Therapy passes NZ test but has yet to stand trial

A first New Zealand trial and follow-up study of Multisystemic Therapy suggests a sizable impact on antisocial behavior among a population of ethnic white, Maori and Samoan adolescents.

The joint study by researchers at Massey University and the University of Central Queensland, Australia, points to improvements in rates of caution, arrest and conviction.

Developed in the US at the University of South Carolina in the late 1970s, Multisystemic Therapy is based on an “ecological model,” which considers antisocial behavior to be the product of factors, ranging from how a young person thinks to the influence of family and friends and school environment.

Primary point of contact is normally the family. Individual diagnosis is followed by behavioral therapy spread over around four months and involving several hours contact time a week.

The New Zealand trial was novel because it located the program in publicly-funded health centers, suggesting that it may be possible to transfer the focus to a public setting without lessening the program’s effect.

The findings are nevertheless limited because the researchers relied on a “pre-/post-test” design, assessing participants’ behavior before and after they took part.

In the absence of a randomized controlled trial, it is impossible to say if changes in behavior were a result of the program, or would have happened anyway (for example, because of increased maturity, improved school funding or a natural response to personal concern).

To arrive at their results, the researchers used a technique called benchmarking. They selected suitable indicators and compared performance recorded from previous evaluations with their own results.

As well as measuring outcomes such as offending rates and higher school attendance, the study also looked at “instrumental outcomes,” the intermediate steps necessary to reach them. There was significant improvement in these areas, too.

Other gains, such as contact with the police, and rates for school attendance and out-of-home placements, proved shorter term.

The authors suggest this may be because so many participants were in their mid-teens and making the transition into paid employment and independent living.

Half the battle in helping children to overcome antisocial behavior is getting them to complete a treatment program. Here the New Zealand findings were impressive: 98% made it through to the end.

There have been several other evaluations of Multisystemic Therapy outside the United States. See, for example, Norwegian researchers find flaws in 'gold standard' program review).

• For more about Multisystemic Therapy’s travels outside the US, see for example, $14m for UK pilots of Multisystemic Therapy Services Inc. [1] and Making sure the benefits aren’t lost in transit [2]

See: Curtis N M, Ronan K R, Heiblum N and Crellin K (2009), “Dissemination and Effectiveness of Multisystemic Treatment in New Zealand: A benchmarking study,” Journal of Family Psychology, 23, 2, pp 119-129