Secure Placement Seemed the Only Option Until MST

Posted by Gordon Wilson

Dec 1, 2015 8:30:00 AM

The last stop before placement: Multisystemic Therapy

At 15, Charlotte had one foot out the door on the way to secure accommodation placement. While she had her grandmother, Doreen, who loved her and was her primary caregiver, as well as an uncle and her mother in the same household, Charlotte’s behaviors were so risky that professionals involved with the family felt that sending her to a secure placement was the only way to keep her safe. 

Charlotte was using illegal substances daily, which at times resulted in the need for medical attention. She was involved in drug dealing and ran away from home frequently. Despite her young age, Charlotte had more than 30 incidents in which police were involved, often stemming from drunk and disorderly conduct. If the family attempted to address her behaviors, Charlotte responded with verbal and physical aggression until the family resigned themselves to her choices.

At the time of her referral to MST,  Doreen was not able to keep her granddaughter from going out, and Charlotte was uncontrollable at home. Doreen also had to consider the impact Charlotte’s behaviors were having on the rest of the family. While she wanted to keep the girl home, she was beginning to believe it was not safe to do so.

Devising a safety plan

The immediate focus for Gordon, the MST therapist, was safety. He worked with the whole family to create a plan for getting Charlotte back when she went missing. Alongside retrieving Charlotte when she left without permission, the family increased their supervision and monitoring of her in the community. The extended family worked together to supervise the teenager 24/7. This eliminated access to drugs and drug dealing and made associating with antisocial peers impossible.

This emphasis on safety outside the home came at a price. Charlotte’s aggression when she was home increased as she challenged her grandmother’s interventions. This led to Doreen and Gordon working on de-escalating the girl’s aggression. The grandmother’s focus and commitment to de-escalation meant that Charlotte’s behaviors would no longer get her what she wanted, and so the behaviors decreased. As Doreen increased her strategies and abilities to deal with her granddaughter, she gained the confidence and motivation to continue the work even when Charlotte was testing the boundaries.

Gradual improvements

The early and intense focus on retrieval and supervision resulted in 10 weeks without Charlotte going missing and eight weeks without substance abuse at the time of discharge. With Doreen and the family interacting differently with Charlotte, her verbal aggression significantly decreased in frequency, and there was no physical violence for the last eight weeks of treatment. By the end, Charlotte expressed herself calmly and people listened to what she was saying instead of reacting negatively. With the safety risk-managed, the family could collaborate with her school and work to greatly improve Charlotte’s attendance, offering her opportunities to connect with prosocial young people. The reduction in negative behaviors meant the relationships in the home and within the extended family got better.

Ultimately, professionals no longer thought secure accommodation was necessary. The social worker involved in the case reported that MST intervention had been “very successful.” Further, she stated, “The change was gradual and the support from MST was consistent and acceptable by the carer ... I was very impressed by the detailed safety plan that was devised by Gordon, which is a very useful tool for the professionals who are working with this child and also for the [maternal grandmother] in the future.”

Doreen was thankful to have MST and wished it had been available earlier. Supported by the therapist, she now has a clear course for maintaining the improvements in Charlotte’s behaviors and keeping her out of harm’s way.

Gordon Wilson is an MST therapist at Action for Children in Essex, UK, and a winner of our success story contest. 

To learn more about how MST can help treat teen substance abuse read this white paper.

Download Now

Topics: MST Success Stories