Multisystemic Therapy Rockingham

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Multisystemic Therapy Rockingham Striving to
Achieve Consilience in Collaboration
Annette Paul (Clinical Psychologist)? Dr Kristin
Wallengren (Forensic Psychologist)? Romana Lee
(Clinical Psychologist)?
MST Program - Rockingham
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The Presentation

• Definition of Collaboration and Consilience
• A brief overview of MST
• Collaboration in MST
• A typical MST family
• Consilience as a goal
• Summary and Questions

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The Presenters

• Centres on our experiences of collaboration and
  consilience as clinicians
• Varied work experience, settings and models
• Working within MST model - experience in MST
  Program ranging from approximately 8 months to
  over 19 months

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Definitions
Collaboration - Collaboration is a structured,
recursive process where two or more people work
together toward a common goaltypically an
intellectual endeavour that is creative in
natureby sharing knowledge, learning and
building consensus. Collaboration does not
require leadership and can even bring better
results through decentralisation and
egalitarianism. In particular, teams that work
collaboratively can obtain greater resources,
recognition and reward when facing competition
for finite resources. Wikipedia
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Definitions
Consilience - A term used in natural sciences to
mean Linkages of facts, methodologies and
theories across scientific domains and multiple
nested levels of complexities. Such consilient
connections, of course, often serves as the
essential precursors to discoveries of great
importance. Rand Iiardi, 2005, p 8
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Consilience

• William Whewell, a 19th century philosopher, used
  consilience in his book The Philosophy of the
  Inductive Sciences in 1840 to describe the
  interlocking of explanations of cause and effect
  between disciplines
• derived it from the Latin word consilere, formed
  from con-, with, and salire, to leap
• Edward O Wilsons best selling book Consilience
  the Unity of Knowledge
• a jumping together, encouraging those who study
  the sciences, the humanities and the arts to
  bridge the gaps between their narrow specialities
  and so link together all the branches of learning
• http//www.worldwidewords.org/turnsofphrase/tp-con
  1.htm

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Consilience in Practice
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Achieving Consilience Through Collaboration
The convergence of understanding from many
different fields...derives from an old English
word meaning the unity of knowledge. This is
characterised by ajoining together of knowledge
across disciplines by the linking of facts and
fact-based theory to create a common groundwork
of explanation...recognising the benefits of
partnership in exploring causal pathways and
developing and introducing interventions that
will serve a mutuality of interests. Vimpani,
Patton Hayes, 2002, p. 20
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Challenge in Consilience
A common challenge across many professional
groups is the operational embodiment of the
principles of consilience the need for
effective interprofessional and intersystemic
collaboration at the local level to facilitate
improved functioning of the social ecology of
the family. Vimpani, Patton Hayes, 2002, p. 26
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MST is
Based on a social ecological theoretical model
in which behaviour is viewed multi-determined by
individual, family, school, peers, community
systems that are interconnected and have
reciprocal influences. According to the social
ecology model, (A) behaviour is best understood
viewed within its natural occurring context (B)
to maximise the probability of achieving change,
treatments must have the capacity to address
various subsets of the factors contributing to
identified problems. Schoenwald, Brown
Henggeler (2000), p113-114

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MST is

• An evidence based program - over 20 years of
  published research on working with antisocial
  behaviours
• The team is comprised of psychologist/social
  workers including a specialist Indigenous
  clinician
• The program focus is on severe behavioural
  problems in 12 to 16 years old
• Often, referrals are received where other
  interventions have failed
• The young person is at imminent risk of being
  expelled from school and/or placed out of the
  home
• 24/7, time-limited (4-6 months), outreach and
  home-based intervention
• The aim is to increase skills of the parents,
  empowering them to successfully manage the
  behavioural problems of the young person

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9 Principles of MST
Understanding the fit Positive and strengths
focused Promote responsible behaviour Interventio
ns are present focused and action oriented Target
sequences of behaviour Interventions are
developmentally appropriate Interventions
require daily or weekly effort Continuous
evaluation from multiple perspectives Generalisati
on long-term maintenance
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The program uses the strengths in all these
systems to facilitate change
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Clinicians Role

