Rozprawy doktorskie na temat „Multisystemic therapy”

This thesis investigated processes of change in Multisystemic Therapy (MST) for adolescents with antisocial behaviour problems. Part 1, the literature review, critically evaluates 28 studies investigating how neighbourhood effects on youth antisocial behaviour are mediated and moderated by family, peer and individual variables. The research demonstrated that neighbourhood risk influences young people's behaviour indirectly through more proximal processes such as parenting practices, peer deviancy and individual antisocial beliefs. Family risk was generally found to be amplified in disadvantaged neighbourhoods, such that parenting practices, especially monitoring, had a closer relationship to child behaviour in high-risk contexts, compared to in more advantaged neighbourhoods. Less interaction was found for individual risk factors such as low empathy, which tended to predict delinquency regardless of neighbourhood context Part 2, the empirical paper, is a qualitative study of families' experiences of receiving Multisystemic Therapy, with a particular focus on processes of change. Semi-structured interviews were conducted with 22 parents and 19 young people, and accounts analysed with thematic analysis. Findings highlighted a wide range of positive changes in the young person's behaviour and attitude, as well as family relationships and parenting practices. Increased parenting confidence and competence, reduced conflict in the home, and a return to education for the young person were key to youth behaviour change. Accounts supported an ecosystemic model of intervention for youth antisocial behaviour. Part 3, the critical appraisal, addresses methodological issues of the study. This includes consideration of the influence of researcher perspective, and the impact the research has had on the researcher's future clinical thinking and practice.

Antisocial behaviour by adolescents continues to present a considerable challenge to society. One intervention which has shown promise in reducing serious antisocial behaviour is Multisystemic Therapy (Henggeler & Borduin, 1990). A systemic review of the most recent research exploring the effectiveness of MST was undertaken. Consistent with the rapid global spread; this review found several randomised control trials conducted in and outside of America. The findings indicate the need for a clear understanding of usual services within local systems prior to adopting new approaches and highlight a number of methodological limitations of the eleven included studies. Chapter 3 explores the personal lived experience of delivering MST in a sample of seven therapists in London teams using the principles of Interpretive Phenomenological Analysis. Four themes were identified 1) Persisting despite challenges 2) MST and us 3) Relationships matter and 4) How do we know we are getting anywhere? The results have implications for clinical practice and are discussed in the context of directions for future investigations. Chapter 4 presents a critique of one of the few widely used risk assessment tools for adolescent general recidivism; the Youth Level of Service/Case Management Inventory 2.0 (Hoge & Andrews, 2011).

Studiens syfte är att belysa vad det kan innebära att arbeta efter en behandlingsmetod som är utarbetad i ett annat land och överföringen av MST från USA till Sverige exemplifierar detta. Frågeställningarna är: Vilka, för MST-arbetet, betydelsefulla skillnader finns det mellan USA och Sverige?, Hur har man löst de dilemman som uppstått på grund av skillnaderna?, Vad återstår att lösa?

Forskning som gjorts i USA och Norge visar på goda resultat, en studie i Kanada visar ingen skillnad mellan MST och andra insatser och en pågående studie finns i Sverige. Tidigare studier på MST har främst perspektiv på dess effektivitet, dels vad gäller förändrade beteenden, dels de samhällsekonomiska följderna. Någon större studie med fokus på kontextuella dilemman vid överföring av MST har inte hittats.

Denna studie har ett socialkonstruktivistiskt perspektiv och bygger på intervjuer med fyra MST-teamledare i Stockholm. Resultaten visar att MST arbetet i Sverige innebär vissa kontextuella dilemman, som oftast är möjliga att lösa på ett tillfredsställande sätt. De dilemman som är svårlösta är främst av samhällsstrukturell karaktär.

Research indicates that Multisystemic Therapy (MST) is an effective intervention for young people presenting with antisocial and offending behaviour (Henggeler & Sheidow, 2011). A model has been developed to explain the process of change in MST, however, little is known about which aspects of the intervention contribute to these change processes and how this ultimately links with outcomes. Research has explored the processes of change in more detail with young people and their families up to two months post MST (Tighe, Pistrang, Casdagli, Baruch, & Butler, 2012). As such, there is limited knowledge regarding factors contributing to sustained positive outcomes at long-term follow-up. The study employed a qualitative design, using grounded theory methodology (Charmaz, 2006; Glaser & Strauss, 1967) to explore young people's experiences of MST and what they perceived as helpful in sustaining positive outcomes over the long-term. The aim was to develop a detailed theoretical model of sustained change for young people following participation in MST, and to explore whether the existing model of the process of change in MST adequately explains this process for young people. Eight young people who had achieved positive outcomes upon completion of MST were interviewed between five to 21 months following MST. Data analysis led to the development of a model of sustained change in MST, incorporating theoretical codes including: the therapeutic alliance, increases in systemic awareness, recognising responsibility, positive peer relationships, acknowledging and celebrating success, the continued use of strategies and the identification and creation of a preferred future. 3 ~ •... -------------------------- This research provides detailed information on the process of change and how c is sustained from young people's perspectives, highlighting relevant developmental, individual and systemic factors in relation to this. This will be discussed in relation to clinical implications and developments needed to the general model of change in MST.

