American model of intensive support improves outcomes for children on edge of care, says charity

Intensive ways of working with children on the edge of care are worth the expense, says Action for Children

A charity has praised the “reliability” of outcomes from two models developed in North America that requires intense work with families and vulnerable children.

Action for Children, in its annual ‘Impact Report’ published this week, praised the Functional Family Therapy (FFT) and multi-systemic therapy (MST) methods it is using to work with children.

Of 21 completed cases, FFT was found to keep 100% of adolescents on the edge of care or at a risk of offending at home, while 90% had ceased offending behaviour and 76% were attending school or a vocational programme.

No referral behaviours

FFT is a whole family intervention targeting troubled adolescents, while MST is a more clinical home-based approach to helping 11-17 year olds on the edge of care or at risk of going into custody.

Based on 85 closed MST cases across Manchester, Derby and Essex, 91% of children were continuing to live at home while a similar number were free from arrest. In Manchester only, 93% of children exhibited no referral behaviours for a period of at least four weeks.

David Derbyshire, director of practice improvement for the charity, said the two methods, which are evidenced based programmes established in North America, were “more reliable” than other forms of intensive support.

Programme manuals

They both have programme manuals, which govern the therapeutic work practitioners carry out. “You can attribute the responsibility for change to these programmes because there is the clinical evidence base that sits behind them,” said Derbyshire.

He denied this turned practitioners into “automatons”, pointing out the manual relied on the high level interpretive skills from those working with children to deliver the interventions.

How strictly a practitioner adheres to the manual is key to its success: “A number of research projects have shown that you can compare therapist fidelity with the model with the rate of outcomes,” Derbyshire said.

“The models are different from ordinary interventions, [because] they provide therapists as well as an organisation with a very high level of specificity about what’s working, and therefore an ability for the therapist to try and change what is going on with an individual family as well,” he said.

Cost saving potential

He estimated that an FFT team could cost a council around £300,000 a year, while an MFT team is around £400,000. But he added the cost saving potential for keeping children with their families – and out of the care systems – was “very high”.

“[These models] are not the solution to everything, they are the solution to the provision to what’s needed when things have reached a particular head, but obviously when they have reached that particular head, then I can’t see why we would be saying there is any reason why they shouldn’t be rolled out further,” Derbyshire said about the programmes.

An Action for Children project, Step Change, which incorporates the two approaches, received £3.4m in funding from the Department for Education’s innovation fund earlier this year.

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