Multi-Systemic Therapy for Problem Sexual Behaviour

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Multi-Systemic Therapy for Problem Sexual
Behaviour an Overview Craig Wood,
Cambridgeshire County Council
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Multi-Systemic Therapy Problem Sexual
Behaviour(MST-PSB)

• Craig Wood MST-PSB Therapist
• January 2013

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Aims

• Brief overview of standard MST
• PSB adaptations
• Local implementation, and referral criteria
• MST-PSB what it looks like in practice

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What is Multi-Systemic Therapy

• Intensive family and community based treatment
• Addresses the multiple influences that contribute
  to serious antisocial behaviour in young people
• Works across the key systems within which the
  young person is embedded (family, peers, school,
  neighbourhood)

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What is Multi-Systemic Therapy

• Aims to promote behaviour change in the young
  persons natural environment
• Goal is to empower parents to develop skills and
  resources to address any difficulties in raising
  their children
• Also aims to empower young people to cope with
  family, peer, school and neighbourhood problems

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MST characteristics

• Services are intensive (up to 4 times a week)
• Services are scheduled to meet the familys needs
  and are delivered in the familys home
• MST therapists work with the young person and
  their parents, teaching the parents the skills to
  sustain the improvements after therapy is over.
• On call support is available 24 hours a day, 7
  days a week
• Workers have small caseloads average 3 families
  (due to large geographical area of our patch)

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Development of MST-PSB

• Existing treatment programmes tend to focus on
  the individual young person without considering
  the wider systems around them.
• Treatment programmes tend to focus on theories
  about deviant sexual arousal, relapse prevention
  and abuse cycles
• Treatment seldom considers developmental
  differences between juvenile and adult sex
  offenders

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Comparing juvenile sex offenders with other
juvenile offenders

• Juvenile sexual offenders share many common
  problems with juvenile non-sexual offenders
  (across all domains of functioning) relative to
  non-delinquent peers.
• This led to the idea that adapting MST to work in
  cases where there had been PSB may have
  significant impact on reducing reoffending.

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Correlates of juvenile sexual offending

• Individual factors (eg externalising and
  internalising problems)
• Family factors (eg low warmth, high conflict, low
  monitoring)
• Parental problems (eg domestic violence,
  substance misuse)
• Peer relations (eg social isolation)
• Instability in school is clearly indicated as an
  indicator of sexual re-offending

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UK position

• Awareness of growing numbers of young people
  presenting with PSB
• Research trial into effectiveness of MST-PSB now
  underway at the Brandon Centre also important to
  test the model in a more rural community
• Building on the existing experience of MST
  implementation in Cambridgeshire and Peterborough
• Opportunity to test out the effectiveness of a
  partnership across a wide geographical area
• Aim to develop further sites in the future

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Local Implementation

• Four Authority Partnership
• Cambridgeshire County Council, Bedford Borough
  Council, Central Bedfordshire Council,
  Peterborough City Council

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Programme Capacity

• 3-4 clients (families) per therapist
• 5-7 months length of treatment
• Estimated capacity of 16-18 in first year, 21
  subsequently

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MST-PSB Quality Assurance

• Weekly Consultant-Supervisor Development
  Teleconference
• Weekly Consultant-Team Phone Consultation
• Weekly Team supervision
• Monthly therapist adherence scores (as adherence
  to the model has been proved to improve outcomes)

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Referral criteria

• Young people aged 10 17
• Severe problem sexual behaviour
• At risk of being accommodated or looked after, at
  risk of custody, or at risk of permanent
  exclusion from school

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Exclusionary criteria

• Young person is living independently
• Young person is actively suicidal, homicidal or
  psychotic
• Young person has pervasive developmental delays
• Young person has denied the offence and is on
  bail pending trial

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Intervention - Safety plan

• Ecologically focussed clearly puts carers and
  other responsible adults in charge
• Identifies who will monitor the youth, with
  specific guidance of how that will be
  accomplished
• Addresses applicable places/contexts within the
  youths ecology, e.g. home, school, neighbourhood
  etc.
• The more serious risk elements are attached to
  immediate caregiver action to inform MST-PSB and
  other professional stakeholders (i.e. social
  worker, YOS worker)

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Intervention - Safety plan

• Identifies specific rules in a clearly defined
  manner, and includes contingencies tied to rule
  violations (consequences, restrictions in freedom
  of movement)
• Identifies warning signs, high risk situations,
  grooming behaviours, that the caregivers should
  be aware of

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Intervention - Clarification

• Involves supporting the parents/carers in
  understanding the drivers or factors that
  contributed to the PSB.
• Working with denial and minimisation
• Have young person acknowledge the PSB
• Hold youth (not victim) responsible
• Develop a clear sequence of events
• Working with high risk cognitions
• Develop risk reduction/safety plan

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Intervention -PSB fit
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Other possible drivers

• Own history of sexual abuse
• Poor attachment relationships
• Witness to domestic violence
• But need to be clear about the mechanism by which
  these impact on the PSB

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Other elements of treatment

• Reunification
• Social skills and sexual education
• CBT / help with faulty thinking patterns
• Sexual abuse history of the offender
• Other non-sexual antisocial behaviours
• Sustainability work

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Discharge

• Sustainability crucial
• Detailed discharge report
• Shared with referral source and family
• Includes recommendations and handover plans
• Family have one session in the bank

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• Craig Wood MST-PSB Worker (Specialist
  Nurse)Cambridgeshire MST Services
  craig.wood_at_cambridgeshire.gov.uk
• Sarah Reeves
• MST-PSB Supervisor
• Cambridgeshire MST Services
• sarah.reeves_at_cambridgeshire.gov.uk

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Multi-Systemic Therapy for Problem Sexual
Behaviour an Overview Craig Wood,
Cambridgeshire County Council