The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on September 11, 2009). Thesis advisor: Dr. Charles M. Borduin, Includes bibliographical references.

Government guidelines for mental health interventions emphasise the importance of taking young people's views into account. This review examines what is known from the adolescent's perspective in research investigating the outcome of psychological therapies. The literature in three mental health domains that are particularly relevant to adolescence is focussed on: anorexia nervosa, depression and antisocial behaviour. Both quantitative and qualitative studies are examined and what has been asked of adolescents is explored. This rev iew highlights what can be learnt from eliciting adolescents' views and considers how these v iews can better inform treatment.

Background: Multisystemic Therapy (MST) is a time limited evidence-based intervention for young people with antisocial behaviour and other emotional and behavioural difficulties. Despite it's robust evidence base with over 19 Randomised Control Trials (RCT), long-term follow-up of outcomes and quantitative process-outcome studies little is known about how these positive outcomes are achieved, how they might be sustained and what the effects of the intervention are beyond improvements in offending rates for families after MST finishes. The aims of this study were to explore this. Method: A qualitative approach was adopted and ten semi-structured interviews were carried out with twelve caregivers. A Grounded Theory analysis was used. Results: Nine theoretical codes emerged to form a model of the process of sustained change from caregiver perspectives: Shifting the relationship to help; Care-giver-therapist alliance as a helpful model; Supporting a family alliance; Privileging a positive story of son/daughter; Shifting perspectives: from individual to interpersonal; Sharing responsibility for change; . Increased positive communication in relationships; Increased personal resilience to new challenges; Increased family resilience. Conclusions: The study revised the current model of change in MST based on caregiver perspectives. 1) It draws attention to the therapeutic alliance as a process of change and . sustained change. 2) Reciprocal processes are highlighted between MST's more linear conceptualisation of how outcomes are achieved. 3) Caregivers highlighted more detail on improved family functioning as an outcome and it's importance in sustaining change. These factors are reconceptualised using systemic theory and referred to as 'second order changes.' 4) These second order changes, facilitated in part by the therapist alliance, fed in to the concept of Resilience for both the family and the caregiver, which contributed to sustained change. Clinical implications and future research directions and study limitations are also discussed.

This volume is comprised of three parts. Part 1 is a systematic literature review examining critically whether the current adolescent sexual offender evidence base supports the existence of a causal relationship between empathy and adolescent sexual offending. Sixteen articles covering cognitive and affective aspects of general empathy, victim empathy, and victim-specific empathy were identified. The evidence base as a whole was found to be limited and sometimes contradictory, meaning that no conclusive evidence of a causal link between empathy and adolescent sexual offending could be found. Part 2 presents the empirical paper. Using thematic analysis of interview data, this study explored the experiences of eight young people and ten caregivers who had undertaken Multisystemic Therapy for Problem Sexual Behaviour (MST-PSB). Eight themes were identified for young people and ten themes for caregivers. Participants were found to experience strong negative emotions and cognitions linked to issues around stigmatisation, which led to barriers to engagement such as the use of denial. A strong therapeutic relationship was found to underpin several different processes of engagement and change in MST-PSB (including processes around denial, the development of new knowledge and skills, and processes that helped to break down barriers between the young person and caregiver), leading to improvements in the young person’s behaviour and in caregiver-young person relationships. Finally, Part 3 is a critical appraisal of some of the epistemological and personal assumptions relating to my research.

This literature review examines the main psychological interventions for youth offending with a focus on Multisystemic Therapy (MST). As a large proportion of youth offending is carried out by youths diagnosed with Conduct Disorder, an overview of the nature of this disorder is firstly given. Traditional treatment approaches are then reviewed and the limitations of these are highlighted. A description and review of MST, which has been specifically developed for treating persistent juvenile offenders is provided, in which it is argued that this approach addresses the limitations of other psychological interventions. MST targets the known multiple determinants of Conduct Disorder and aims to intervene in the multiple settings that the youth and family are embedded. Although it is considered to have a relatively large evidence base, nearly all studies have been carried out by its developers, there is uncertainty about its 'active ingredients', and little is known about service users' experiences of MST. Qualitative research may be one useful approach to understanding the processes and outcome of MST from the perspectives of youth and families themselves.

