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NICE guidance and MultisystemicTherapy for Young People

Dr. Jenny TaylorConsultant Clinical Psychologist & MST Team Manager

HackneyVina BrambleParent, Hackney

Cathy JamesChildren, Young people & Families leadPersonality Disorder Team, Department of Health

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Aim of presentation

Relevance of NICE guidance for youngpeople and families

Introduction to the Multisystemic Therapyprogramme in England

Parent and professional experience ofMST in London borough of Hackney

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NICE guidance 77

Guidance on Anti-social Personality Disorderpublished in January 2009

Includes prevention and interventions for

children & young people and families(1) For younger children, group parenting

programmes are effective but for adolescentswith more severe problems individualisedprogrammes, including Multisystemic Therapyare most effective

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Conduct Disorder & AntisocialPersonality Disorder

Significant chronic antisocial behaviour inteenage years conduct disorder

Approx a third of kids who meet criteriafor conduct disorder go on to meet criteriafor Antisocial Personality Disorder inadulthood

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Recognition of developmental context

People with ASPD have often grown up in fractured families inwhich parental conflict is typical and parenting is harsh andinconsistent. As a result of parental inadequacies and/or thechilds difficult behaviour, the childs care is often interrupted and

transferred to agencies outside the family. This in turn oftenleads to truancy, having delinquent associates and substancemisuse, which frequently result in increased rates ofunemployment, poor and unstable housing situations, andinconsistency in relationships in adulthood. Many people withASPD have a criminal conviction and are imprisoned or die

prematurely as a result of reckless behaviour.

NICE clinical guideline 77

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What is Multisystemic Therapy?

An intervention program for young peopleat risk of care or custody due tosignificant anti-social behaviour

Developed in the USA Currently being researched here to

compare its efficacy against standardtreatments

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Multisystemic Therapy in England

2008 Ten pilot sites of MST were established as part ofa national research programme into effectiveness ofthe model in England: Barnsley, Greenwich, Hackney,

Leeds, Merton & Kingston, Peterborough, Plymouth,Reading, Sheffield & Trafford Building on the experience of the two existing

licensed MST sites in England (Cambridgeshire &Brandon Centre in North London) and of programmes

in Northern European Sites are funded over four years by Department of

Health, Department for Children Schools and Familiesand Youth Justice Board

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MST in Hackney

Service opened in October 2008

Staff team:

MST Supervisor/Manager (plus 2x backupsupervisors)

4 x MST Therapists

MST Administrator

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MST: the intervention

What does it actually involve?

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The ecological model

Child

Family

Peers

School

Neighborhood

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How does MST differ from otheravailable interventions?

Prioritising evidence-based interventions

Delivered in a way that engages families Focus and quality control Emphasis on long term sustainability

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Referrals from 1/10/08 1/10/09

58 referrals 33 families worked with

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Families worked with over the last year

Of the 33 who went on to treatment:

16 closed and completed 5 closed without completion 12 in progress

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And what about theoutcomes..?

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Outcomes in terms of familysatisfaction

I loved MST, its a really great service and ithelped my family loads. It taught me thetechniques of doing the fit circles and things to

do in different situations and this has reallyhelped, Im missing MST

You are the only thing (Service) weve everstuck with

MST Support when no one else did, made adifference when nothing else did.

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Outcomes in terms of living at home

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Outcomes in terms of education

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Outcomes in terms of offending