Multisystemic Therapy for Child Abuse and Neglect
Multi-systemic Therapy for Child Abuse and Neglect (MST-CAN) is an intensive treatment for families who have recently been reported to Child Protection Services for physically abusing and/or neglecting a child between the ages of 6 and 17.
MST-CAN therapists provide the family with tailored individual and family support and therapy over a six- to nine-month period with the aim of helping parents learn how to parent their child in a way that is not abusive or neglectful. MST-CAN has initial evidence of reducing parents’ maltreating behaviour and out-of-home placements.
EIF Programme Assessment
Child outcomes
This programme can affect outcomes for children in Active and healthy, physical and mental wellbeing.
According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:
Supporting children's mental health and wellbeing
Reduced symptoms of child PTSD
based on study 1
- Statement: 1.43 point improvement on the Administrative data from the Child Protective Services
- Score: 21
- Timeframe: Between the end of the intervention and 10 months later
- Statement: 0.25 point improvement on the Trauma Symptom Checklist for Children
- Score: 25
- Timeframe: Between the end of the intervention and 10 months later
Reduced child dissociative symptoms
based on study 1
- Statement: 0.94 point improvement on the Trauma Symptom Checklist for Children
- Score: 27
- Timeframe: Between the end of the intervention and 10 months later
Reduced internalising symptoms
based on study 1
- Statement: 2.13 point improvement on The Child Behaviour Checklist (parent report)
- Score: 26
- Timeframe: Between the end of the intervention and 10 months later
Preventing child maltreatment
Reduced neglect
based on study 1
- Statement: 0.18 point improvement on the Conflict Tactic Scale (child report)
- Score: 31
- Timeframe: Between the end of the intervention and 10 months later
- Statement: 0.04 point improvement on the Conflict Tactic Scale (parent report)
- Score: 11
- Timeframe: Between the end of the intervention and 10 months later
Reduced psychological aggression
based on study 1
- Statement: 0.03 point improvement on the Conflict Tactic Scale (child report)
- Score: 8
- Timeframe: Between the end of the intervention and 10 months later
Reduced minor assault
based on study 1
- Statement: 0.02 point improvement on the Conflict Tactic Scale (child report)
- Score: 6
- Timeframe: Between the end of the intervention and 10 months later
Reduced severe assault
based on study 1
- Statement: 0.34 point improvement on the Conflict Tactic Scale (child report)
- Score: 21
- Timeframe: Between the end of the intervention and 10 months later
- Statement: 0.15 point improvement on the Conflict Tactic Scale (parent report)
- Score: 22
- Timeframe: Between the end of the intervention and 10 months later
Reduced non-violent discipline
based on study 1
- Statement: 0.02 point improvement on the Conflict Tactic Scale (child report)
- Score: 8
- Timeframe: Between the end of the intervention and 10 months later
- Statement: 0.04 point improvement on the Conflict Tactic Scale (parent report)
- Score: 22
- Timeframe: Between the end of the intervention and 10 months later
Increased placement stability
based on study 1
- Statement: 0.18 point improvement on the administrative data from the Child Protective Services
- Score: 8
- Timeframe: Between the end of the intervention and 10 months later
Preventing crime, violence and antisocial behaviour
Reduced total problem behaviours
based on study 1
- Statement: 3.50 point improvement on The Child Behaviour Checklist (parent report)
- Score: 30
- Timeframe: Between the end of the intervention and 10 months later
This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.
Who is it for?
The best available evidence for this programme relates to the following age-groups:
Primary school Preadolescents Adolescents
How is it delivered?
The best available evidence for this programme relates to implementation through these delivery models:
- Individual
Where is it delivered?
The best available evidence for this programme relates to its implementation in these settings:
- Out-patient health setting
How is it targeted?
The best available evidence for this programme relates to its implementation as:
- Targeted indicated
Where has it been implemented?
- Australia
- Netherlands
- Norway
- United Kingdom
- United States
Ireland provision
Ireland evaluation
About the programme
What happens during the delivery?
How is it delivered?
- MST-CAN is delivered by a therapist individually to families in their homes.
- Therapists are available 24/7 to the family and carry a caseload of three to four families at a time.
- Therapy sessions typically last between 50 minutes and two hours.
- The frequency of the sessions vary depending on the needs of the family and the stage of the treatment, typically ranging from three days a week to daily.
- Therapists work with individual families for an average of six to nine months.
What happens during the intervention?
- The MST-CAN therapist works closely with his or her MST-CAN expert, supervisor and family to find a good ‘fit’ between the family’s issues and tailored strategies. This includes identifying barriers to the success of the programme (eg parental substance misuse or mental health problems) and developing methods for removing these barriers.
- A key aim of the intervention is to help families assume greater responsibility for their behaviours and actively work to resolve serious family issues.