The study was performed based on a qualitative method using a hermeneutical approach used to interpret the semi-structured interviews. The study aimed to investigate the Multisystemic therapy (MST) team in Halmstad municipality perceptions on the treatment method multisystemic therapy for youths from the ages of 12-18 years old.The questions were: Does the MST therapists experience that the MST is a method that leads to an improved situation for young people who receive the method? What do the MST therapists describe as opportunities and obstacles in the work with the method? The study builds on previous research on MST and empowerment based on MST. The study shows three therapists and an MST leader's experiences of the treatment and how it is aimed at influencing the parents and the youth for a change. From therapists statements it highlights how the MST method is designed for the young people’s motivation to change by means of the internal and external networks. The result shows that previous research shows a lot of criticism on the treatment in Sweden. It turns out that other interventions from the social services give the same results or even better. All therapists reported that they have seen changes in the families and that most families have been guided to a new way of thinking but that collaboration with other parties concerned should be better. It has been positive and negative sides to treatment from psychiatrist’s perspective and that it constantly going research on the method for behavior problems will be prevented effectively. When the youth was involved the treatment was more effective. The benefit of MST is that the treatment occurs multi systemically with the whole youths network but the risk of the treatment is that the youths network could disappear and that would lead to discontinuing treatment that may not help it to achieve empowerment. There are advantages and disadvantages to treatment, and it comes to that MST therapist to interpret the MST's principles as well as possible for parents and youth to strengthen and not being dependent on other treatment interventions. There has been an improvement on the MST treatment when MST Sweden was formed and got swedish consultants. The study's conclusions is that it is important to create opportunities for youth to participate in the treatment and obtain the youths opinions on why it does not work and how the networks will work with the youth to get it to evolve. To gain achievement, the MST team has to ignore the youths, age treat individuals according to their maturity, integrating family members as much as possible and get a good interaction between the therapists and families.
Studien är gjord utifrån en kvalitativ metod där en hermeneutisk ansats har använts för att tolka de semistrukturerade intervjuerna. Studiens syfte var att undersöka Multisystemisk terapi (MST) teamet i Halmstads kommuns uppfattningar på behandlingsmetoden multisystemisk terapi för ungdomarna i åldern 12-18 år. Frågeställningarna var: Upplever MST terapeuterna att MST är en metod som leder till en förbättrad situation för ungdomarna som får metoden? Vad beskriver MST terapeuterna att det finns för möjligheter och hinder i arbetet med metoden? Studien bygger på tidigare forskning om MST och förstärkning utifrån MST. I studien framkommer det tre terapeuters och en MST ledares upplevelser av behandlingen och hur den är riktad till att påverka föräldrarna och dens ungdom till en förändring. Från terapeuternas utsagor belyses det hur MST metoden är utformad till att ungdomarna motiveras till förändring med hjälp av det interna och externa nätverken. Resultatet visar att tidigare forskning framför mycket kritik på behandlingen i Sverige. Det visar sig att andra insatser som finns hos socialtjänsten ger samma resultat eller ännu bättre. Alla terapeuterna uttryckte att de har sett förändringar hos familjerna och att de flesta familjerna har vägletts till ett nytt sätt att tänka men att samarbetet med fler berörda parter bör bli bättre. Det har framkommit positiva och negativa sidor på behandlingen från terapeuternas perspektiv och att det ständigt pågår forskning på metoden för att beteendeproblemen ska förebyggas effektivare. När ungdomen var delaktig blev behandlingen effektivare. Fördelarna med MST är att behandlingen sker multisystemiskt med hela ungdomens nätverk men risken med behandlingen är att ungdomens nätverk kanske inte finns kvar när behandlingen avslutas som kan hjälpa den att stärkas. Det finns fördelar och nackdelar på behandlingen och det gäller att som MST terpeut att kunna tolka MST:s principer så bra som möjligt för att föräldrarna och ungdomen stärks och inte blir beroende av andra behandlingsinsatser. Det har skett en förbättring på MST behandlingen när MST Sverige bildades och fick svenska konsulter. Studiens slutsatser är att det är viktigt att skapa förutsättningar till att ungdomen blir delaktig i behandlingen och få fram dens åsikter på varför det inte fungerar och hur nätverken ska jobba med ungdomen för att få den att utvecklas. För att förstärkning ska uppnås måste MST teamet bortse från ungdomarnas ålder behandla individerna efter deras mognad, integrera familjemedlemmarna så mycket som möjligt och få ett gott samspel mellan terapeuterna och familjerna.

