NICE guidance and Multisystemic Therapy for Young People

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NICE guidance and Multisystemic Therapy for Young
People

• Dr. Jenny TaylorConsultant Clinical Psychologist
  MST Team Manager
• Hackney
• Vina Bramble
• Parent, Hackney
• Cathy James
• Children, Young people Families lead
• Personality Disorder Team, Department of Health

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Aim of presentation

• Relevance of NICE guidance for young people and
  families
• Introduction to the Multisystemic Therapy
  programme in England
• Parent and professional experience of MST in
  London borough of Hackney

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NICE guidance 77

• Guidance on Anti-social Personality Disorder
  published in January 2009
• Includes prevention and interventions for
  children young people and families(1)
• For younger children, group parenting programmes
  are effective but for adolescents with more
  severe problems individualised programmes,
  including Multisystemic Therapy are most effective

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Conduct Disorder Antisocial Personality
Disorder

• Significant chronic antisocial behaviour in
  teenage years conduct disorder
• Approx a third of kids who meet criteria for
  conduct disorder go on to meet criteria for
  Antisocial Personality Disorder in adulthood

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Recognition of developmental context

• People with ASPD have often grown up in
  fractured families in which parental conflict is
  typical and parenting is harsh and inconsistent.
  As a result of parental inadequacies and/or the
  childs difficult behaviour, the childs care is
  often interrupted and transferred to agencies
  outside the family. This in turn often leads to
  truancy, having delinquent associates and
  substance misuse, which frequently result in
  increased rates of unemployment, poor and
  unstable housing situations, and inconsistency in
  relationships in adulthood. Many people with ASPD
  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 people at risk
  of care or custody due to significant anti-social
  behaviour
• Developed in the USA
• Currently being researched here to compare its
  efficacy against standard treatments

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Multisystemic Therapy in England

• 2008 Ten pilot sites of MST were established as
  part of a national research programme into
  effectiveness of the 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
  Families and Youth Justice Board

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MST in Hackney

• Service opened in October 2008
• Staff team
• MST Supervisor/Manager (plus 2x backup
  supervisors)
• 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
Neighborhood
School
Peers
Family
Child
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How does MST differ from other available
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 the outcomes..?
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Outcomes in terms of family satisfaction

• I loved MST, its a really great service and it
  helped my family loads. It taught me the
  techniques of doing the fit circles and things to
  do in different situations and this has really
  helped, Im missing MST
• You are the only thing (Service) weve ever
  stuck with
• MST Support when no one else did, made a
  difference 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