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UK & Ireland Research

Standard MST
MST Research Papers

Pattni, S, Fox, S & Glorney, E (2022), 'Therapist and supervisor experiences of the application of standard MST to young people with suspected or diagnosed Level 1 Autistic Spectrum Disorder', Journal of Family Therapyhttps://doi.org/10.1111/1467-6427.12396

Multisystemic Therapy (MST) is an intervention offered to young people presenting with antisocial and aggressive behaviour and is currently being adapted for use with the autism spectrum disorder (ASD) population. This qualitative study aimed to provide the first consideration of the experiences of MST therapists and supervisors of delivering standard MST to young people with suspected or diagnosed Level 1 ASD. Semi-structured interviews were carried out with 11 MST therapists and supervisors with experience of working with the client group. Thematic analysis identified three major themes: (1) nuanced delivery of MST for Level 1 ASD, (2) need for knowledge and resources, and (3) positive experiences with delivering the intervention.

Findings suggested the need for an increased focus on understanding the individual needs of a young person in assessment and intervention, the increased importance of structure and consistency, and psychoeducation for all systems around the young person in order to meet the developmental needs of young people with Level 1 ASD.

Bunting, A, Fox, S., Adhyaru, J., & Holland, A. (2021). Considerations for minority ethnic young people in Multisystemic Therapy. Clinical Child Psychology and Psychiatry. 26 (1), 268-282.


Research has indicated that multisystemic therapy (MST) is an effective treatment for youth with antisocial behaviours. This qualitative study explored minority ethnic young peoples’ experiences of MST, focusing on their understanding of their presenting difficulties and aspects of the intervention which facilitated or hindered engagement and change. Seven semi-structured interviews were conducted with young people from London who had taken part in MST. A constructivist version of grounded theory analysis was employed. Specific cultural theoretical codes emerged; understanding the family culture and the practitioner acting as a cultural broker, consideration of acculturation differences within the family, exploring the young person’s cultural identity and reflecting on cultural differences in the therapeutic relationship. Findings suggest potential advances to MST practice to meet the needs of minority ethnic young people, including the importance of appropriate training and supervision, sensitively working with salient cultural issues such as the impact of acculturation, and consideration of the role of therapist ethnicity and culture.


Khan, N., Fox, S., & Glorney, E. (2020). Practitioner experiences of working with ethnic minority families using Multisystemic therapy (MST). 

Existing research has focused on accounts of ethnic minority young people and caregivers using Multisystemic Therapy (MST), but research examining the perspectives of practitioners is lacking. Further, there has been little to advance understanding of ethnic minority groups that do not engage or complete treatment, or do not speak English. This study aimed to utilise the clinical experience of MST therapists and supervisors in order to better understand the issues facing ethnic minority families using MST, particularly those who are ‘harder to reach’.  A qualitative design using a constructivist version of grounded theory was used.  A purposive, theoretical sampling strategy led to a total of 22 participants. Data was collected from seven focus groups and one interview across three geographical regions of the United Kingdom (UK). Ten theoretical codes emerged in the current analysis, and were used to build a theoretical model to understand factors related to engagement and change for ethnic minority families.  These included: access; the family’s relationship to help; building a therapeutic alliance; family structure and functioning; acculturation and identity; the disempowered family context; working as a cultural broker; empowering families; power and language within the family; and working with interpreters. The analysis highlighted a number of novel findings. Overarchingly, this study draws attention to the systemic factors associated with power, culture and language, influencing the family’s journey through MST. 


Fonagy et al. (2020). Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): 5-year follow-up of a pragmatic, randomised, controlled, superiority trial. The Lancet, 7 (5) 420-430


Naughton, C., & Redmond, S.  (2019). Bail Supervision Scheme for Children: A Realist Evaluation of the Pilot Scheme.
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).
D I D  T H E  B A I L  S U P E R V I S I O N  S C H E M E  W O R K ?
Systematic analyses of both primary (research interviews)7 and secondary (administrative)8 data sources provide substantive evidence that the BSS contributed to positive changes in the participating young people’s behaviour. Using a quasi-experimental design in partnership with the An Garda Síochána Analysis Service (GSAS),9 the evaluation evidenced a 72 per cent reduction in reoffending (six months post-BSS compared with six months pre-BSS).

