Multisystemic Treatment of Antisocial Adolescents in Norway: Replication of Clinical Outcomes Outside of the US (original) (raw)
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Background: Multisystemic Treatment (MST) is an intensive home-and community based intervention for youths with serious behaviour problems. The aim of this study was to examine the effectiveness of MST compared to 'regular services' (RS) two years after intake to treatment. In particular, our goals were to investigate whether MST was successful at preventing placement out of home, and to examine reductions in behaviour problems in multi-informant assessments. Method: Participants were 75 adolescents who were randomly assigned to MST or Regular Child Welfare Services (RS) at 3 sites across Norway. Data were gathered from youths, caregivers and teachers. Results: MST was more effective than RS in reducing out of home placement and behavioural problems. Discussion: The sustainability of treatment effects was evident, supporting the MST approach to the treatment of serious behavioural problems in youth. Site differences and the moderating effects of age and gender are discussed.
The lancet. Psychiatry, 2018
Adolescent antisocial behaviour is a major health and social problem. Studies in the USA have shown that multisystemic therapy reduces such behaviour and the number of criminal offences committed by this group. However, findings outside the USA are equivocal. We aimed to assess the effectiveness and cost-effectiveness of multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour. We did an 18 month, multisite, pragmatic, randomised controlled, superiority trial in England. Eligible participants aged 11-17 years with moderate-to-severe antisocial behaviour had at least three severity criteria indicating past difficulties across several settings and one of five general inclusion criteria for antisocial behaviour. We randomly assigned families (1:1) using stochastic minimisation, stratifying for treatment centre, sex, age at enrolment to study, and age at onset of antisocial behaviour, to receive either management as usual or 3-5 months of mult...
Criminal Behaviour and Mental Health, 2016
Background Behavioural problems are common among adolescents. The burden on society in social disturbance, health, failures to contribute and costs has triggered innovative community-based interventions such as multisystemic therapy (MST). Aims Our aim was to compare the cost-effectiveness of MST and treatment as usual (TAU). Methods Cost-effectiveness was assessed alongside a randomised clinical trial. One hundred and sixteen adolescents were allocated to MST or TAU. Follow-up lasted six months. Quality of life (EQ-5D) as perceived by the adolescents was the primary outcome. A societal perspective was used for cost assessment. Results There was no significant difference between groups in the small improvement experienced in quality of life (EQ-5D average score improvement in both 0.02 points, standard deviation 0.13 MST; 0.23 TAU). Dropout before follow-up was 48% and 69% respectively. Overall costs attributed to these young people were, however, 50% lower in the MST group. The incremental cost-effectiveness ratio (ICER) was 384,633€ (95% CI: À2,001,433 to 2,024,681€), which indicates dominance of MST over TAU. Conclusions/Implications for practice Our study shows that, at worst, MST offers no advantage to young offenders in terms of their experienced quality of life, but 'TAU' included family focused intervention as well as standard supervision.
2009
This paper discusses the implementation and evaluat ion of two family and community based intervention programmes for children and young people implemented in Norway, namely Parent Management Training (PMTO) (Ogden and Amlund Hagen in press) and Multisystemic Therapy (Ogden and Halliday-Boykins 2004; Ogden and Amlund-Hagen 2006), and a school-wide intervention programme, PALS (Sorlie and Ogden 2007). In PALS universal interventions are combined with treatment by offering PMTO to the parents of the high risk children. The Norwegian experiences and r esults also illustrate how evidence-based programs developed in the US have been transported across geographical and language borders, implemented nationwide, evaluated for thei r effectiveness in regular practice and examined for sustainability. This paper describes t his national strategy, and the main components and immediate outcomes of the PMTO- and PALS-programmes in Norway.
Journal of Family Psychology, 2008
This randomized clinical trial assessed the effectiveness of multisystemic therapy (MST) for 156 youths who met the diagnostic criteria for conduct disorder. Sweden's 3 largest cities and 1 small town served as the recruiting area for the study. A mixed factorial design was used, with random allocation between MST and treatment as usual groups. Assessments were conducted at intake and 7 months after referral. With an intention-to-treat approach, results from multiagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behaviors among participants across treatments. There were no significant differences in treatment effects between the 2 groups. The lack of treatment effect did not appear to be caused by site differences or variations in program maturity. MST treatment fidelity was lower than that of other studies, although not clearly related to treatment outcomes in this study. The results are discussed in terms of differences between Sweden and the United States. One difference is the way in which young offenders are processed (a child welfare approach vs. a juvenile justice system approach). Sociodemographic differences (e.g., rates of poverty, crime, and substance abuse) between the 2 countries may also have moderating effects on the rates of rehabilitation among young offenders.
