multi-systemic therapy (mst) katherine mackay / debbie thorp 12 august 2010
DESCRIPTION
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 PresentationTRANSCRIPT
Multi-Systemic Therapy(MST)
Katherine Mackay / Debbie Thorp12 August 2010
1
2/5 (two fifths) of children diagnosed with a behaviour disorder still have the same diagnosis 3 years later
2
3
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
4
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
5
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
15
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)