Multisystemic therapy (MST)

What is MST?

Multisystemic therapy (MST) is an intensive family and community-based intervention that targets the multiple causes of antisocial behaviour in young people who, without intervention, could be at risk of being placed into local authority care or at risk of custody or secure care.

MST adopts a social-ecological approach to understanding problematic behaviours in young people. Viewing the individual as being surrounded by a network of interconnected systems that include the young person themselves, their family as well as their peer group, school and wider neighbourhood.

In MST, parents and caregivers are viewed as the main instigators of change in the young person. Therefore, the ultimate goal of MST is to empower the family to take responsibility for making and maintaining positive changes in the young person’s behaviour.

*MST has been adapted for different populations and includes MST for Child Abuse & Neglect (MST-CAN) and MST for Family Integrated Transitions (MST-FIT). Please visit the Multisystemic Therapy (UK and Ireland) website for more information.

Who is MST for?

INCLUSIONARY CRITERIA

• Young people at risk of placement (Care or custody) due to their own anti-social behaviours, including substance abuse.
• Young people involved with the Youth Justice System (Youth Offending Team).
• Young people who are aged between 11 and 17.

EXCLUSIONARY CRITERIA

• Young people living independently.
• Young person is presenting with suicidal, homicidal or psychotic behaviour.
• Sex offending in the absence of other anti-social behaviour.
• Young people with Autism Spectrum Disorder (ASD) where this is assessed as being moderate to severe

MST in Scotland

The first team was developed in 2011 and continues to serve families to this day. Fife Council has two MST teams and is currently developing the first MST-CAN team in Scotland (due to open later this year). To date they have supported 917 families.

The Scottish teams joined the UK & Ireland network partnership in 2016 and the following year a Scottish based consultant was hired. The Scottish based consultant is employed by NES (NHS Education for Scotland) to provide consultation and quality assurance to the Scottish teams and offer centralised support for NHS Boards and Local Authorities and Third sector organisations who may have interest in developing MST

Research and evaluation

MST has an evidence base that spans over 30 years and includes numerous Randomised Controlled Trials (RCT) completed both within the US and across Europe. The majority of studies show positive and sustainable outcomes for MST compared to management as usual.

Find out more about MST research in the UK.

Finding from across the UK

MST training

MST UK & Ireland is dedicated to helping agencies implement MST with full integrity to the treatment model. All therapists and supervisors working in a licenced MST team are required to attend MST orientation training which is a blend of learning experiences including webinar, eLearning modules and a 2 day in person classroom experiential training and MST exam. Supervisors also attend an additional two-day supervisor orientation training course. MST teams are also provided with ‘booster’ training every quarter that is tailored to the team, family and organisational needs.

Because of the complexity of this treatment protocol, training is not routinely offered to individuals without their membership in a licensed MST treatment programme. For further information about MST training, please contact: Natalie.Wilmot@kcl.ac.uk

Developing an MST programme

The MST UK and I team will guide you through the stages of the MST site development process which covers the following areas:

• needs analysis of local population
• funding and sustainability
• MST model fidelity requirements
• stakeholder collaboration and support
• recruitment and training
• ongoing quality assurance

For more information about the setup process. 

MST-CAN (Multisystemic Therapy – Child Abuse and Neglect)

Scotland first MST-CAN team is being developed in Fife and will operational this year (2025).

MST-CAN was adapted from MST to support families affected by multiple and complex needs in children and adults, including parental substance use, past trauma, neglect and physical abuse of children, building on the best evidence of what is effective in tackling these complex issues.

The MST-CAN team works intensively with families in the community to address underlying problems, tackle practical issues and help parents/caregivers to develop the skills to enable children to remain safely at home. In MST-CAN a multidisciplinary team, including a team manager, three practitioners, a family resource specialist and dedicated psychiatry or mental health nurse prescriber time work intensively with families for up to 9 months, visiting families a minimum of three times a week and providing 24-7 on-call support. The team is provided with intensive and ongoing training, guidance and quality assurance from an MST-CAN consultant based within the NHS. The workforce is degree educated in social work, applied psychology, mental health nursing, or other relevant accredited therapy or qualification.

High priority is given to increasing safety through detailed risk assessment and safety planning and collaborative working with social workers and other professionals.  Interventions are tailored to the unique needs of each family and include evidenced based interventions to address past trauma, including PTSD; Prolonged Exposure and Trauma Focused CBT, Reinforcement Based Therapy (RBT) to target parental substance use (inc. alcohol), Cognitive Behavioural Therapy for anger management and structural, strategic, and behavioural family therapy to help families manage conflict and improve family relations. Families are supported with a plan to sustain the positive gains they have made following MST-CAN, this can include support from extended family and friends, as well as statutory and voluntary services.

Research evidence on the implementation of MST-CAN indicates that it is effective in reducing incidents of re-abuse, reducing trauma symptoms and improving mental health in both adults and children.

How Families experience MST

To hear about family’s experience of MST please click here.

Related documents

NICE guidelines

Multisystemic Therapy for Child Abuse and Neglect - Foundations

The Matrix - Multisystemic Therapy (MST)

External links

Youtube

Contact us

For more information about MST in Scotland please contact us at psychology@nes.scot.nhs.uk or Mhairi.fleming@nhs.scot or visit: www.mstuk.org