Will Multisystemic Therapy work across the pond?
When I was first introduced to MST about two years ago, I approached it with a healthy dose of caution. Among my questions were will what works in the U.S. translate to the U.K.? Do the positive outcomes reflect actual impact or clever evaluation? Does this service cherry-pick and therefore is guaranteed to get good outcomes? And as a licensed provider, will we be micro-managed by MST-UK? The program sounded very prescriptive, and I had the sense that it was “painting by numbers.”
My organization, Action for Children, is driven to ensure that all our services have a positive impact on children, young people and their families. In addition, we have a growing interest in specific programs that are underpinned by a strong evidence base. Naturally, one of our primary charitable objectives is that our fundraised and contracted incomes are spent efficiently and effectively.
Rigid for a reason
We have delivered MST for more than 12 months, and my views have changed substantially. I now know that the prescriptive nature of the program, which at first seemed so strict, is the key to the quality of the service delivered. The case-conceptualization process keeps every therapist and family on track, and minimizes the risk of cases drifting or just being experimental interventions. Absolutely, our service cherry-picks cases—but not in the way you’d think. They aren’t the “easy” ones—they are the young people who fit the MST criteria and for whom there is a strong evidence base that tells us we can make a difference. For me, “cherry-picking” means finding the right intervention for the right young person. We should not be taking cases that don’t fit our criteria. We would only be wasting our commissioners’ money and possibly not making any immediate or sustainable difference for that young person. The MST model has a huge potential for therapists to be creative and innovative in how they work with individual families—whether that be using role-play to practice and embed new behaviors and language, establishing individualized reward charts or just knowing when that well-done message is needed to keep families focused.
The support from MST-UK has also been instrumental in developing our organizational knowledge, as well as supporting our local service to stay on track and take action at the earliest indication of concern. MST-UK’s weekly clinical oversight is crucial. Their engagement in our steering group has helped important stakeholders to understand where MST fits within the wider local authority offer and has aided the development of a MST supporters’ network.
From Skeptic to Supporter
The MST model, with all the quality-assurance processes in place, is delivering positive outcomes for us. Whether you’re the organization delivering, the supervisor overseeing, the therapist mentoring or family receiving—there is no place to hide. This makes the service accountable and transparent, as all services should be.
Helen McKee is the operational director of children's services at Action for Children. She supports both the Manchester and Wigan MST teams as Program Manager.
To learn more about what makes MST such an effective intervention, download this white paper.