What are the implementation requirements?
Who can deliver it?
- The practitioner who delivers this programme is an MST-CAN therapist with NFQ-7/8 level qualifications.
What are the training requirements?
- Practitioners have 104 total hours of programme training. Booster training of practitioners is recommended.
How are the practitioners supervised?
- It is recommended that practitioners are supervised by one host-agency supervisors (qualified to NFQ-9/10 level), with 120 hours of programme training.
- It is recommended that practitioners are supervised by one programme developer supervisors (qualified to NFQ-9/10 level)
What are the systems for maintaining fidelity?
Programme fidelity is maintained through the following processes:
- Training manual
- Other printed material
- Other online material
- Video or DVD training
- Face-to-face training
- Fidelity monitoring.
Is there a licensing requirement?
There is a licence required to run this programme.
How does it work? (Theory of Change)
How does it work?
- MST-CAN is informed by ecological theory that suggests that child maltreatment is multiply determined by risks occurring at the level of the child, family, school and community.
- MST-CAN therapists help families identify strengths within each ecological level that will help them overcome the risks contributing to the maltreating behaviours.
- Parents also learn strategies that are specific to their identified strengths to overcome the risks they are experiencing.
- In the short term, parent and child behaviours improve; families experience greater cohesion and improved relationships with their child’s schools and wider support systems.
- In the long term, the risk of child maltreatment decreases, children are at less risk of behavioural problems, and there is less likelihood that the child will need to go into care.
Intended outcomes
- Safe and protected from harm
Contact details
Cathy James
cathy.james@kcl.ac.uk
www.mstcan.com
www.mstservices.com
www.mstuk.org
www.mstinstitute.org
About the evidence
The most rigorous evidence for MST-CAN comes from an RCT, which was conducted in the USA. This is a rigorously conducted (level 3) study, which has identified a statistically significant positive impact on a number of child and parent outcomes. A programme receives the same rating as its most robust study, and so MST-CAN receives a level 3 rating overall.
Study 1
| Citation: | Swenson et al., 2010 |
| Design: | RCT |
| Country: | United States |
| Sample: | 90 parent-child dyads in families with a child between the ages of 6-17 |
| Timing: | Baseline; 2 months post-baseline; 4 months post-baseline; 10 months post-baseline; 16 months post-baseline |
| Child outcomes: |
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| Other outcomes: |
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| Study rating: | 3 |
Swenson, C. C., Schaeffer, C. M., Henggeler, S. W., Faldowski, R., & Mayhew, A. M. (2010). Multisystemic Therapy for Child Abuse and Neglect: a randomized effectiveness trial. Journal of Family Psychology, 24(4), 497.
Available at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928578/
Study Design and Sample
The first study is a rigorously conducted RCT.
This study involved random assignment of 90 children to a MST-CAN group (n=45), or Enhanced outpatient treatment (n=45).
This study was conducted in the USA (Charleston, South Carolina), with a sample of families who were known to child protection services. Families were eligible if there was a reported incident of abuse or neglect in the past 90 days and they had a child between the ages of 10 and 17 years.
Measures
Participants completed a battery of validated parent and child measures at baseline (pre-treatment) and then 2, 4, 10, and 16 months post-baseline:
- Youth behavioural and emotional functioning was measured using The Child Behaviour Checklist (CBCL) (parent report), the Trauma Symptom Checklist for Children (TSCC) (child self-report), and the Social Skills Rating System (child self-report).
- Psychiatric distress in parents was measured using the Global Severity Index (GSI) of the Brief Symptom Inventory (parent-report).
- The number of psychiatric symptoms was measured using the BSI Positive Symptom Total Scale (PST) (parent report).
- Parenting behaviour was measured using the Conflict Tactics Scale (CTS) (parent and child repot).
- Social Support for the parents was measured using the 40-item Interpersonal Support Evaluation List (ISEL).
- Maltreatment (re-abuse) and youth out-of-home placement was measured using data obtained from CPS records. Re-abuse was defined as a new report of abuse of the target child, abuse of any child by the target parent. With regards to out-of-home placements; this referred to whether children were placed, for how many days they were placed, and whether there were any placement changes.
Findings
This study identified statistically significant positive impact on a number of child and parent outcomes. This includes:
- Reduced internalising behaviour (CBCL),
- Reduced total behaviours (CBCL),
- Reduced PTSD (CBCL, TSCC),
- Reduced dissociative symptoms (TSCC).
- Reduced neglect (parent and child report),
- Reduced psychological aggression (child report),
- Reduced minor assault (child report),
- Reduced severe assault (parent and child report),
- Reduced non-violent discipline (parent and child report).
- Improved parental psychiatric distress (GSI),
- Improved social support.