Confidence among UK policy makers in the value of 'proven models' for dealing with antisocial behavior has been given fresh momentum by the announcement that the government is to fund trials of Multisystemic Therapy in up to six sites.

Developed during the 1970s by the Family Services Research Center at the Medical University of South Carolina, Multisystemic Therapy (MST) is described as a family and community-based treatment for young people with complex clinical, social, and educational problems, including violence, drug abuse and school expulsion.

The program is licensed and 'manualised,' and is notable for the level of expertise it requires of teams of practitioner-therapists who receive continuous coaching from Multisystemic Therapy Services Inc. in the US.

The UK initiative, which invites local authorities and primary care trusts to bid for a share of $14million for pilot projects, follows a review of the outcome evidence by David Utting and colleagues at the Policy Research Bureau. They assessed and compared the benefits of six proven models, the others being: Functional Family Therapy, Multidimensional Treatment Foster Care, Nurse Family Partnership, The Incredible Years and Triple P.

As the Utting review explains, evidence for the effectiveness of MST has been persuasive but not unequivocal.

Several randomized controlled trials have reported positive results and the program is one of 11 included on the Blueprints for Violence Prevention database. However, the results of some trials have been less compelling, and in 2005 a systematic review for the Cochrane Collaboration by Julia Littell and colleagues failed to find any conclusive evidence that MST was any more effective than any other intervention.

Their findings provoked a strong rebuttal in the Children and Youth Services Review by the program’s designer Scott Henggeler and were also the subject of sceptical re-analysis by Terje Ogden and Kristine Amlund Hagen at the Norwegian Center for Child Behavioral Development (see Norwegian researchers find flaws in "gold standard program review").

The UK investment is predicated on the evidence that MST is capable of reducing levels of offending, family conflict and placement away from home by engaging antisocial young people and their families in tailored, community-wide interventions.

Government interest in rigorous evaluation of the initiative has been markedly absent – but seems to be improving. No mention was made in the latest announcement of an experimental evaluation of MST – the first of its kind in Britain – being undertaken by The Brandon Centre. The first phase of the work relied on private funding – from The Atlantic Philanthropies and the Tudor Trust – but the Department of Health is supporting the last two years of the trial from April 2007 to March 2009, when the findings will begin to be published.

The Brandon Centre trail is being run in partnership with Camden Youth Offending Service and Haringey Youth Offending Service.

references

David Utting, Helen Monteiro and Deborah Ghate (2007) Interventions for children at risk of developing anti-social personality disorder, London, Policy Research Bureau (available from Sharon Lawson at the Thomas Coram Research Centre: s.lawson@ioe.ac.uk).

Littell, J. H., Popa, M. & Forsythe, B. (2005) Multisystematic therapy for social, emotional, and behavioral problems in youth aged 10-17. The Cochrane Database of Systematic Reviews, 2005, Issue 4.

Scott Henggeler, Sonja Schoenwalda, Charles Borduinb and Cynthia Swenson (2006) Response Children and Youth Services Review Volume 28, Issue 4, pp. 447-45