The purpose of this study was to investigate multi-systemic training of counselors on families who participated in counseling to determine differences in the family's social functioning and in children's behaviors within home and school settings. The sample of counselors (n = 10) and families (n = 29) were from the New Horizon's Family Counseling Center, affiliated with the School of Education at the College of William and Mary.;Systemic theory as it relates to family therapy possesses two major tenets: the family is best understood as a system of mutually interacting and interdependent parts, and interventions should include the whole family (Minuchin & Fishman, 1979). A multi-systemic model asks counselors to view the family's behavior as a function of the family and its relationship with each other and with other systems (e.g. schools, social agencies, extracurricular groups and the workplace). Evaluating patterns which emerge between families and larger systems provides information regarding possible replication of unsatisfactory relationships and clarifies interactions among professionals (Imber-Black, 1988).;A non-equivalent, quasi-experimental design with pre and post tests was employed. The dependent measures included: Achenbach Child Behavior Checklist (CBCL) and Teacher Report Form (TRF) and Family Environment Scale (FES). Data was analyzed using multivariate and univariate repeated measures analysis of variance statistical procedures. to supplement the standard analyses, a multi-systemic orientation questionnaire and interviews were completed.;Results indicate that counseling in general resulted in improvement on the FES, CBCL and TRF, and on CBCL subscales Internal and External. However, there were no significant differences between families served by the experimental and comparison groups. In addition to a multitude of confounding variables, the outstanding factors which may have affected results include pretest differences between groups, and training which may not have provided a significant enough change to result in the anticipated hypotheses.;The author concluded that, despite statistical results, which reflect more upon numerous limitations in the design and implementation, the concept of a multi-systemic approach to assessment and intervention is one which possesses a practical significance and continues to warrant further investigation.

Evidence has shown that Multisystemic Therapy (MST) an intensive family- and community-based intervention has been particularly effective in the treatment of youth with antisocial behaviour from ethnically diverse backgrounds. Although the process of change within MST has been explored, there is a dearth of research in looking at this for families from ethnic minority backgrounds. The current research aimed to address this gap by exploring the experiences of a sample of London based caregivers who had completed an MST intervention. A qualitative approach was adopted, using grounded theory methodology to explore ethnic minority caregiver experiences of MST and generate a model of the processes of engagement and change based on participants' accounts. Seven semi-structured interviews were carried out with caregivers from two London sites. The emergent model consisted of seven interacting theoretical codes. Three of these codes were organised around the process of engagement; deciding to engage with MST, becoming therapeutically aligned and considering cultural difference, and four related to the process of change; working within a safe and trusting relationship, therapist acting as cultural broker, empowering the parent and increased communication within and outside the family. The author makes novel suggestions relating to the specific mechanisms that are thought to underlie the process of engaging with MST, and highlights the importance of considering cultural difference in the initial stages of the MST intervention.

The purpose of this study was to describe the school situation of adolescents who were subject to multisystemic therapy in Sweden, and also if a change could be measured after treatment. Factors that preceded the need for treament were also investigated. The sample consisted of 83 adolescents, boys (65 %) and girls (35 %), with an average age of 14 years. The method used was a secondary data analysis using pre-treatment- and post-treatment data collected from a 7-month follow-up conducted by Lunds Universitet. Results showed that the adolescents were low in school performance and high in truancy at pre-treatment. Truancy was the main reason for the need of treatment (50 %). The follow-up data showed tendencies of positive outcomes in the adolescent's school performance. Further research is needed to better detect weakness in adolescent's school performance and focus interventions to improve that area.