• Work with the caregiver/family as primary client
  to -
• Reduce offending and anti-social behaviour
• Reduce substance misuse
• Improve caregiver discipline practices
• Enhance family relationships
• Emphasis on parental empowerment
• Decrease youth association with anti-social
  peers
• Increase youth association with pro social peers
• Improve youth school or vocational performance
• Develop a support network of extended family,
  neighbours, and friends to help caregivers
  achieve and maintain changes

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Collaboration in MST

• Many different levels

Client - family Fellow Clinicians Clinical
Supervisor MST Consultant Local Community Support
Services
Clinician
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The MST Family

• Genogram

Partner 2
Partner 1
Partner 3
Mum
42
12
19
22
16
14
8
5
4
4
Child 1
Child 2
Child 3
Child 4
Child 5
Child 7
Child 6
Child 8
Child 9
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The Family Profile

• An Aboriginal family based in metropolitan Perth
• Single Mum - 42 years old
• Children - 9 with ages ranging from 4 to 22
• 5 children under the age of 14, with a set of
  twins
• Children all reside at home
• All the children have significant educational
  needs
• Oldest daughter - head trauma
• Extended family members often reside at the home
  - 20 individuals in the home

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Referral Behaviours

• Engaging in anti-social behaviours (including
  lower end of offending)?
• Physical and verbal aggression at home and in the
  community
• Low school engagement - poor attendance and
  truancy
• Substance use
• Running away from home

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Sources of Referral

• The referral for this family came from Department
  of Education and Training (DET)?
• Referrals - 40 DET, 40 CAMHS, 20 Others
  (including SHAP and DCP)?

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Typical Characteristics of the MST Family
Housing - substandard housing, no electricity or
heating, overcrowding, threat and experiences of
eviction, vandalism. Financial Issues - extended
debts fines no money for basics. Family - lack
of positive role models extended family in the
justice system direct or vicarious violence
drug use, single parent, mental health
issues Transport - no phone or car in case of
emergency, or no valid MDL, poor public transport
system Educational/Vocational - unemployment low
to no positive experience of education and
school disconnectedness Agency Contact - Poor
relationship with agencies, avoidant, failure to
follow through with appointments, complex needs
requiring multiple agency involvement, past
failures
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Agencies Involved

• DCP
• Housing
• SHAP
• (Supported Housing Assistance Program)?
• Schools
• DET Representative
• Mentor
• (Retention and Participation Program)?
• Centrelink

• Employment Assistance Agencies
• Neighbourhood Watch
• Community Justice Services
• Strong Families
• Police
• Salvation Army
• St Vincent de Paul
• Odyssey House
• (funding agency)?

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MST - Meeting the Challenge

• Assessment Phase
• Inherent within the model is the need for a
  comprehensive assessment (finding the fit)?
• Collaboration with all stakeholders is a
  prerequisite. This is often a challenge for the
  clinician
• Consilience (unity of knowledge) through
  collaboration provides the clinician with
  information that is from multiple perspective,
  rich and complex, and is then the foundation for
  intervention and intervention implementation
  plans
• We strive to formulate goals and interventions
  for the family that address community concerns
  and can be supported by the community (family,
  school, peers, neighbourhood, agencies)?

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MST - Meeting the Challenge

• How does MST meet that challenge?
• The Assessment process of our MST family
• Stronger Families meetings provided the forum for
  agencies to meet
• The goal of these meetings is to have all
  agencies that have a vested interest (mandated
  and voluntary) come together to assist the family
  and problem solve
• All agencies have their own focus, agenda and
  goals
• Low school attendance/truancy
• School and Mentor wanted to have increased
  parental involvement in getting the YP to school
  on time, fully equipped, prepared for a day of
  learning without the disruptive behaviours
• Neighbourhood Watch Committee, Police, Homeswest,
  and SHAP wanted the YP in school so that she was
  not at home during school week, increasing the
  opportunity to engage in anti-social behaviours
• DCP, Police, and NW were concerned about the
  general well being and welfare of the YP when she
  was not at school because there was inadequate
  adult supervision when she is at home during
  school hours
• Mum and the YP wanted greater support from the
  education system, including educational aid
  support time so that the YP can attend school for
  longer period during the day and to be moving
  towards participation in the mainstream system

