Research

International Evidence Base

MST Services
 
MST was originally developed in the USA building on the best evidence of what worked for keeping young people at home with their families and tackling problems with offending and anti-social behaviour. Over the last 30 years a number of research trials across the world have shown MST to be effective in reducing offending and improving family relationships and also to be cost effective.
 
Results from international research shows MST leads to:
  • long-term re-arrest rates reduced by median of 42%;
  • out-of-home placements, across all studies, reduced by a median of 54%;
  • improved families functioning;
  • decreased substance use;
  • fewer mental-health problems
  • higher levels of client satisfaction;
  • considerable cost savings.
 
MST’s positive results are long lasting
 
A 14-year and 22-year follow-up study by the Missouri Delinquency Project showed young people who received MST were still significantly less likely to be rearrested or placed away from home in care or custody than their comparison group.
 
For more information about MST's evidence base, please download the MST Research At A Glance document or visit the MST Services website.
 
 
MST has proven the importance of treatment adherence
 
A large, 45-site study on the transport of MST involving almost 2,000 families, and more than 450 therapists and 80 supervisors, concluded:
  • High therapist adherence can reduce the number of young people with criminal charges by 36 percent at 2.3 years after treatment;
  • high supervisor adherence can reduce the number of young people with criminal charges by 53 percent at 2.3 years after treatment;
  • MST has been effectively transported to community practice settings;
  • MST currently has more than 500 active programmes;
  • adherence measures demonstrate that MST is being delivered with high levels of fidelity;
  • outcomes in community practice settings are similar to those of university-based trials.
 

UK Research

The Brandon Centre
 
The Brandon Centre in London has been running a Multisystemic Therapy (MST) programme since 2001 and 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.
 

MST Research Papers

Fox, S., Bibi, F., Millar, H., & Holland, A. (2016). The role of cultural factors in the engagement and change in Multisystemic Therapy. Journal of Family Therapy, DOI: 10.1111/1467-6427.12134

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.

 

Kaur, P., Pote, H., Fox, S., & Paradisopolous, D. (2015). Sustaining change following multisystemic therapy; caregivers’ perspectives. Journal of Family Therapy. DOI: 10.1111/1467-6427.12093

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.

 

Paradisopoulos, D., Pote, H., Fox, S & Kaur, P. (2015). Developing a model of sustained change following Multisystemic Therapy: Young people’s perspectives. Journal of Family Therapy. DOI: 10.1111/1467-6427.12070

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.

 

Fox, S., & Ashmore, Z. (2014). Multisystemic therapy as an intervention to prevent young people entering the care system.  British Journal of Social Work. 1-17. DoI 10.1093/bjsw/bcu054

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.

 

Ashmore, Z., & Fox, S. (2011). How does the delivery of Multisystemic therapy to adolescents and their families challenge practice in traditional services in the Criminal Justice System? The British Journal of Forensic Practice, 25-31.

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.

 

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 has now completed recruitment of 684 families across 9 MST sites. The study is following young people and families for two years post intervention and will report findings on outcomes for young people and families and on cost effectiveness of the programme in 2017.
 
 
STEPS-B research study
 
STEPS-B (Services for Teens Engaging in Problem Sexual Behaviour) is a research study investigating a form of intervention for young people and their families where young people are displaying problem sexual behaviour. These young people may also be having difficulties at home, at school and sometimes with the law. The study is looking at services working in fourteen London boroughs; Barking and Dagenham, Barnet, Brent, Camden, Ealing, Enfield, Hackney, Haringey, Islington, Lewisham, Merton, Newham, Southwark, Tri-borough (Westminster, Hammersmith & Fulham, & Kensington & Chelsea) and Waltham Forest.

Click here for more information about the STEPs B trial

Click here to view the STEPS-B referral leaflet