Young people at risk of developing anti-social personality disorder: the use of multisystemic therapy as an early intervention with the family

8/9/2019 Young people at risk of developing anti-social personality disorder: the use of multisystemic therapy as an early intervention with the family

1/20

Young People at risk of developing ASPD:the use of multi-systemic therapy as an early

intervention within the family

Dr Simone FoxChartered Clinical & Forensic Psychologist

MST Supervisor Merton & Kingston

Dr Juliette WaitChartered Clinical Psychologist

MST Supervisor Reading

PD Congress19th November 2009


2/20

Aims of Presentation

To think about Personality Disorder froman adolescent perspective

To develop an understanding of the risk

factors in the development of antisocialPD

An overview of MST and how it addresses

these risk factors


3/20

Group Exercise

In pairs identify one risk and oneprotective factors for the onset ofbehavioural problems in adolescence;o Individualo Familyo Schoolo Peer groupo Community

Feedback on flipchart


4/20

Risk & Protective FactorsContext Risk Factors Protective FactorsIndividual Low verbal skills

Favourable attitudes towards ASB Psychiatric symptomatology Cognitive bias to attribute hostile intentions to others

Intelligence Being first born Easy temperament Conventional attitudes Problem-solving skills

Family Lack of monitoring Ineffective discipline Harsh and inconsistent discipline Low warmth High conflict Parental difficulties e.g. drug abuse, psychiatric

conditions, criminality

Attachment to parents Supportive family environment Marital harmony

Peer Association with deviant peers Poor relationship skills Low association with pro-social peers

Bonding with pro-social peers

School Low achievement Dropout Low commitment to education Aspects of school e.g. weak structure & chaotic

environment

Commitment to schooling Good school-home links Good relationship with teacher(s)

Community High mobility Low community support High disorganisation Criminal subculture

Ongoing involvement in community activities Strong indigenous support network


5/20

Common findings of 50+ years ofresearch: delinquency and drug use are

determined by multiple risk factors:o Family (low monitoring, high conflict, etc.)o Peer group (law-breaking peers, etc.)o School (dropout, low achievement, etc.)o

Community ( supports, transiency, etc.)

o Individual (low verbal and social skills, etc.)

Delinquency is a Complex Behaviour


6/20

Causal Models of Delinquency andDrug Use

Condensed LongitudinalModel

Family

School

DelinquentPeers

DelinquentBehavior

Prior DelinquentBehavior

Low Parental MonitoringLow AffectionHigh Conflict

Low School InvolvementPoor Academic Performance Elliott, Huizinga & Ageton

(1985)


7/20

Theoretical Assumptions

Children and adolescents live in a social

ecology of interconnected systems that impacttheir behaviors in direct and indirect ways These influences act in both directions (they

are reciprocal and bi-directional)

Based on Bronfenbrenner, Haley and Minuchin


8/20

EcologicalModel

Child

Family

Peers

School

Neighborhood

Community/Culture


9/20


10/20

What is MST?

Intensive, goal oriented and time limitedintervention

Community-based, family-driven

Targets the multiple causes of anti-social andcriminal behaviour in young people Highly structured clinical supervision and quality

assurance processes

Strong track record of client engagement,retention and satisfaction


11/20

Who is the target population for MST?

Family and key participants in the environment of youngpeople

MST client is the entire ecology of the young person -family, peers, school, community

Age range 11-17 years High risk of out-of-home placement

eg. care, custody, residential school Placement risk due to their behaviour

at home / school / in the community May be involved with the criminal justice system


12/20

What is MST? Focus is on families as the solution Focus on empowering the caregivers / parents to solve

current and future problems Parents are full collaborators in planning and delivering

interventions Assumption - Childrens behaviour is strongly influenced

by their families, friends and communities (and viceversa)

Works in partnership with a combination of systems(parents, family, peers, school and community) toaddress risk factors


13/20

How does MST work? Assessing and understanding the factors contributing to

identified problems Having clear goals to work towards Prioritising key factors and interventions

Interventions based on techniques that have strongevidence base:

Behaviour therapy Parent management training Cognitive behavior therapy Pragmatic family therapies

Pharmacological interventions (e.g., for ADHD) Supporting the parent/carer in devising strategies to

target factors contributing to the young personsbehaviour


14/20

How is MST implemented?

Single therapist works intensively with 4 familiesat a time

Meetings at least 2-3 times a week

Community and home based Out-of-hours service run by the team which isavailable to families 24 hours a day, 7 days aweek

Team has 3-4 therapists and clinical supervisor Involvement typically ranges from 3 to 5 months


15/20

How is MST implemented?

Team provides the family with a single point ofcontact

MST team deliver all treatment

Typically no services are referred outside theMST team Never ending focus on engagement and

alignment with the primary caregiver and other

key stakeholders addressing barriers MST team must be able to have a lead role inclinical decision making for each case


16/20

MST Quality Assurance System

Team comprised of range of professionals multi-disciplinary/multi-agency

Structured training orientation and regular

boosters Frequent professional development planning Weekly clinical supervision and case review Weekly consultation with consultant in USA

Research validated adherence process fortherapists and supervisor


17/20

Whats different?

Traditional models Individual (family) Clinic-based

Fixed times High caseloads less intensive

Open-ended

Supervision

MST Ecological Home-based Flexible/24 hour Low caseloads

3x weekly + Fixed goal-driven Quality assurance

NB Not better, just different approach to address a different need


18/20

Why does it need to be different?

Multi-determined nature of serious antisocialbehaviour

Risk factors span the ecology in which the child

is embedded Families with complex problems struggle toaccess traditional services

High costs of antisocial behaviour

incarceration, placement, victimisation Therapist adherence predicts outcome


19/20

Video


20/20

References

Kazdin A. E., & Weisz, J. R. (1998). Identifyingand developing empirically supported child andadolescent treatments. Journal of Consulting and

Clinical Psychology, 66, 19-36. Henggeler, S. W., Schoenwald, S. K., Borduin,C. M., Rowland, M. D., & Cunningham, P. B.(2009). Multisystemic treatment of antisocial

behaviour in children and adolescents 2ndedition. New York: Guildford Press. www.mstservices.com

Documents

Young people at risk of developing anti-social personality disorder: the use of multisystemic therapy as an early intervention with the family