The control group (young people outside Court 55 for which the presiding Judge refused bail) experienced a reduction in reoffending of 37 per cent over an equivalent timeframe. As such, on average the young people enrolled on the BSS had a reduction in reoffending almost twice that of the control group. Combining findings from analysis of both Extern’s case records and interview data provides evidence that the young people who completed BSS with a planned exit10 showed marked improvement in adherence to bail conditions as the intervention progressed. Indeed, the majority of young people who completed the intervention demonstrated full adherence to bail conditions on exit. In addition, of the 13 young people who completed a full course of MST intervention, 11 attracted a non-custodial disposal at the sentencing hearing,11 thereby avoiding detention.


Pattni, S., Fox, S., & Glorney, E. (submitted). Therapists’ experiences of delivering MST to young people with ASD. Journal Family Therapy. 

Multisystemic Therapy (MST) is an intervention offered to young people presenting with conduct problems and is currently being adapted for use with the ASD population.  This qualitative study aimed to provide the first consideration to MST therapists’ experiences of delivering the non-adapted MST to young people with a mild Autism Spectrum Disorder (ASD), with a focus on the strengths and challenges associated with the model.  Semi-structured interviews were carried out with 11 MST therapists.  Thematic analysis identified three major themes: (1) Nuanced delivery of MST for ASD; (2) Need for knowledge and resources; and (3) Therapists had positive experiences when delivering MST to an ASD population.  Findings were discussed in light of the current application of MST.  Findings suggested the need  for an increased focus on understanding the individual needs of the young person in assessment and intervention, the increased importance of structure and consistency, and psychoeducation for all systems around the young person in order to meet the developmental needs of the young people with ASD.  Limitations and directions for future research were discussed.


European Multisystemic Therapy (MST®) Research Summary 2020 This document provides a summary of the many areas of MST research and proven outcomes conducted in Europe with traditional MST and MST clinical adaptations as well as research on the transport of MST to community practice settings.


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 the young people with behavioural 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‚Äźstructured 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 behaviour, and doing ‘whatever it takes’ to overcome challenges; while underpinning these were two categories of implicit roles related to coping with the organisational environment and interpersonal skill demands of the role. This study widens the understanding of both individual and organisational factors/climate and its impact on therapist performance in MST practice.

Multisystemic Therapy (MST) is an intervention offered to adopted young people presenting with antisocial behaviour. 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.
Evidence has shown that Multisystemic Therapy (MST) has been particularly effective in the treatment of youth with antisocial behaviour 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 analyse the data. Specific cultural theoretical codes that emerged were around the consideration of cultural difference in terms of the engagement process, the conceptualisation of difficulties and the therapist acting as 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 analyse 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 analyse 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 behaviour, 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 which 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 individualised 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 effectiveness 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 programme. 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.
The effectiveness of MST-CAN was evaluated in a randomised 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 UK, Europe and US. A recent evaluation study in Leeds established during the pilot phase there was a £1.59 return for every £1 spent on the programme. An evaluation of the Thurgau, Switzerland programme indicated that MST-CAN was 16-50% lower than the costs of contingency plans. From the randomised trial in the US, MST-CAN realised US $2.93 savings per dollar spent.

Bauch J, Hefti S, Oeltjen L, Pérez T, Cupit Swenson C, Fürstenau U, Rhiner B, Schmid M, Multisystemic therapy for child abuse and neglect: Parental stress and parental mental health as predictors of change in child neglect, Child Abuse & Neglect, Volume 126, 2022, 105489, ISSN 0145-2134. The following intervention study investigated whether changes in parental mental health and parental stress after MST-CAN are related to changes in child neglect. The findings suggest that parental stress might be a promising target for evidence-based interventions to reduce the occurance of child neglect.

The full study and findings can be accessed HERE.


If you would like more information about MST-CAN, click here to request an information sheet or visit the MST-CAN website www.mstcan.com
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.