Multi-Systemic Therapy (MST) Katherine Mackay / Debbie Thorp 12 August 2010

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Multi-Systemic Therapy (MST) Katherine Mackay / Debbie Thorp 12 August 2010 1

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Multi-Systemic Therapy (MST) Katherine Mackay / Debbie Thorp 12 August 2010. 1. 2/5 (two fifths) of children diagnosed with a behaviour disorder still have the same diagnosis 3 years later. 2. Programme Description. - PowerPoint PPT Presentation

Transcript of Multi-Systemic Therapy (MST) Katherine Mackay / Debbie Thorp 12 August 2010

Page 1: Multi-Systemic Therapy (MST) Katherine Mackay / Debbie Thorp 12 August 2010

Multi-Systemic Therapy(MST)

Katherine Mackay / Debbie Thorp12 August 2010

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Page 2: Multi-Systemic Therapy (MST) Katherine Mackay / Debbie Thorp 12 August 2010

2/5 (two fifths) of children diagnosed with a behaviour disorder still have the same diagnosis 3 years later

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Programme Description

MST is an intensive family and community based intervention which targets the multiple causes of serious anti-social behaviour in young people. It is aimed at preventing anti-social and offending behaviour and resultant out of home placements

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Programme Aims

Enable young people to remain at home with their family

Re-engage young people in an educational or vocational placement

Enable young people to avoid offending behaviour and involvement with the Youth Justice System

Reduce behavioural difficulties Increase the family’s ability to manage

independently and reduce families involvement with multiple and costly intensive services

Return young people to pro-social activities

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Target Group

Young people, 11 (secondary school age) to 17 years old, at imminent risk of out-of-home placement (in care, residential school or secure setting) due to anti-social or offending behaviours.

Young People with behavioural difficulties who have complex social, educational and clinical needs

Young people known to two services – CAMHS, Social Care, YOS, EWO

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Typical Referral Behaviours

Truancy or school exclusion Verbal aggression and threats of

harm Physical aggression (violence,

fighting, property destruction) Offending behaviour Drug and alcohol problems Serious risk taking behaviour Association with anti-social peers

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Income Grant for MST

Year 1 - £345,000 Year 2 - £287,000 Year 3 - £222,000 Year 4 - £150,000

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Research Evidence Based

In comparison with control groups, MST: Higher consumer satisfaction Decreased long-term rates of re-arrest

25% to 70% 47% to 64% decreases in long-term rates

of days in out-of-home placements Improved family relations and functioning Increased mainstream school attendance Decreased adolescent psychiatric

symptoms Decreased adolescent substance use Cost effective compared to out-of-home

placement

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Cost Comparisons UK

Family Information Direct –£33.86 per family via telephone helpline£1.95 per family via digital services

Co

st p

er

child

/ fa

mily

Severity of need

Cost

Family Intervention Projects –£8-20,000 per family per year

Family Nurse Partnerships – £3,000 per family per year

Child looked after in children’s home – £125,000 per year

Child looked after in foster care – £25,000 per year

Schools - £5,000 per pupil

Children’s Centres - £300 for each 0-5 year old

Costs increase as children get older

Multi-dimensional Treatment Foster Care - £70,000 per year

Child looked after in secure accommodation –£134,000 per year

Parenting programme –£900-1,000 per family

Unit costs at different levels of need

MST

Multisystemic Therapy –£6000-£8000 per family

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Lessons Learnt So Far

It takes time to develop a new service Initial referrals were the most complex in

Trafford and this impacted on staff who were newly trained

There was confusion for referrers with many similar new projects starting at the same time.

There needs to be more work with schools. We needed to develop a system to improve

through put and reduce assessment time.

