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- 2007- 2008- 2006 2007 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 of 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 others 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 ¡ $34,000 ¡ supervisors ¡ Training ¡ MST ¡ $13,000 ¡ Travel ¡expenses ¡for ¡MST ¡ $12,000 ¡ training ¡ Mileage, ¡phones ¡during ¡ Expenses ¡reimbursed ¡to ¡ $12,000 ¡ interven=on ¡ therapists ¡ 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
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