Multisystemic therapy compared with management as usual for adolescents at risk of offending: the START II RCT

Reducing the risk of criminal exploitation using multi-systemic therapy (the RESET Study): study protocol for a feasibility study and process evaluation

BACKGROUND

Child criminal exploitation is a form of child abuse that poses a serious risk to the welfare, safety, and wellbeing of young people. Multisystemic therapy (MST) is an intensive family and community-based intervention for young people with anti-social behavioral problems, many of whom will be at risk of criminal exploitation. This protocol describes a pilot feasibility study and process evaluation, designed to examine MST for children at risk of criminal exploitation.

METHODS

This pilot feasibility study and process evaluation involves two phases with associated subphases: phase 1.1 involved the collaborative refinement of the logic model adapting MST for children at risk of criminal exploitation; phase 1.2 involved pre-pilot interviews with MST therapists, families, and young people; phase 2.1 is a pilot modeling study of MST for children at risk of criminal exploitation, and; Phase 2.2 is a process evaluation that will involve interviewing stakeholders, MST therapists and employees, families, and young people. The dataset for the process evaluation will include questionnaires completed by parents and young people at baseline, mid-treatment, end of treatment, and 6 months after treatment. We will supplement these data with participant-level data linkage from MST sites and services.

RESULTS

Accrual to the pilot stage of this project opened on 6th August 2021 and is due to close on 31st May 2022. We aim to publish the results of this feasibility study and process evaluation in 2023.

CONCLUSIONS

The results of this feasibility study and process evaluation will inform the decision as to whether it is advisable to progress to a pilot clinical trial of MST for children at risk of criminal exploitation.

TRIAL REGISTRATION

Trial registration: ISRCTN registry, ISRCTN16164816 on 25th January 2021- https://doi.org/10.1186/ISRCTN16164816 .

The Long-Term Impact of Multisystemic Therapy: An Experiential Study of the Adolescent-Young Adult Life Transition

This qualitative study examines the possible long-term impact of multisystemic therapy (MST) as young people experience the transition from adolescence to young adulthood. MST is an intensive intervention aimed at reducing antisocial behavior among young people. Interviews were conducted with 32 young people aged 16 to 22 years at their 48-month follow-up as part of the Systemic Therapy for At-Risk Teens (START) evaluation trial in the United Kingdom. Sixteen participants had received MST while 16 received management as usual (MAU). Interviews addressed participants’ current life experiences and were analyzed with interpretative phenomenological analysis (IPA). The inductive qualitative analysis data were transformed into numerical data. Interview extracts were coded as either forward-looking and hopeful (“mature”) or static and frustrated (“stuck”). Among males, significantly more mature outcomes were found among participants who had received MST compared with MAU. No differences were seen between the female groups. A detailed qualitative commentary shows how the constructs, mature and stuck, are manifest across the four domains. The findings suggest that working with an MST therapist during adolescence helped young men cultivate more mature, forward-looking viewpoints and life activities 4 years later when transitioning into adulthood. Findings are discussed in relation to relevant theory and practical applications.