Syftet med denna systematiska litteraturöversikt är att undersöka vilka förebyggande metoder och/eller modeller som finns för att bemöta syskon till grovt kriminella ungdomar. Studien syftar dessutom på att jämföra metodernas olika för- och nackdelar. Resultaten i denna studie är framtagna genom att använda databaserna Libsearch och ProQuest. Vald litteratur har lästs och analyserats upprepade gånger, och två teman valdes för att beskriva artiklarnas fokus, och koppling till studiens syfte och frågeställningar. Valda teman är 1) intervention metoder, och 2) fördelar med MST. Trots en bristande mängd forskning på området så pekar resultatet på att familjeterapin Multisystemisk Terapi (MST) är den dominerande metoden. Förutom fokus på den kriminella individen i MST så involveras syskonet och påverkas direkt, eller indirekt i MST. Till skillnad från individuell terapi (IT) där endast den kriminella ungdomen involveras så sjunker risken att syskonet börjar begå brott markant med MST. Forskningen inom detta område behöver utökas och metoder och arbetssätt går att förbättra.
The aim with this systematic literature review is to investigate the intervention methods and/or models available to deal with siblings for serious criminal youths. The study also aims to compare the methods pros and cons. The results are produced by using the databases Libsearch and ProQuest. Chosen literature has been read and analysed several times, and two themes was selected to describe the articles focus and connection to the study’s aim and research questions. The chosen themes are 1) intervention methods, and 2) advantages with MST. Despite a small amount of research in the field, the result indicates that the family therapy method Multisystemic Therapy (MST) is a dominant method in the field. Except only focusing on the criminal individual in MST, the sibling is involved and directly or indirectly affected. Unlike individual therapy (IT) involving only the criminal juvenile, the risk of the sibling beginning to commit crimes significantly decreases with MST. Research in this area needs to be expanded and methods and ways of working can be improved.

Multisystemic Therapy (MST) provides intensive short-term interventions for young people with antisocial behaviour and the systems that surround them. A wealth of research over the past 30 years has demonstrated the efficacy of MST. Its success has led to it being transported to many countries and this prompted investigations into the need for cultural adaptation. Despite these investigations highlighting the importance of tailoring MST to new countries, when MST was transported to England in 2001, it did not undergo a formal process of cultural tailoring. This study employed a qualitative approach using a Grounded Theory methodology to explore the assumption that all transported programmes require a level of adaptation and aimed to identify the processes and rationale behind informal ‘cultural tailoring' undertaken by therapists. It aimed to explore areas in MST that might benefit from ‘cultural tailoring' to improve the effectiveness of its implementation in England. Eight MST therapists from across three MST teams in England participated in semi-structured interviews. Analysis of the data generated a theoretical model of adherence: the Post Implementation Model of Adherence (PIMA). The PIMA model seeks to explain how therapists in England experience and manage adhering to MST. It proposes that MST therapists strive to adhere to all aspects of the MST model whilst ensuring that it is acceptable and workable for the families and systems they work with. The PIMA model comprised four theoretical codes: Facilitators to therapists staying faithful to the MST model; barriers to therapists implementing MST, overcoming barriers to implementing MST; and the therapist holding the tension. The findings highlight important cultural adjustments to improve MST's ‘fit' in England. Findings also extend Schoenwald's (2008) recommendations for successful transportation of MST, by drawing attention to how a lack of cultural tailoring can be overcome or experienced as stressful by therapists.

The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on October 5, 2009). Thesis advisor: Dr. Charles M. Borduin. Includes bibliographical references.

A one-group pre-test post-test design (including 6- and 12-month follow-up), supplemented with benchmarking analyses, was employed to assess the effectiveness of Multisystemic Therapy (MST) for youth displaying antisocial behaviours in New Zealand. An additional aim of the current study was to assess for predictors and moderators of outcome. The predictor variables assessed included: Client satisfaction, therapeutic and supervisory alliance, therapist and supervisor adherence, therapist and supervisor allegiance, and therapist and supervisor accountability. Seventy-three youth and their families completed the MST program (M = 162 days) and the present study’s measures. Youth and their families experienced improvements in ultimate outcomes (offending frequency, offending seriousness, and days in out-of-home placements) and instrumental outcomes (youth positive and negative behaviour, parent well-being and psychopathology, parent ability, and family functioning) following MST treatment. With a few exceptions, these gains were largely maintained up to 12 months following treatment. Benchmarking analyses indicated that the completion rate and effect sizes were comparable with those from previous MST studies both in New Zealand and the United States. The predictor variables of service satisfaction, therapeutic alliance, and therapist adherence predicted higher levels of change in most instrumental outcomes as expected. However, of significant importance, higher supervisor adherence and supervisory alliances were associated with significantly lower therapist adherence, therapeutic alliance, and some client outcomes. Furthermore, the few significant interactions between predictor variables produced mixed findings, many of which contradicted widely held assumptions. As MST has been demonstrated to be an effective treatment for youth offenders in New Zealand, continuing dissemination and ongoing evaluation of MST in New Zealand is recommended. In particular, given the negative impact of supervision variables on therapist adherence, therapeutic alliance, and some client outcomes, this would include research aimed at assessing various quality control functions of supervision, including supervisor training, mechanisms of supervision related to therapist and client variables, and the potential value of more closely monitoring the process of supervision.