1. THE WAY THE PROGRAM IS DESIGNED TO BE AN EFFECTIVE SOLUTION FOR A FACTOR LINKED TO HIGH RE-OFFENDING RATES, WHAT THE FACTOR IS AND HOW IT RELATES TO HIGH RE-OFFENDING RATES 1.1 About the program To address the objectives of the Youth Justice Innovation Fund, Life Without Barriers (LWB) proposes to deliver a Multisystemic Therapy (MST) program. MST is an internationally recognised evidencebased program that has been shown through rigorous, multiple research studies to reduce criminal activity and out of home placements for serious and chronic young offenders 1. Evaluations have demonstrated that MST achieves significantly better and more sustainable outcomes when compared to other interventions for serious juvenile offenders. The benefits of MST have been widely recognised for example, in 2011 the United Kingdom National Institute for Health and Care Excellence identified MST as the most promising available intervention for reducing adolescent antisocial and offending behaviour. MST operates in 15 countries including Australia and New Zealand and has more than 500 active programs. In 2013, MST served 12,127 young people and their families globally. LWB is the Australasian Network Partner/license holder for the MST program. MST was developed specifically to address youth conduct problems and was designed to work with hard-to reach families. It is an intensive family and community-based program that addresses the multiple factors known to be related to anti-social behaviour and youth offending across the key settings or systems within which a young person lives. In effect, MST addresses the young person s entire environment. Instead of removing young people from their home, MST treats them in the community. MST is pragmatic and goal-orientated and mobilises the strengths and resources of each system (e.g. family, peers, school, neighbourhood, Indigenous support network) to facilitate positive long term behavioural change. Intervention may be targeted to any one or a combination of these systems. (See Appendix 1 for an overview of the MST model). MST goes to where the young person lives, hangs out and attends school. This is because there is overwhelming evidence that all the components in a young person s life family, friends, school and neighbourhood contribute to serious antisocial behaviour. Kids don t live in a vacuum, therefore, one cannot treat them in one- MST Service MST was informed by the empirical literature which found strong associations between various forms of antisocial behaviour and key characteristics (i.e. risk and protective factors) of individual young people and the social systems in which they are embedded. Across studies, researchers have shown that youth anti-social behaviour is linked directly or indirectly with key risk and protective factors of youth and the systems in which they interact. 1 MST is a well validated treatment model with 34 published outcome, implementation and benchmarking studies over the last 30 years including, 23 random control trials and 17 independent evaluations (not involving the MST developer). Studies have included violent and chronic juvenile offenders, substance abusing and dependent juvenile offenders and adolescent sexual offenders.
MST is an intensive 4-5 month intervention for young people generally aged between 12 and 16 years which focusses on supporting parents and caregivers by teaching them the problem-solving skills necessary to better manage their children s behaviour. Skills learned help to improve communication within the family and between relevant systems such as school and the community. MST also equips young people with the skills to cope with family, peer, school, and neighbourhood problems. MST interventions typically aim to: Reduce at risk, anti-social and offending behaviour Improve caregiver parenting practices Enhance family relations Reduce drug and alcohol misuse Decrease the young person s association with deviant peers Increase the young person s association with pro-social peers Improve the young person s school or vocational performance Engage the young person in positive recreational outlets Develop a natural support network of extended family, neighbours, and friends to help caregivers achieve and maintain such changes. By treating the family as a whole, the court is not sending rehabilitated youths back into the same dysfunctional environment. The goals are healthier families and reduced recidivism. MST aims to stop the cycle of dysfunction and criminality - generationally. I think the unique thing about MST is the intensive way parents are worked with. I see an astonishing change in parents. They walk into my courtroom differently. They are empowered to establish boundaries for their kids and then appropriately enforce them. I think we ll see a trickle-down effect to the other siblings- Judge Dorene S. Allen, MST is delivered in the home making it accessible for hard to reach families and young people. Travelling to the family also overcomes the high drop-out rates of other treatments, increases the likelihood that families will stay in treatment, provides families with intensive services and helps to maintain treatment gains. MST is also available 24/7 because crises do not keep business hours and both these factors have been repeatedly cited by families as critical to their success with the program. Another important element is that at the outset, the young person does not need to or want to be present for the intervention to be successful as long as the caregivers agree and engage. This works because the primary mechanism for creating sustainable change is through building caregiver parenting capacity and problem solving skills. As a holistic, systemic approach MST provides most of the immediate interventions required by a young person and their family but also work closely with other stakeholders such as education, justice services and other NGOs to ensure sustainability.
