Sustainable change: stronger
families, effective networks,
better outcomes
Presented by:
Veronica Watt and Justin Douglas
Reducing Youth Offending Programme,
Multisystemic Therapy,
Child, Youth and Family
Session overview
> Multisystemic Therapy (MST): the model and
evidence base
> Local implementation in Aotearoa
> RYOP MST in Auckland: bringing the model
into our specific context- richness,
complexity and sustainable outcomes in our
whānau / families.
What is MST?
> An intensive family and community-based
treatment for antisocial behaviour in youth
> Focus is on empowering caregivers
(parents) to solve current and future
problems
> MST “client” is the entire ecology of the
young person – family, peers, school,
neighbourhood.
MST Beliefs
> Families and communities are central and
essential partners and collaborators in MST
treatment (Manaakitanga, Kaitiakitanga)
> Families can live successfully without formal
mandated services (Whakamanawa)
> Change can occur quickly
> Science/research provides valuable
guidance.
How is MST implemented?
> A single therapist works intensively with four to
six families at a time
> 24 hour, 7 days a week on call system
> 20 weeks (5 months) is the typical treatment
time
> Work is done in the community, home, school,
neighbourhood to remove any barrier to
service access
> Is not dependent on the youth engaging in
treatment.
MST Principles and Bicultural Practice
> MST - Nine Treatment Principles
> Bicultural Practice Framework: Eight Pou to
guide / anchor accountable practice
> Strong alignment: MST by definition is
multicultural and multiagency in its
ecological approach
> Flexibility within a framework for culturally
responsive and meaningful practice.
Principles in practice
Multisystemic Therapy (MST)
CYF Pou Waru
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Finding the fit
Positive and strength focused
Increasing responsibility
Present focused, action-oriented
and well-defined
Targeting sequences
Developmentally appropriate
Continuous effort
Evaluation and accountability
Generalization
Te Reo Māori
Whakamanawa
Whakapapa
Kaitiakitanga
Manaakitanga
Tikanga
Rangatiratanga
Wairuatanga
Theoretical underpinnings
> Bronfenbrenner's social ecological theory
> Children and young people live in a social
ecology of interconnected systems that
impact their behaviour directly and
indirectly
> Influence is bidirectional and reciprocal
(multifactorial and mutually influencing).
Causal Model of Offending and Substance Misuse:
Common Findings of 50+ Years of Research
Neighbourhood/Community
Context
Family
Prior Delinquent
Behaviour
Antisocial
Peers
School
Antisocial
Behaviour
Evidence base over 30 years
> 34 published outcomes, transportability and
benchmarking studies including 23
randomized trials
> 15 studies with youth offenders
> 17 independent studies.
> www.mstservices.com/outcomestudies.pdf
Consistent outcomes
Compared with control groups MST cohorts have:
> Decreased long-term rates of re-arrest
> Decreases in long-term rates of days in out of
home placement
> Increased school attendance and
performance
Improved family relations and functioning
> Decreased adolescent substance use.
But none of this happens without adherence to
MST
MST in Aotearoa
> MST has a 14 year history here: the first MST
teams were established in NZ in 2001
> We currently have eight MST teams in NZ
> Child, Youth and Family Auckland (RYOP)- two
teams
> Youth Horizons Trust (YHT)
> Richmond NZ Ltd- three teams (Wellington,
Wairarapa and Christchurch)
> Central Health Ltd
> Links back to MST Services and Institute.
RYOP: Reducing Youth Offending
Programme, Child, Youth and Family
> Established 2003 initially as two phase pilot
> Two evaluations that informed service
delivery changes (2006 and 2008)
> Two teams in Auckland metropolitan area:
one programme manager, two supervisors,
eight therapists from diverse personal and
professional backgrounds
> National MST consultant - weekly contact.
Eligibility criteria
Child Offenders must have an intention to charge by Police, who are prepared to
place a declaration for Care and Protection before the Family Court under section
14(1)(e).
Youth Offenders must have admitted an offence, and generally have had at least two
previous Youth Justice FGCs for offending.
Additionally, clients must:
- Be aged 10 to 16 years
- Have a Risk Score of at least 32 from the Risk Screen for Child or Youth Offenders
- Have (an) identified primary caregiver(s) who is prepared to act in a parental role
and participate fully in the Programme
- Not have committed sexual offences only
- Not be actively psychotic, suicidal, or homicidal, or in need of crisis stabilisation at
the time of referral
- Have signed an agreement to take part in the referral process and the Programme
- Have sufficient intellectual and language capacity to benefit from taking part in
the Programme.
RYOP Client Group
> Young people at high risk of reoffending/
chronic offending
> Age group 10-16 for index client
> 2014-15 referrals: 116 young people
> 100 male and 16 female
> 60% Māori; 20% Pacific Island
> 10% child offenders (10-13 years)
> 90% 14 years or older.
