Family intervention model to keep children out of care

Trafford was one of the first councils to pilot an intensive family intervention model four years ago. Rosie Walker investigates its results

Trafford in Greater Manchester was already one of four areas piloting an intensive fostering scheme, an alternative to custody for young offenders, when it applied to take part in the government’s multi systemic therapy (MST) pilot programme in 2007. As MST focuses on changing behaviour before a young person falls into care or custody, it seemed a logical companion to the fostering scheme – particularly in an area with increasing levels of antisocial behaviour.

Emma Breukers, social worker and senior practitioner on Trafford’s MST team, finds it refreshing that the treatment places the emphasis on a person changing their own behaviour and reduces the number of professionals visiting a family.

“Without the time or resources to see a family three times a week, sometimes it’s just easier for a social worker to do things for them,” she says. “But having lots of different services involved does not always help a family; people get used to it.”

Being the sole point of contact for a family means seeing them several times a week and being on call 24 hours a day. It can be exhausting, Breukers says, but it offers the chance to fully explore the root of a young person or parent’s problems. MST therapists often use techniques borrowed from cognitive behavioural therapy, asking clients to examine the thought processes that trigger their behaviour.

“We do what we call a ‘fit’,” says Breukers. “The therapist and the client will put the behaviour in a bubble on paper and then write around it what is driving that behaviour. If we do another fit two months later, we sometimes find that the real drivers are different from the ones we first identified. When we get down to the root of things, we might find that a parent doesn’t actually believe their child’s behaviour is a problem, or they don’t understand why professionals are demanding certain things.”

Cases are referred to the MST team from a range of agencies, including the young offenders service, mental health services or welfare officers. Clients must have complex clinical, social or educational problems and be known to at least two services. Breukers says it is essential to “sell” MST properly to other professionals, making sure they understand how it works and whom it is for.

“The really difficult cases do have a higher success rate with MST than with other approaches, but it’s still a lower success rate when compared with approaches that tackle lower-level behaviour.

“People need to be realistic about cases, such as where a young person has pending offences and might be placed in custody. MST is definitely for the ‘active antisocial’, but also for those with medium- to low-level antisocial behaviour which is at risk of increasing. You can get in early and prevent it escalating.”

Breukers adds: “Not every case is a success, but MST works more often than it fails. The caseload is increasing all the time.”

CASE STUDY

Groundwork was key to behaviour plans

Legal proceedings were about to start to remove all of the children from a mother in Trafford after the extreme antisocial behaviour of one teenage sibling.

“In this case, the boundaries set for the children were inconsistent, there were poor links with the school, and the mother didn’t see the child’s behaviour as a problem,” says Emma Breukers, of Trafford’s MST team.

“The first three months of work were with the mum, and were all about getting her to want to supervise her child.

“We looked at the kind of things she had experienced in her life, to help her understand other people’s concerns. So when we moved into the behaviour plans for her child, they were effective because all of that groundwork had been done beforehand.”

It emerged that the mother lacked confidence, and didn’t know how to de-escalate aggressive behaviour, so Breukers focused on behaviour management skills with her.

“She did brilliantly – and she did it herself,” says Breukers. The effects were felt by the whole family. The MST treatment ended six months ago, and this month the child protection plan was removed. The case is closed.

What is multi systemic therapy?

As part of its Social Exclusion Action Plan, the government invested £17.5m to pilot multi systemic therapy (MST) in 10 areas.

First developed in the US, MST is a family-based treatment for young people with severe antisocial behaviour issues.

Rather than removing a young person from their home or arranging visits from multiple agencies, MST offers a single point of contact – a social worker, teacher, psychologist or therapist – to work with a family for 60 hours over three to six months. The aim is to equip parents and young people with the confidence and self-awareness to change their behaviour.

Research, mostly from the US, has shown that MST can reduce reoffending and improve antisocial behaviour, although recent European research has been less positive. The government is committed to evaluating the outcomes of the 10 pilots by 2011.

This article is published in the 1 April 2010 edition of Community Care under the headline “Family focus to save children from care”