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MST in Trafford

Progress: a developing service

Performance Indicator Target MST Key Data (N=8) PIR (N= 10) Last 3 months (N=6)

ULTIMATE OUTCOME DATA  1/07/2009 to

31/12/200901/8/2009 to

01/02/201031/12/2009 to

31/03/2010

Percent of youth living at home 90% 71% 80% 100%

Percent of youth in school/working 90% 71% 80.00% 80%

Percent of youth with no new arrest  90% 71% 60.00% 100%

CASE CLOSURE DATA        

Average LOS in treatment 120 195 177.4 140.8

Percent of cases completing treatment 85% 85% 80% 80%

Percent of cases due to lack of engagement <5% 0% 10% 16%

Percent of youth placed 10% 14% 10% 0%

ADHERENCE DATA        

Overall Average Adherence Score 0.61 0.53 0.48 0.68

Percent of clients reporting above 0.61 80% 54% 50% 62%

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Cases seen by new serviceJune 08-August 10

05

1015202530354045

numberof girls

numberboys

referred

referred

treated or arein process ofbeing treated

withdrawn orunsuitable

Length of stay – 100-140 days

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6 months follow up : Trafford's first 8 ( T2) (T1 = at start of MST)

5 completed treatment 2 young people placed in care

DM – transferred to Me2 KB - going through Care

Proceedings One went to custody for

offense committed in first month of MST

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Positive Outcomes for Young People

Number of Identified Issues

0

1

2

3

4

5

6

CJ DM GM JS KB KS NB RL

T1

T2

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Cost Savings

Number of Professionals / Services involved 6 months pre / post MST

0

1

2

3

4

5

6

CJ DM GM JS KB KS NB RL

T1

T2

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Costs of Services per week

MST costs - £250.00 Placement in Trafford Children’s Home -

£2,400.00 Hospital care - £2,400.00 Secure placement - £5,000.00

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Cost Savings

Average Number of Professional Meetings

0

1

2

3

4

5

6

7

8

9

10

CJ DM GM JS KB KS NB RL

T1

T2

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Cost Savings to Trafford

Number of Services Young Person is known to

0

1

2

3

4

5

6

7

8

CJ DM GM JS KB KS NB RL

T1

T2

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Cost Savings

Number of home visits 6 months pre / post MST

0

5

10

15

20

25

30

CJ DM GM JS KB KS NB RL

T1

T2

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Qualitative Data

What Service Users Say… My behaviour towards them (the family) has

improved. I’m calmer now – not losing it. MST helped us to look at ourselves. The school contracts are very good. We needed a referee, a co-ordinator – that referee was MST, [therapist] always remained neutral and very calm

Got us communicating Just FAB. Couldn’t ask for anyone better Seemed to go on for a long time at the start. I’m

more aware of how I feel – moods Changed my way of thought, made me stronger

as a parent. MST has made me think of alternative ways of dealing with confrontations, demands which have been unreasonable, bad behaviour etc

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Successes Outcomes are improving with each ‘round’ of

cases New protocols have been developed to improve

efficiency Customer (referrers and families) satisfaction is

extremely high Team adherence (our measure of effectively

implemented MST) is increasing well above the threshold

Preparing to go into the research phase Good staff retention throughout the project so far Team up to capacity caseload Completion of work within specified time limit 3-5

months Trafford has an internationally recognised ‘Gold

Standard’ intensive intervention in MST

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Current Focus Established a Multi Agency MST Referral

Panel Clearer referral pathway Completion of National Research Ongoing measurement of local statistics Wider Systemic change in the

community Further promotion of MST Provisional Licensure replaced by full

Licence ensuring effective service deliverance

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Improving Outcomes for Young People

Number of Offending (all) prior to MST / 6 months post MST

0

0.5

1

1.5

2

2.5

3

CJ DM GM JS KB KS NB RL

T1

T2

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Outcomes Nationally

Cost effectiveness research on MST from Washington State Institute for Public Policy suggests that £5 is saved for every £1 invested in the programme. In the UK young people with conduct disorder currently cost public services 28 x the costs of young people without conduct disorder between the ages of 10 and 28 years (Scott and Knapp 2001)