1.2 Proven Outcomes MST has proven to be a cost-effective program that reduces re-arrests and out-of-home placements for chronic and/or violent juvenile offenders. Studies show a reduction in re-arrest rates post MST of 25%-70% with long-term benefits. A 14-year follow-up study by the Missouri Delinquency Project showed that youths who received MST had: 59% fewer re-arrests 68% fewer drug-related arrests 57% fewer days of incarceration 43% fewer days on adult probation The UK pilot of MST at the Brandon Centre in 2011 focused on youth who had committed both violent and non-violent offences. The pilot compared 108 young offenders receiving MST with young people who had experienced the usual intervention provided by Youth Offending Teams (YOTs) as shown in Figure 1. The data shows that the young people who received MST had significantly better outcomes with a much greater reduction in repeat offences compared to the young people receiving the YOT intervention. Significantly, this reduction was sustained 18 months post intervention. Figure 1- Comparison of Treatment as Usual - Brandon Centre Study UK, Butler et Al 2011
Several US studies with long term follow-ups show that MST also reduced the number of days in out of home care placements by 47% to 64% compared to control groups. Compared with control groups, MST studies have consistently demonstrated improved family relationships and family functioning, decreased substance use and fewer mental health problems. Australian and NZ data for young people referred to MST programs showed that post case closure for the period 1/01/2013 31/12/201: 89.1% of young people were living at home 84.4% of young people were in school or working 85.3% of young people had no new arrests 86.5% of young people completed treatment Data 2 collected by the W.A. Department of Health in relation to the WA MST Child and Adolescent Mental Health Service (CAMHS) program (see section 9.2) suggest that MST is effective with a typical Australian conduct disorder population that includes many young people from Aboriginal families. The program has reliably achieved positive outcomes with this high-risk population. The continuing longitudinal research outcomes of this program indicate that the improved behaviour of the young people is typically accompanied by mental health improvements within most families and the improved behaviour of the young persons. Figure 2 below shows data for both Aboriginal and non- Aboriginal clients of the WA MST CAMHS using the Child Behaviour Checklist (CBCL) which measures problematic internalising and externalising behaviour (see Figure 2 for an explanation of these behaviours). Behaviour improvements are reflected in a decrease in the CBCL score. Figure 2 shows the CBCL score at baseline, discharge and 6 month follow. The results demonstrates significant positive effects for both Aboriginal and non- Aboriginal young people - the average CBCL score decreased post treatment and was sustained at 6 month follow up. This trend is also observed at 12 months as shown in figure 3. This maintenance of improvements after the intervention indicates that parents and carers have learnt the necessary positive communication styles and problem-solving skills and strategies to better manage their child s behaviour without reverting to their previous methods or in most cases requiring further professional help. It is also noted that few of these families are referred back for further mental health intervention following MST. The general improvements in family functioning that have been maintained indicate that families have recovered their ability to maintain improved functioning and well-being. 2 Mark Porter and Leartluk Nuntavisit WA CAMHS Multisystemic Therapy (MST) Program, Forging the Future - Proceedings of the 3 rd TheMHS Conference 2013.
CBCL Scores YOUTH JUSTICE INNOVATION FUND Figure 2- Comparing CBCL scores at Baseline, Post-treatment, and 6-month Follow up of Aboriginal (N = 20) and Non-Aboriginal families (N = 183) 100 90 80 70 60 50 40 30 20 10 0 Baseline Total problems Non-Aboriginal Post-treatment 6-month follow-up Total problems Aboriginal Externalising problems Non-Aboriginal Externalising problems Aboriginal Internalising problems Non-Aboriginal Internalising problems Aboriginal *Internalising behaviours are negative, problematic behaviours that are directed toward the self. People with internalizing behaviours have difficulty coping with negative emotions or stressful situations, so they direct their feelings inward. Because they occur on the inside, internalizing behaviours are usually not visible to others. These include, social withdrawal, feelings of loneliness or guilt, unexplained physical symptoms, not talking to or interacting with others, feeling unloved or sadness, irritable, fearfulness, not standing up for yourself, changes in sleeping or eating patterns or difficulty concentrating **Externalising behaviours are directed toward others and things. Examples include physical aggression, destruction of property, underage drinking, running away from home or offending behaviour. Figure 3- Average CBCL scores at Baseline, Post- treatments, 6 and 12 month follow up of Aboriginal and non- Aboriginal families 100 90 80 70 60 50 40 30 20 10 0 Baseline Post Treatment 6 month follow up 12 month follow up Internalising Problems Externalising Problems Total Problems
1.3 Cost effectiveness Data indicates that in WA it costs between $219,000 and $255,500 per annum to keep one juvenile in custody. For juveniles who had the most intersection with the criminal justice system the cost was estimated at an average of $400,000 per juvenile. 3 An evaluation of MST in the USA undertaken by the Washington State Institute for Public Policy (2006) found significant savings to criminal justice costs. The evaluation found that for every dollar spent on MST there was a corresponding saving of $12.40 to $28.33. The Washington State Institute for Public Policy concluded that MST is one of the most effective of a wide variety of treatments designed to reduce serious criminal activity by adolescents. In addition, the results of a 25 year follow up study 4 on the impact of MST on siblings show that there is a 40% reduction in siblings overall arrest rates and a 55% reduction in sibling serious crime arrest rates. The study showed cumulative benefits of $35,582 per juvenile offender and $7,798 per sibling for each family that had received MST. Overall it showed that for every dollar spent on MST, there was a saving of $5.04 to taxpayers and crime victims. The research and data collected by the NSW and WA teams also demonstrate positive outcomes for the care givers themselves citing reduction in AOD use, improved employment and mental health outcomes. 1.4 What distinguishes MST from other treatments? Generally, there are four major points that separate MST from other treatments for anti-social behaviour: Research: proven long term effectiveness through rigorous scientific evaluations Treatment theory: a clearly defined and scientifically grounded treatment theory based on adherence to defined treatment principles (see Appendix 2) and reflecting the findings of research demonstrating that youth anti-social behaviour is multi-determined from factors across the youth s social network. Implementation: A focus on provider accountability and adherence to the treatment mode. Specific treatment methodologies that are used as part of MST are empirically based (e.g. CBT, behavioural parenting training and the pragmatic family therapies such as structural family therapy and strategic family therapy) Focus on long-term outcomes: Empowering and skilling caregivers to manage future difficulties and sustainably changing the determinants of offending behaviour. 3 Hon Wayne Martin (2010) Misspent Youth Opportunities for Juvenile Justice. John Curtin Institute of Public Policy 4 MST, MST Works for Juvenile Offenders and Their Siblings information card, 843.856.8226