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Fit Circle

Poor communication with the school
Lack of support
No consequences or rewards
Truancy
Poor attendance of other siblings
Low monitoring
Mums lack of energy
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MST and Consilience

• In working collaboratively and in partnership
  with all parties involved (individuals
  agencies)
• shared knowledge of that family and the systems
• gain richer information of possible causal
  pathways
• develop more appropriate strategies and
  interventions delivered across systems by all
  agencies involved, especially the parents as
  change agents
• achieve sustainable and meaningful outcomes for
  the family which all agencies have contributed
  towards
• the outcomes meet agencies needs as well as
  those of the families

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Consilience through Collaboration

• Achievements for the MST family
• School is supportive of the YP and the family -
  communication between parent and school greatly
  improved, school providing physical resources,
  supporting the YP to enter mainstream education.
  School looking at providing extra remedial
  support targeting the needs of all the children
  attending the school, school and MST collaborated
  on an application for additional funding for
  remedial assistance, DCP collaborated with DET to
  provide funding for mentoring support...

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Consilience through Collaboration

• Housing - Recognising the needs of the community
  and the family, appropriate housing was sourced
  by the Housing Commission whilst anti-social
  behaviours were managed and addressed in
  collaboration between Police, SHAP, MST and the
  family
• Improved communication - The communication
  between the mother and the agencies was greatly
  improved. There was a sense of collaboration and
  the consilience achieved by the group. This lead
  to significant gains for the family and the
  agency workers
• Funding grant application made in collaboration
  between agencies driven by MST Clinician to
  support the family with additional educational
  needs that have not been met

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Consilience through Collaboration

• The collaboration and the resulting consilience
  has had an impact on the general well being of
  the children, the family and the community as a
  whole -
• DCP no longer actively involved
• no Police call outs
• little to no tension in the neighbourhood
• increased parental involvement, monitoring and
  supervision
• The children actively engaging in the education
  system and being supported by the school

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Summary

• How is consilience nested in MST?
• Expectation within the model and inherited in the
  model theory, training and practice at all
  levels
• Collaboration occurs at all levels and
  consilience is the key in understanding the
  system (the fits)?
• Beyond collaboration to consilience in
  assessment, goal identification, intervention
  planning, implementation, and evaluation

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Further Information

• For further information on anything related to
  MST, may we suggest the following site
• www.mstservices.com

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References

• Rand, K L and IIardi, S S (2005), Toward a
  Consilient Science of Psychology. Journal of
  Clinical Psychology, Vol. 61(1), 7-20.
• Henggeler, S W, Schoenwald, S K, Borduin, C M,
  Rowland, M D and Cunningham, P B, (1998),
  Multisystemic Treatment of Antisocial Behaviour
  in Children and Adolescents, New York, Guildford
  Press.
• Schoenwald, S K, Brown, T L and Henggeler, S W,
  (2000), Inside Multisystemic Therapy Therapist,
  Supervisory and Program Practices, Journal of
  Emotional and Behavioural Disorders, Vol. 8(2),
  113-127.
• Vimpani, G., Patton G. and Hayes, A. (2002), The
  Relevance of Child and Adolescent Development for
  outcomes in Education, Health and Life Success.
  In A Sanson (Eds.), Childrens Health and
  Development New Research Directions for
  Australia, (pp.14-33). Melbourne Australian
  Institute of Family Studies, Research Report No.
  8. http//www.aifs.gov.au/institute/pubs/resreport
  8/main.pdf
• Wikipedia http//en.wikipedia.org/wiki/Collaborat
  ion

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Thank you