Each of us must come to care about everyone else s children. We must - - PowerPoint PPT Presentation

Each of us must come to care about everyone else’s children. We must recognize that the welfare of our children is intimately linked to the welfare of all other people’s children.... To worry about all other people’s children is not just a practical or strategic matter; it is a moral and ethical one; to strive for the well- being of all other people’s children is also right.

Lilian G. Katz, international leader in early childhood education

Multisystemic Therapy: An Ecological Approach to Intervention for At-Risk and Delinquent Youth

A one year pilot project focusing on Aboriginal youth in the Sea to Sky Corridor (School District #48)

MST: An alternative to incarceration

http://mstservices.com/ (Video)

Presentation outline

• What is MST?
• Who is our target population?
• What is the theory that supports MST?
• What does the research say?
• How much will this cost?

Please feel free to ask questions anytime!

Multi-Systemic Therapy

Intensive intervention young people social ecology embedded

MST is an intensive family and community based intervention which targets the known risk factors of serious anti-social behaviour in young people. The focus of the intervention is on changing the social ecology factors in which the youth is embedded.

9 Principles of MST

• Assessment for fit between identified problems and the context
• Interventions must emphasize system strengths
• Interventions must be action oriented and target-specific
• Interventions must target sequences of behaviours within multiple

systems

• Interventions must be developmentally appropriate
• Interventions must be designed for daily or weekly family efforts
• Intervention efficacy must be evaluated continuously from multiple

perspectives

• Interventions must be designed to promote long-term maintenance and

empower care-givers across multiple systems

Provincial High School Completion Rates:

• Over the last six years, the overall student

completion rate was 79 per cent, except for 2006-07 when it was 80 per cent.

• The completion rate for aboriginal students has

swung between 47 and 48 per cent from the 2003-04 school year to 2007-08.

(CBC-December 3, 2009 9:14 PM PT The Canadian Press )

Sea to Sky (SD # 48) Six-Year Completion Rate for Aboriginal Students, 2005/06 2007/08 2008/09:

% % % % 2005- 2006 2006- 2007 2007- 2008 2008- 2009 Boys Girls Total Boys Girls Total Boys Girls Total Total 37 54 47 46 66 53 22 62 40 35

B.C.’s Aboriginal Youth:

 Aboriginal children and youth are dramatically over-represented in the British Columbia child in-care population. Aboriginal children and youth are six times more likely to be admitted into care than non-Aboriginal children and youth.  Aboriginal youth constitute a disproportionately large section

• f the province’s in-custody youth.

 Aboriginal children and youth encounter significant disadvantages – they face more health risks, experience less success in school and are over-represented in the child welfare and juvenile justice systems (Growing Up In B.C. 2010)

Theoretical Foundation for MST:

Developed in the 1970s by MST Services board director

• Dr. Scott Henggeler and Dr. Charles Borduin.

The MST model is based on the belief that youth behavior is determined by multiple factors:

• youth's social and cognitive development
• family relations
• peer interactions
• community influences

Each of these factors, and more, in any combination, can be targeted to promote positive behavioral change.

Theoretical Foundation for MST:

Depending on the youth's individual circumstances, MST treatment may aim to:

• improve a caregiver's discipline practices

( barriers to effective parenting, such as high stress, low social support, parental substance abuse, marital problems, or lack of knowledge)

• ameliorate those factors within and across the

various systems or subsystems (i.e. family, peers, school, community) contributing

• decrease the youth's interaction with deviant peers
• decrease the youth’s use / abuse of drugs and alcohol
• improve the youth's school performance
• aim to produce other positive results specific to the youth’s individual needs

Theoretical Foundation for MST:

 SYSTEMS THEORY Von Bertalanffy 1968 Mechanistic /linear cause to mutually influential model (family therapy)  ECOLOGY MODEL Bronfenbrenner 1979 Broader than Systems Theory, nested structure includes individual within ecology and individual’s interpretation of his/her circumstances

Bronfrenbrenner’s Ecological Model of Human Development:

Is MST a good fit for our Aboriginal youth?

