A Family Intervention for Severe Behaviour Problems
- Simone Fox
- 9 hours ago
- 4 min read
A culturally sensitive family intervention for young people on the edge of care or custody
I am Simone, a consultant clinical and forensic psychologist employed by South London & Maudsley NHS Foundation Trust. I am both a researcher and a clinician. I work within a National Specialist team that oversees the delivery of an evidence-based intervention to young people and their families, where there are high concerns around the young person’s behaviour. The intervention is called Multisystemic Therapy or MST. The aim of treatment is to prevent the young person from going into care or custody and to remain safely at home with their family.
What Is MST and Who Is It For?
MST is a family intervention for young people (age 10-17) with significant behavioural concerns where they are at risk of going into care of the local authority or custody. Their behaviours might include physical aggression in the home, truancy or school exclusion, substance misuse and antisocial behaviour in the community. Referrals usually come from social care or via the criminal justice system. MST is recommended in the NICE guidelines for conduct disorder and there is a very strong evidence base, with over 110 published outcome studies.
The family will be allocated a therapist who will meet them at times that are convenient for them, usually in their home and will work intensively (several times a week) for 3 to 5 months. There is also a 24/7 on-call system available for families during crises. The therapist will also work with various systems around the young person, such as the school, other professionals involved (including social workers, youth justice workers and the police) and the peer group. The therapist’s goal is to empower and skill up the carers so that they can better understand and support their child once the intervention is finished.
Working with Diverse Communities
MST started in the US and has grown internationally. It is now delivered in over 15 countries worldwide. We have 30 teams working across the UK and Ireland. Although MST uses a model and therapists are guided by a set of treatment principles, each intervention is very much tailored to the specific needs of the family.
MST therapists work with a diverse range of families, many of whom may be from racially marginalised communities. Young people from minority backgrounds are disproportionately represented across many stages of the care and criminal justice system. Many of the families we work with have had previous poor experiences of services, including social care, education and the police. Teams are skilled at working with interpreters and attending to issues of discrimination and racism. This is so vital in building good relationships with the young person and their carers. Trust and engagement often take time and the therapist is sometimes a bridge between the family and the wider professional systems, which may include advocating for them in meetings.
Research on MST Working with Culturally Diverse Families
I have been involved in several research projects that have looked at understanding the experiences of families from diverse communities, and the practitioners who are working with them. By listening to carers, young people and practitioners, we hope to learn and improve the service we provide to ensure it best responds to the needs of everyone we work with.
Research with Carers:
Research with Carers highlighted the therapist skills that help build good engagement. These include taking time to learn about the family’s culture, being culturally sensitive, asking questions and respecting differences. For second-generation young people, carers highlighted how differences between dual cultures can cause conflict in the home and the therapist may act as a cultural broker, helping them and their child to see things from each other’s perspectives.
Research with Young People:
Young people also talked about the importance of the therapist exploring the family culture and increasing their knowledge and understanding. They said that their parents might disengage if this was not done well. It was also important for therapists to explore the young person’s cultural identity which might include how both their parents’ culture and that of their friends impacts them. They also spoke about the therapist helping them to see things from their parents’ perspective and vice versa.
Research with MST Therapists:
Therapists talked about how experiences of systemic racism affect engagement, reluctance to share information and willingness to involve other systems in plans which could help them. For example, fear around contacting the police if their child is missing. Families often feel disempowered by the systems around them including education, social care and the criminal justice system. Therapists spent time helping families to understand how different systems work, preparing them for meetings and supporting them to have more of a voice. They would sometimes need to directly address oppressive practices and overt racism. Language barriers led to further power imbalance and there were challenges around using interpreters especially around the 24-7 on call system.
Impact
The team I work for is responsible for the recruitment, oversight and training of the therapists and supervisors who work directly with the families. We have a Diversity and Inclusion Group where we are continuously reviewing our support to the teams. This includes developing resources and guidance to improve recruitment of a diverse workforce, career development for racially marginalised staff and training for teams. We take the voices of the young people, carers and therapists into account in shaping the work that we do.
To conclude, MST is a systemic intervention that supports families from diverse communities. We are continually learning and adapting our practice based on findings from the research and the feedback that we get from families and the teams that we work alongside.