Introducing Jamie (all names changed)
> 14-year-old young man with whakapapa here in
Aotearoa and elsewhere in the Pacific ocean
> Excluded from two mainstream schools; now in
alternative education; stopped all sports activities
> Brief period with mother but mostly raised by maternal
grandmother; now living with maternal grandfather after
short period in group home; never met father
> Significant use of alcohol and drugs (especially synthetic
and herbal cannabis)
> Offending profile: assault, wilful damage, intentional
damage, insulting language
> Allocated to a Māori female therapist
MST Analytical process
Referral
Behavior
Desired Outcomes
of Family and Other
Key Participants
MST
Analytical
Process
Overarching
Goals
Environment of Alignment and Engagement
of Family and Key Participants
MST Conceptualization
of “Fit”
Re-evaluate
Prioritize
Assessment of
Advances & Barriers to
Intervention Effectiveness
Intermediary
Goals
Measure
Intervention
Implementation
Do
Intervention
Development
Environment of Alignment and Engagement
of Family and Key Participants
Assessment
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Environment of engagement and alignment
Genogram
Reasons for referral: clear behavioural description
Initial goals and desired outcomes
Strengths and struggles ecological assessment
Finding the “fit” between the identified problems
and their broader systemic context (MST
conceptualisation/ hypothesis development)
> Overarching goals.
Desired outcomes
> Jamie: Go home and stay home, get a job and
show everyone I can do the right thing, stay at
school
> Grandfather: Have Jamie home, Get help to know
what to do when he gets angry, have family on
same page to manage Jamie safely, go back to
mainstream school, play a sport
> Mum: Jamie stop using drugs, not go down same
path as me, go to school and work experience,
stop threatening family members
> Also taken from Police Youth Aid, Youth Justice
Social Worker and two other whānau members.
Practice: Understanding the fit
> Text goes here
Lack of
– Second
level
coping
• Third
level
strategies
AOD use
Unrealistic and
unclear expectations
Why did
Jamie
offend?
Increases
aggression to get
what he wants
Not in
education
Parenting
styles different
in different
homes
Antisocial peers
Age and stage
(development
al needs)
Treatment
> Intermediary Goals: logical steps to achieving Overarching
Goals that target immediate and powerful drivers of a
behaviour or interaction pattern
> Weekly and daily goals (Principle 7)
> Observable change (Principle 8)
> Make use of strengths (Principle 2)
> Makes use of empirically validated methods
• (CBT, behavioural tracking and monitoring, rules, rewards
and consequences, structural and strategic family therapy
approaches)
• (Principles 2,4,5 and 6)
> Maintenance planning and discharge (Principle 9).
Intermediary Goals
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Increase granddad's communication between home and school (Rangatiratanga )
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Improve positive communication at home (Wairuatanga, Whakapapa, Tikanga)
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Granddad will speak to education provider re attendance and behaviour
Therapist will cross check reports
Granddad will schedule a school meeting to establish a behaviour plan
Granddad and Jamie will have one meal together each day
Granddad and Jamie will share updates on their day
Both will make use of their own spaces during potentially conflictual situations
Granddad will praise Jamie for positive communication efforts
Granddad will establish effective rules and consequence (Kaitiakitanga,
Whakamanawa)
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Therapist and granddad will complete a FIT assessment on lack of rules and
consequences
Therapist and granddad will develop appropriate rules an consequences
Granddad will consult with Jamie on rules an consequences during a calm time.
Quality assurance
> High adherence to the model determines
the quality of delivery and outcomes
> Adherence processes include:
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Weekly reports tracking progress and outcomes
Weekly team and individual clinical supervision
Weekly telephone consultation
TAM-R and SAM analysis
Live supervised and taped sessions
Changes tracked for two years post treatment.
Recent outcome data
> At the end of treatment:
90% of young people were living at home
83% were at school/vocational placement
84% had no new arrests
100% improved family relations and parenting
skills
• 70% involved in prosocial activities.
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Why is MST successful?
> Targets known causes of offending: Family
relations, peer relations, school performance,
community factors
> Treatment is family/whānau driven and occurs
in natural environment
> Significant energy devoted to positive
multiagency working
> Continuous quality improvement at all levels
> Fits well with bicultural practice framework
> Cost effective: at least 3.17 to 1.
Whatever happened to Jamie?
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Cultural connection: whakapapa, Te Reo Māori
Education with vocational aspiration
No reoffending
Reduced AOD
Improved family relationships
Clear authority, guidance and boundaries
Improved monitoring and supervision
Prosocial activities
Improved multiagency relationships
Community links and resources.
Voice of the whānau
> At first I just couldn’t get it together, but [the therapist]
persevered and was really tactful about getting me to answer
questions that helped. There’s been a turnaround in his
behaviour over the last couple of months which is great.
> [The therapist] is wonderful. She's helped me a lot especially to
realise that I was part of his problem, always letting him do
what he wanted. Now she's helping me to say no to him and
helping him to take responsibility for things he should have
been doing all along.
> At first I was sceptical cause I like to keep family business in the
family so it was hard to accept that we all needed help. When
[the therapist] came and listened and I talked things through
with her I realised that I was part of the problem and that I
needed to change what I was doing. I am forever grateful for
her support.