Outcome Findings from a Parent Training Programme for Young People with Conduct Problems.

BACKGROUND: Group-based parent training programmes are a common intervention for tackling conduct problems in young people. The objective of this study was to evaluate the impact of a parent training programme on young people presenting with conduct problems. METHOD: 123 parents of young people aged 10 to 17 with conduct problems participated in the study. A one-group, pre-post design was adopted. Participants completed the Child Behaviour Check List (CBCL) at the beginning and end of the parenting programme. The degree of change was indexed by: a) Mean change; b) change from clinical to non-clinical status; and c) Reliable change. Logistic regression was used to identify predictors of reliable positive change in CBCL problems. RESULTS: Analyses from all three sources suggest that there was a significant reduction in CBCL internalising, externalising and total scores. Withdrawn score pre-treatment was the only independent predictor of reliable change in internalising and total scores: the higher the score pre-treatment, the greater the chances of reliable improvement in post-treatment scores. CONCLUSIONS: The study provides evidence in support of the therapeutic improvement achieved by some young people whose parents attended the group parent training programme. The programme had a significant impact on internalising as well as externalising problems. Further studies of the programme would benefit from being run as a randomised clinical trial.

Collecting Routine Outcome Data in a Psychotherapy Community Clinic for Young People: Findings from an Ongoing Study.

BACKGROUND: The paper reports on the collection of routine outcome data from an ongoing audit at a voluntary sector psychotherapy service for young people aged 12 to 21 years in London offering once-weekly psychotherapy. METHOD: The study uses intake and follow-up data from an ongoing audit of the psychotherapy service that started in 1993; 1608 young people were included in the study. Measures and areas of interest include the Youth Self Report Form, a significant other (SO) version of the Teacher's Report Form, the Young Adult Self Report Form, and the Young Adult Behaviour Check List. RESULTS: Percentage returns at intake were 94% (self), 66% (SO) and 80% (therapist), but became 35%, 21% and 38% at 3-month follow-up, and decreased further at 6- and 12-month follow-up. At all time points, significant other report rates were lower than self or therapist report rates. Young people who did not provide data at intake were more likely to have dropped out of treatment. Over the 15-year period of the audit, intake self-report data rates remained stable (about 94%) whereas SO and especially therapist report rates increased. However, there was a reduction in self, significant other and therapist report rates at 3- and 6-month follow-up. CONCLUSIONS: Collecting routine outcome data was compromised by a variety of factors, and systematic efforts, including introducing initiatives for participation are needed to increase follow-up data rates and improve their quality.

Multisystemic Therapy (MST) for Youth Offending, Psychiatric Disorder and Substance Abuse: Case Examples from a UK MST Team.

BACKGROUND: The paper illustrates the MST treatment model with three types of presenting problem in young people aged 14-15. METHOD: The MST model is described and then illustrated with detailed case material from a violent young person convicted of robbery, a young person with a history of serious self-harming behaviour and hospitalisation, and a young person persistently smoking cannabis. RESULTS: All three cases improved after the MST intervention despite disparate presenting problems that included re-offending, the elimination of self-harming behaviour and a significant reduction in the use of cannabis. The three young people were re-integrated into the education system. CONCLUSION: This case series illustrates the potential uses of the MST model in CAMHS although RCT data are needed to replicate the effectiveness of MST in the British context.

Evaluation of multisystemic therapy pilot services in Services for Teens Engaging in Problem Sexual Behaviour (STEPS-B): study protocol for a randomized controlled trial.

BACKGROUND: Clinically effective and cost-effective methods for managing problematic sexual behaviour in adolescents are urgently needed. Adolescents who show problematic sexual behaviour have a range of negative psychosocial outcomes, and they and their parents can experience stigma, hostility and rejection from their community. Multisystemic therapy (MST) shows some evidence for helping to reduce adolescent sexual reoffending and is one of the few promising interventions available to young people who show problematic sexual behaviour. This paper describes the protocol for Services for Teens Engaging in Problem Sexual Behaviour (STEPS-B), a feasibility trial of MST for problem sexual behaviour (MST-PSB) in antisocial adolescents at high risk of out-of-home placement due to problematic sexual behaviour. METHODS/DESIGN: Eighty participants and their families recruited from five London boroughs will be randomized to MST-PSB or management as usual with follow-up to 20 months post-randomization. The primary outcome is out-of-home placement at 20 months. Secondary outcomes include sexual and non-sexual offending rates and antisocial behaviours, participant well-being, educational outcomes and total service and criminal justice sector costs. Feasibility outcomes include mapping the clinical service pathways needed to recruit adolescents displaying problematic sexual behaviour, acceptability of a randomized controlled trial to the key systems involved in managing these adolescents, and acceptability of the research protocol to young people and their families. Data will be gathered from police computer records, the National Pupil Database and interviews and self-report measures administered to adolescents and parents and will be analysed on an intention-to-treat basis. DISCUSSION: The STEPS-B feasibility trial aims to inform policymakers, commissioners of services and professionals about the potential for implementing MST-PSB as an intervention for adolescents showing problem sexual behaviour. Should MST-PSB show potential, STEPS-B will determine what would be necessary to implement the programme more fully and at a scale that would warrant a full trial. TRIAL REGISTRATION: ISRCTN28441235 (registered 25 January 2012).

