advances to current MST practice to meet the needs of adoptive populations, including the importance of appropriate training and supervision, sensitivity working with adoption and the incorporation of adoption-related theory. Limitations and future developments are also discussed.
  • The role of cultural factors in the engagement and change in Multisystemic Therapy. Journal of Family Therapy (2016)
    Evidence has shown that Multisystemic Therapy (MST) has been particularly effective in the treatment of youth with antisocial behavior from ethnically diverse backgrounds. Although the process of change within MST has been explored, there is a dearth of research in looking at this for families from ethnic minority backgrounds. This qualitative study aimed to explore ethnic minority caregiver experiences of MST and understand how this might impact on engagement, the presenting problems and the process of change. Semi-structured interviews were conducted with seven ethnic minority caregivers who had completed treatment. A constructivist version of grounded theory was used to analyze the data. Specific cultural theoretical codes that emerged were around the consideration of the cultural differences in terms of the engagement process, the conceptualization of difficulties and the therapist acting as a cultural broker in the process of change. This research integrates culturally specific ideas into the existing MST Analytical Process.
    Click here to listen to a podcast about this research.
  • This study explored the process of sustaining positive outcomes following MST from caregiver perspectives. Semi-structured interviews were carried out 5–21 months post-MST with 12 caregivers. A grounded theory methodology was used to analyze the data. Caregivers in this study identified the following themes as contributing to sustaining change; improvements in their relationship with their child, shifting how they viewed difficulties and solutions and feeling personally strengthened and resilient. The therapeutic alliance in MST was described as important in initiating these changes. Clinical implications and how the themes from this study fit into the existing model of change in MST are discussed.
  • This qualitative study aimed to explore young people's experiences of MST and learn what had helped them to sustain positive outcomes over time. Semi-structured interviews were conducted with eight young people at an average of 14 months after MST (range: 5–21 months). A constructivist version of grounded theory was employed to analyze the data, leading to the development of a model of sustained change in MST. Themes from the model included therapeutic alliance, increases in systemic awareness, recognizing responsibility, positive peer relationships, acknowledging and celebrating success, continued use of specific strategies (for example, worry boxes) and the identification and creation of a preferred future. This research presents an understanding of how change may be sustained after MST, highlighting systemic, developmental and individual factors in relation to this. Clinical implications and a proposed model of sustained change in MST are discussed.
  • There are almost 90,000 young people in care in the UK. Many over the age of eleven years enter care due to anti-social behavior, acute stress, and family dysfunction. The short-term and long-term costs at an individual, family and societal level of going into care are high. There are a number of preventative interventions available for this vulnerable group in common use but not all have a strong evidence base. Multisystemic therapy (MST) is a community intervention that targets the systems around the young person including the family, school, peer, and community. Some barriers of the intervention are that it does not target every young person at risk of care, nor is it available in every local authority and there is a low annual capacity. Some of the strengths of MST include the robust evidence base, the cost savings and the strong emphasis on implementation fidelity. It is argued that all young people at risk of care or entering custody need to have access to evidence-based treatments which aim to enable them to remain safely at home. The implications for commissioners and social care practitioners in changing current practice are discussed.
  • Multisystemic therapy (MST) is described and contrasted with practice in traditional services for young people who have committed crime, behaved anti-socially, abused substances or suffered family conflict. The challenges to traditional services posed by MST are examined, including consideration of the process of engagement in therapy, the intensive individualized therapy delivered in the young person’s own home or local community, and the quality assurance systems.

The Brandon Centre

The Brandon Centre in London was funded by the Department of Health and charitable foundations to complete a small Randomised Control Trial of MST in partnership with Camden and Haringey Youth Offending Services.
Research and audit outcomes from the Brandon Centre study (December 2011) indicates that:
  • young people showed significant reductions in offending compared to usual services;
  • MST resulted in significant improvements in family relationships;
  • MST was more cost-effective than usual services.
The research team also published a qualitative study detailing families’ experiences of the MST therapeutic processes and outcomes (April 2012), which supports the MST theory of change.

START Research Trial 

To investigate further whether MST is an effective intervention for young people, families, and communities here in England and to test which young people and families it is most effective for, a multi-site Randomised Control Trial (RCT) - the START research trial - was commissioned in 2009 by Department of Education, Department of Health and the Youth Justice Board. The START research trial will also monitor outcomes for young people and families and calculate the cost-effectiveness of the program. The START team is led by Professor Peter Fonagy of University College London, working alongside colleagues in Leeds and Cambridge Universities. START recruited of 684 families across 9 MST sites. The study will also follow young people and families for two years post-intervention.

Click here for more information about the START research trial

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The effectiveness of MST-CAN was evaluated in a randomized controlled trial (Swenson, Schaeffer, et al., 2010 and Swenson & Schaeffer 2018) in South Carolina. The study involved 86 families implicated in a Child Protective Service’s report of physical abuse. This study showed that MST-CAN was twice as effective as the alternative outpatient therapy at preventing out-of-home placement. Moreover, MST-CAN was more effective at reducing parent’s physical and psychological aggression towards their children and neglectful parenting. MST-CAN also was more effective at reducing parent and child mental health problems and increasing natural social supports.
In the UK, of the 71 families evaluated during the pilot period;
  • 98% of children remain at home;
  • 97% are in school or working;
(Data period: July 2009 to May 2015)
There has been work to establish the cost-effectiveness of MST-CAN within the UK, Europe, and the US. A recent evaluation study in Leeds established during the pilot phase there was a £1.59 return for every £1 spent on the program. An evaluation of the Thurgau, Switzerland program indicated that MST-CAN was 16-50% lower than the costs of contingency plans. From the randomized trial in the US, MST-CAN realized the US $2.93 savings per dollar spent.
If you would like more information about MST-CAN in the UK, click here to request an information sheet or visit the MST-CAN website

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The study aimed to:
  • identify the issues in implementing MST-FIT;
  • determine whether it is a feasible intervention;
  • identify other groups for whom it may be suitable.

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