It sounds excellent for working with Aboriginal families though- a community based way of looking at problems is the most effective and also tends to be more culturally

• appropriate. Healing through connection to culture is a

very important piece for the communities we serve, so an approach that understands and works this way is likely to be more fitting. Sounds like a great project, good luck with it. April

• April Lies, M.A.
• Child and Youth Mental Health Clinician
• Ministry of Children and Family Development

Research – Current trends

• Scaling up
• Ecological
• Efficacy; effectiveness; sustainable

Chart of research results

• Author and date
• Location
• Target population
• Method
• Results

US

• Fidelity of intervention and success
• Shifting trajectories

Canada

• Indicators of success focused on criminal

convictions and rates of custody

• The size of the pilot project is critical as is

fidelity of the intervention

• Statistics don’t tell the whole story

Norway

• Statistically heavy
• Looked at many measures to evaluate

success of the MST intervention

Hawaii

• Suggested that younger clients may have

better success rates

• Youth with co morbid diagnoses were more

likely to be successful with MST

• Demographics had no impact on success

rates

• Success in MST group was correlated with

improvements shown in other measures

UK

• Keeping the numbers small aided the success for

the families and therapists involved in the project

• Much attention was given to developing goals at

the outset and then reviewing goals for obstacles

• Level of satisfaction with the service was a

measure of evaluation

• The results suggest a possible shift in the

trajectory of the participants

Story behind the statistics . . .

Rationale for Funding: Sea to Sky “Makes it Happen”

• Purveyor organizations do the work of helping
• thers integrate science into practice
• Operationalizes interventions
• Develops a competent workforce
• Establishes organizational supports for

practitioners.

• Locates and develops facilitative leadership.

Fixsen, D.L. et al. (2010).

The Projected Costs

• MST Inc and Washington State Institute of Public

Policy estimates $4,500 to $5000.

• Ontario study, under non-research conditions is

expected to between $6,000 and $7,000 per case.

• “Sea to Sky” will dedicate twelve cases in 6-7

months

• On average $7,500 per case

MST and the Oversight of MST Services Inc.

“Sea to Sky” Framework

• Three therapists with

specialization in working with Aboriginal youth

• Squamish Nation Child and

Family Services

• Lil’wat Nation Mental Health
• School District #48
• Sea to Sky Community Services
• Ministry of Children and Families
• Specific referral process

Allocation of Funding

• Three MST trained therapists salary
• One MST trained supervisor salary
• MST Consultations
• Initial and follow-up training
• Accommodation & travel
• Other miscellaneous costs

Budget Allocations

Salaries ¡ Therapists ¡and ¡ supervisors ¡ $34,000 ¡ Training ¡ MST ¡ $13,000 ¡ Travel ¡expenses ¡for ¡MST ¡ training ¡ $12,000 ¡ Mileage, ¡phones ¡during ¡ interven=on ¡ Expenses ¡reimbursed ¡to ¡ therapists ¡ $12,000 ¡ MST ¡site ¡license ¡ MST ¡ $6,000 ¡ Consulta=on ¡fees ¡ MST ¡ $18,000 ¡

Three MST Trained Therapists

• Compensatory overtime salary ($8,300- $8,500)
• Partner organization pays base salary
• Dependant on qualifications, location & experience
• 20 hours per week on-call/overtime (5 months)
• Available on-call 24/7
• Five day training program for therapists ($2,550)
• Flights and accommodation for training ($6,000)

Therapist recruitment toolkit: A guide to MST Therapist hiring (2010).

MST Trained Supervisor

• Compensatory salary ($8,000)
• 50% of work with therapists
• Two-day training program ($350)
• Flights, food and accommodation for

training ($1,200)

Other Misc. Expenses

• Quarterly booster sessions, including travel and

accommodations ($14,000)

• Consultations Fees ($18,000)
• Mileage expenses ($5,000)
• Long-distance phone calls ($250)
• Cell phones ($1,500)
• MST site licenses ($6,000)

MST and the Oversight of MST Services Inc.

Canada Revenue Agency 2011

Costs associated with At-Risk Youth

• School attendance: attendance, drop-out rates
• Legal dealings: Incarceration, police, lawyers
• Poverty cycle: Teen pregnancy, welfare
• Health: Harm to others, self-harm, mental health,

child abuse & substance abuse

Standing Committee on Justice and Human Rights, (2000). The National Council of Welfare Reports, Welfare Incomes, (2009).

Cost-Benefit Reports

• Greenwich reports (2007):
• Costs $3,500 initially for MST (1997)
• Compared to $17,769 of usual services
• Or $30,000-$100,000/year (2003)
• Ontario (2002) reports:
• $7,500-9,500 per family for MST
• Compared to up to $106,000/year
• Washington (2001) reports:
• $4,743 per person for MST
• Compared to $31,661 and $131,918/year

(Hengler,1997 & Sheidow and Woodford (2003): in Lesley French “2007” Greenwich)

The true measure of a nation’s standing is how well it attends to its children – their health and safety, their material security, their education and socialization, and their sense of being loved, valued, and included in the families and societies into which they are born.

Growing Up in B.C. Office of the Provincial Health Officer UNICEF, Innocenti Report Card 7, 2007

Questions?