The evaluation of mental health outcome at a community-based psychodynamic psychotherapy service for young people: a 12-month follow-up based on self-report data.

The present study focuses on the evaluation of mental health outcome of 151 young people who received psychodynamic psychotherapy at the Brandon Centre, a community-based psychodynamic psychotherapy centre; for young people. This paper reports the results from a 1-year follow-up based on self-report data. Participants aged 12-18 years completed either the Youth Self Report form or, if they were aged over 18, the Young Adult Self Report form at intake, 3 months, 6 months, and 1 year. The domains evaluated included young people's externalizing problems, internalizing problems, and total problems. Outcome was measured in three different ways: the change in mean scores; the change in numbers from the clinical to the non-clinical range; and categorizing cases according to the presence of statistically reliable change in the level of adaptation. These approaches showed improvement among participants in all three domains. Although there was a high general tendency to improve, the rate of improvement dropped significantly over time. Several tentative predictors of improvement were identified. The paper discusses how the results from systematic monitoring of effectiveness at the Brandon Centre have formed an empirical basis that has led to changes in service delivery with the aim of optimizing provision for troubled young people.

Economic evaluation of multisystemic therapy for young people at risk for continuing criminal activity in the UK.

OBJECTIVE: To evaluate whether multisystemic therapy (MST) is more cost-effective than statutory interventions that are currently available for young offenders in England. METHOD: A cost-offset evaluation of MST based on data from a randomised controlled trial conducted in North London, England, comparing MST with usual services provided by two youth offending teams (YOT). Service costs were compared to cost savings in terms of rates of criminal re-offending. RESULTS: 108 adolescents, aged 11-17 years, were randomly allocated to MST+YOT (n = 56) or YOT alone (n = 52). Reductions in offending were evident in both groups, but were higher in the MST+YOT group. At 18-month follow-up, the MST+YOT group cost less in terms of criminal activity (£9,425 versus £11,715, p = 0.456). The MST+YOT group were significantly cheaper in terms of YOT services than the YOT group (£3,402 versus £4,619, p = 0.006), but more expensive including the cost of MST, although not significantly so (£5,687 versus £4,619, p = 0.195). The net benefit per young person for the 18-month follow-up was estimated to be £1,222 (95% CI -£5,838 to £8,283). CONCLUSIONS: The results reported in this study support the finding that MST+YOT has scope for cost-savings when compared to YOT alone. However, the limitations of the study in terms of method of economic evaluation, outcome measures used and data quality support the need for further research.

Multisystemic therapy for young offenders: families' experiences of therapeutic processes and outcomes.

Multisystemic Therapy (MST) has been found to be effective in reducing youth antisocial behavior, but little is known about the process and impact of MST from the perspective of families themselves. This qualitative study explored parents' and young people's experiences of MST, focusing on aspects of the intervention that promoted or limited change. Thirty-seven semistructured interviews were conducted with a consecutive sample of 21 families (21 parent interviews, 16 young people) who had participated in a randomized controlled trial of MST for young offenders in the United Kingdom. Thematic analysis yielded 10 themes, organized into two domains: (a) engagement in MST and initial processes of change captures the central importance of the therapeutic relationship and the MST engagement model in families' positive experiences of MST; and (b) outcomes are complex reflects the range of positive outcomes reported (notably increased parental confidence and skills, improved family relationships, a return to education, and greater reflection and aspiration on the part of the young person) and mixed behavior outcomes. Even when the young person had reoffended, respondents indicated a range of other benefits for the family. The findings support the MST theory of change as well as point to some outcomes not usually measured in MST outcome studies. They also suggest some adaptations that may increase the impact of the intervention, including more attention to the influence of deviant peers, and ongoing support for families struggling to maintain strategies beyond the prescribed treatment period.

A randomized controlled trial of multisystemic therapy and a statutory therapeutic intervention for young offenders.

OBJECTIVE: To evaluate whether Multisystemic Therapy (MST) is more effective in reducing youth offending and out-of-home placement in a large, ethnically diverse, urban U.K. sample than an equally comprehensive management protocol; and to determine whether MST leads to broader improvements in youth sociality and in mediators believed to be responsible for change in MST. METHOD: 108 families were randomized to either MST (n=56) or the comprehensive and targeted usual services delivered by youth offending teams (YOT, n = 52). RESULTS: Although young people receiving both MST and YOT interventions showed improvement in terms of reduced offending, the MST model of service-delivery reduced significantly further the likelihood of nonviolent offending during an 18-month follow-up period. Consistent with offending data, the results of youth-reported delinquency and parental reports of aggressive and delinquent behaviors show significantly greater reductions from pre-treatment to post-treatment levels in the MST group. In this study MST was observed to have some delayed impact on offending, the nature and causes of which will require further study. CONCLUSIONS: The superiority of the MST condition in reducing offending and antisocial behavior suggests that MST adds value to current U.K. statutory evidence-based youth services. The provision of MST does not supplant existing services but is best used to facilitate the appropriate and cost-effective organization of statutory services for young persons and their families.