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Young People at risk of developing ASPD: the use of multi-systemic therapy as an early intervention within the family. Dr Simone Fox Chartered Clinical & Forensic Psychologist MST Supervisor Merton & Kingston Dr Juliette Wait Chartered Clinical Psychologist MST Supervisor Reading

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Young People at risk of developing ASPD: the use of multi-systemic therapy as an early intervention within the family

Dr Simone Fox

Chartered Clinical & Forensic Psychologist

MST Supervisor Merton & Kingston

Dr Juliette Wait

Chartered Clinical Psychologist

MST Supervisor Reading

PD Congress

19th November 2009


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Aims of Presentation multi-systemic therapy as an early intervention within the family

  • To think about Personality Disorder from an adolescent perspective

  • To develop an understanding of the risk factors in the development of antisocial PD

  • An overview of MST and how it addresses these risk factors


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Group Exercise multi-systemic therapy as an early intervention within the family

  • In pairs identify one risk and one protective factors for the onset of behavioural problems in adolescence;

    • Individual

    • Family

    • School

    • Peer group

    • Community

  • Feedback on flipchart


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Risk & Protective Factors multi-systemic therapy as an early intervention within the family


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Common findings of 50+ years of research: delinquency and drug use are determined by multiple risk factors:

Family (low monitoring, high conflict, etc.)

Peer group (law-breaking peers, etc.)

School (dropout, low achievement, etc.)

Community ( supports,  transiency, etc.)

Individual (low verbal and social skills, etc.)

Delinquency is a Complex Behaviour


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Causal Models of Delinquency and Drug Use drug use are determined by multiple risk factors:

Condensed Longitudinal Model

Prior Delinquent

Behavior

Family

Low Parental Monitoring

Low Affection

High Conflict

Delinquent

Peers

Delinquent

Behavior

School

Low School Involvement

Poor Academic Performance

Elliott, Huizinga & Ageton (1985)


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Theoretical drug use are determined by multiple risk factors: Assumptions

Children and adolescents live in a social ecology of interconnected systems that impact their behaviors in direct and indirect ways

These influences act in both directions (they are reciprocal and bi-directional)

Based on Bronfenbrenner, Haley and Minuchin


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Ecological drug use are determined by multiple risk factors:Model

Community/Culture

Neighborhood

School

Peers

Family

Child


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Implications for Effective Intervention drug use are determined by multiple risk factors:

The research on delinquency and substance use suggests that, to be most effective, services should be:

Comprehensive and have the capacity to address all of the relevant risk factors present for each youth and family

Individualised to the strengths and needs of each youth and family

Delivered in the naturally occurring systems and be implemented in “ecologically valid” ways


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What is MST? drug use are determined by multiple risk factors:

Intensive, goal oriented and time limited intervention

Community-based, family-driven

Targets the multiple causes of anti-social and criminal behaviour in young people

Highly structured clinical supervision and quality assurance processes

Strong track record of client engagement, retention and satisfaction


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Who is the target population for MST? drug use are determined by multiple risk factors:

Family and key participants in the environment of young people

MST “client” is the entire ecology of the young person - family, peers, school, community

Age range 11-17 years

High risk of out-of-home placement eg. care, custody, residential school

Placement risk due to their behaviour at home / school / in the community

May be involved with the criminal justice system


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What is MST? drug use are determined by multiple risk factors:

Focus is on families as the solution

Focus on empowering the caregivers / parents to solve current and future problems

Parents are full collaborators in planning and delivering interventions

Assumption - Children’s behaviour is strongly influenced by their families, friends and communities (and vice versa)

Works in partnership with a combination of systems (parents, family, peers, school and community) to address risk factors


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How does MST work? drug use are determined by multiple risk factors:

Assessing and understanding the factors contributing to identified problems

Having clear goals to work towards

Prioritising key factors and interventions

Interventions based on techniques that have strong evidence base:

Behaviour therapy

Parent management training

Cognitive behavior therapy

Pragmatic family therapies

Pharmacological interventions (e.g., for ADHD)

Supporting the parent/carer in devising strategies to target factors contributing to the young person’s behaviour


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How is MST implemented? drug use are determined by multiple risk factors:

Single therapist works intensively with 4 families at a time

Meetings at least 2-3 times a week

Community and home based

Out-of-hours service run by the team which is available to families 24 hours a day, 7 days a week

Team has 3-4 therapists and clinical supervisor

Involvement typically ranges from 3 to 5 months


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How is MST implemented? drug use are determined by multiple risk factors:

Team provides the family with a single point of contact

MST team deliver all treatment

Typically no services are referred outside the MST team

Never ending focus on engagement and alignment with the primary caregiver and other key stakeholders – addressing barriers

MST team must be able to have a lead role in clinical decision making for each case


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MST Quality Assurance System drug use are determined by multiple risk factors:

Team comprised of range of professionals – multi-disciplinary/multi-agency

Structured training – orientation and regular boosters

Frequent professional development planning

Weekly clinical supervision and case review

Weekly consultation with consultant in USA

Research validated adherence process – for therapists and supervisor


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Traditional models drug use are determined by multiple risk factors:

Individual (family)

Clinic-based

Fixed times

High caseloads – less intensive

Open-ended

Supervision

MST

Ecological

Home-based

Flexible/24 hour

Low caseloads – 3x weekly +

Fixed goal-driven

Quality assurance

What’s different?

NB Not better, just different approach to address a different need


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Why does it need to be different? drug use are determined by multiple risk factors:

  • Multi-determined nature of serious antisocial behaviour

  • Risk factors span the ecology in which the child is embedded

  • Families with complex problems struggle to access traditional services

  • High costs of antisocial behaviour – incarceration, placement, victimisation

  • Therapist adherence predicts outcome


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Video drug use are determined by multiple risk factors:


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References drug use are determined by multiple risk factors:

  • Kazdin A. E., & Weisz, J. R. (1998). Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology, 66, 19-36.

  • Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic treatment of antisocial behaviour in children and adolescents – 2nd edition. New York: Guildford Press.

  • www.mstservices.com


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