BMC Public Health, 2013
Background: Multisystemic Therapy (MST) is an intensive, short, family-and community-based treatment for serious antisocial behaviour and delinquency in youth. It is an emerging intervention for serious juvenile delinquents. However, conclusive evidence on the balance between costs and effects is limited and in fact non-existent for the Netherlands. The aim of this protocol is to describe the design of a study to evaluate the cost-effectiveness of MST as compared to Care-As-Usual (CAU). Methods: The cost-effectiveness of MST will be assessed through a Randomised Controlled Trial. Primary outcomes aggressive and delinquent behaviour will be assessed with the parent-reported CBCL and adolescent-reported YSR. Health care utilisation, production loss, and quality of life are recorded using the self-report 'Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness' (TiC-P), and with the MOS Short-Form General Health Survey (SF-20) and EuroQol -5D (EQ-5D), respectively. The study aims to enrol 100 clients in both conditions (MST and CAU). Data will be obtained before treatment (T1), immediately after treatment (T2; 5 months after T1) and at follow up (T3; 6 months after the end of the treatment) from a variety of sources, i.e. clients, parents/primary carers, professionals and police records.
Cochrane Database of Systematic Reviews, 2005
Background Multisystemic Therapy (MST) is an intensive, home-based intervention for families of youth with social, emotional, and behavioral problems. Masters-level therapists engage family members in identifying and changing individual, family, and environmental factors thought to contribute to problem behavior. Intervention may include efforts to improve communication, parenting skills, peer relations, school performance, and social networks. Most MST trials were conducted by program developers in the USA; results of one independent trial are available and others are in progress. Objectives To provide unbiased estimates of the impacts of MST on restrictive out-of-home living arrangements, crime and delinquency, and other behavioral and psychosocial outcomes for youth and families. Search strategy Electronic searches were made of bibliographic databases (including the Cochrane Library, C2-SPECTR, PsycINFO, Science Direct and Sociological Abstracts) as well as government and professional websites, from 1985 to January 2003. Reference lists of articles were examined, and experts were contacted. Selection criteria Studies where youth (age 10-17) with social, emotional, and/or behavioral problems were randomised to licensed MST programs or other conditions (usual services or alternative treatments). Data collection and analysis Two reviewers independently reviewed 266 titles and abstracts; 95 full-text reports were retrieved, and 35 unique studies were identified. Two reviewers independently read all study reports for inclusion. Eight studies were eligible for inclusion. Two reviewers independently assessed study quality and extracted data from these studies. Significant heterogeneity among studies was identified (assessed using Chi-square and I 2), hence random effects models were used to pool data across studies. Odds ratios were used in analyses of dichotomous outcomes; standardised mean differences were used with continuous outcomes. Adjustments were made for small sample sizes (using Hedges g). Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were used. Main results The most rigorous (intent-to-treat) analysis found no significant differences between MST and usual services in restrictive out-of-home placements and arrests or convictions. Pooled results that include studies with data of varying quality tend to favor MST, but these relative effects are not significantly different from zero. The study sample size is small and effects are not consistent across studies; hence, it is not clear whether MST has clinically significant advantages over other services.
Research on Child and Adolescent Psychopathology, 2021
The effect of Multisystemic Therapy (MST) treatment for serious behavior problems among adolescents has been established through multiple studies. However, variations across individuals should also be examined to better understand how MST works or for whom. In this study, we explored and identified subgroups of youth with serious problems in Norway regarding their responses to MST in terms of ultimate MST outcomes (e.g., living at home, abstaining from violence) over time. We further explored whether immigrant background, in addition to gender and age of the youth at intake, predicted belonging to the subgroups. Data came from 1674 adolescents ( Mean Age = 14.55, SD Age = 1.58; 60.7% boys) and their families referred to MST treatment by the municipal Child Welfare Services for serious and persistent antisocial behavior. The outcomes were assessed at five time-points from intake to 18-months after discharge for youth and families who completed the treatment. Latent class growth ana...
Research on Social Work Practice, 2009
This article sums up 8 years of experience with evidence-based programs in the treatment of conduct problems in children and youth. A conceptual model describing the implementation components relevant to the Norwegian project is presented and discussed. Next, we describe a case study of the implementation strategy accompanied by outcomes from the clinical trials of Multisystemic Therapy (MST) and Parent Management Training-the Oregon model (PMTO). The national implementation strategy for evidence-based treatment programs is a combination of a ''top-down'' and ''bottom-up'' approach to implementation based on collaborative efforts of a national center for dissemination, implementation, and research and the public child and adolescent service system operating in the municipalities. The strategy further includes recruitment of candidates for training through the various service systems and the establishment of permanent networks for collaboration, supervision, and support.