MST-FIT is an American-based programme initially developed to help young people return home after incarceration. This feasibility trial evaluated whether MST-FIT can be adapted in the UK for helping young people return home after a period of residential care. A total of 135 interviews were conducted with young people, parents, and professionals involved in MST-FIT in two sites (Leeds and Northamptonshire). An analysis of the interviews revealed common themes around the programme's benefits and drawbacks, the barriers and facilitators, and early stage outcomes.
What is Multisystemic Therapy?
Multisystemic Therapy (MST) is an intervention specifically designed for young people who exhibit antisocial behaviour, and their families. The programme was original developed in the United States to help young people who were at higher risk of becoming young offenders. An adaptation of the programme, Multisystemic Therapy - Family Integrated Transitions, was created to help young people return home from a residential care home. In the first phase of MST-FIT the young person comes to a specialist MST-FIT residential home, where the trained staff help them develop useful skills for returning home. At the same time, an MST-FIT therapist works intensely with the parent or carer, to help them with the transition. The young person then returns home, where the therapist continues working with both of them.
The aims of MST-FIT are to strengthen family relationships, reduce young people's substance misuse, help improve their mental health, and reduce the risk of offending. MST-FIT professionals use elements of different therapies to help the young person return home successfully and to give carers the tools to parent effectively, such as cognitive- behavioural therapy, and group therapy. MST involves all systems around the young person, including school, friends, peers, and the community.
For more information about MST-FIT in the US, see: http://depts.washington.edu/pbhjp/projects-programs/page/mst-family-integrated-transitions-fit
- Who took part in the research?
In total, 20 young people, 14 parents and carers, and 42 professionals (including therapists, residential home staff, managers, and social workers) were interviewed for the study. Two sites were involved: Northamptonshire and Leeds.
- How was data collected?
The research team met and interviewed participants at the beginning of the trial, when MST-FIT was first being introduced in England, and again about 9 months later to get a sense of what changed over these early stages of introducing the programme. Semi-structured interview schedules were created for the study. In total, 135 interviews were conducted, the content of which was transcribed and analysed using Thematic Analysis. The analysis resulted in several common themes, which the research team felt reflected the reality of the families' and professionals' experience with MST-FIT in the most accurate way possible.
- What were the findings?
A full report on the results of the study can be found here: https://www.gov.uk/government/publications/multisystemic-therapy-family-integrated-transitions
Below is a list of themes which emerged from the qualitative interviews.
- Thoughts going into the programme. The professionals were aware that MST-FIT was only just being introduced in the UK and that there would be a "learning curve" to begin with. When starting MST-FIT, parents often felt that the most important problems were poor communication with their child, and their child's bad behaviour and problems managing their emotions. Many young people already had past experiences with therapy or being in residential homes, which were sadly often negative for them.
- What was good about MST-FIT? Professionals felt that there was "nothing else like MST-FIT" and that the programme was filling a gap in the services. The skills taught as part of MST-FIT were often described as "skills for life" and could help the young people in the long term, not just for returning home. Social workers were a bit less positive, and thought that sometimes young people's problems are too complex to be solved by MST-FIT alone.
- What was bad about MST-FIT? Some families felt that MST-FIT did not help them because their child's needs were too complicated. Residential home staff felt a bit unsure about delivering the programme at first, but their confidence improved a lot over time.
- Outcomes. At the time of the second round of interviews, 4 young people had successfully returned home, but 4 others had returned to residential care. But even in those cases parents and therapists thought that there were improvements to communication, the child's behaviour, and the parent's ability to manage stress.
- What helps MST-FIT be successful? Professionals thought that they saw better results when the programme was structured with set "moving home" and end dates. Therapists also spoke about the importance of helping parents improve their communication and parenting style, rather than just focusing on the child's behaviour.
- What barriers are there to MST-FIT? MST-FIT professionals and social workers sometimes disagreed on what the best course of action was for the young person. In part this was because social workers did not yet understand MST-FIT well, which should hopefully improve as they continue working together.
We also found that more people were in education and were in less trouble with the police after MST-FIT. Within the residential homes, there was also a strong decrease in assaults against the staff. However, these results are descriptive only, as the sample size was not large enough for a statistical analysis.
Finally, all three residential homes (two in Leeds and one in Northamptonshire) received "Good" or "Outstanding" ratings from Ofsted.
What do we recommend?
As requested by the Department for Education, the research team made several recommendations for the future of the MST-FIT programme, based on the findings from the study.
- Professionals need a better understanding of the different needs of young people returning home. This will help with providing MST-FIT to families who are the most likely to see positive results.
- Professionals need to work closely with social workers to help them understand MST-FIT, how it helps families, and which types of problems it is useful for.
- Parents and carers who took part in the study often had mental health problems of their own - professionals should ensure that they also receive help for their specific needs.
- MST-FIT could also be useful for young people returning home from foster care - this is something that can be considered in the future. A few foster care cases have already successfully gone through MST-FIT in Leeds.
The team is currently in the process of writing a journal article based on the study, with the aim of commenting on the feasibility and acceptability of the programme, as well as whether further research (such as a full-scale Randomised Controlled Trial) is warranted. The article is due to be submitted by the end of 2017.
This research study was funded by the Department for Education.
Professor Peter Fonagy
Dr Stephen Butler
Dr Alisa Anokhina
For information about the trial, please contact the Trial Coordinator. email@example.com
MST-UK website: http://www.mstuk.org/