young people at risk of developing personality disorder: making sense of nice guidance in practice

NICE guidance and Multisystemic Therapy for Young People

Dr. Jenny TaylorConsultant Clinical Psychologist & MST Team ManagerHackney

Vina Bramble Parent, Hackney

Cathy JamesChildren, Young people & Families leadPersonality Disorder Team, Department of Health

Aim of presentation

Relevance of NICE guidance for young people and families

Introduction to the Multisystemic Therapy programme in England

Parent and professional experience of MST in London borough of Hackney

NICE guidance 77

Guidance on Anti-social Personality Disorder published in January 2009

Includes prevention and interventions for children & young people and families(1)

For younger children, group parenting programmes are effective but for adolescents with more severe problems individualised programmes, including Multisystemic Therapy are most effective

Conduct Disorder & Antisocial Personality Disorder

Significant chronic antisocial behaviour in teenage years – ‘conduct disorder’

Approx a third of kids who meet criteria for conduct disorder go on to meet criteria for ‘Antisocial Personality Disorder’ in adulthood

Recognition of developmental context

People with ASPD have often grown up in fractured families in which parental conflict is typical and parenting is harsh and inconsistent. As a result of parental inadequacies and/or the child’s difficult behaviour, the child’s care is often interrupted and transferred to agencies outside the family. This in turn often leads to truancy, having delinquent associates and substance misuse, which frequently result in increased rates of unemployment, poor and unstable housing situations, and inconsistency in relationships in adulthood. Many people with ASPD have a criminal conviction and are imprisoned or die prematurely as a result of reckless behaviour.

NICE clinical guideline 77

What is Multisystemic Therapy?

An intervention program for young people at risk of care or custody due to significant anti-social behaviour

Developed in the USA Currently being researched here to

compare its efficacy against standard ‘treatments’

Multisystemic Therapy in England

2008 Ten pilot sites of MST were established as part of a national research programme into effectiveness of the model in England: Barnsley, Greenwich, Hackney, Leeds, Merton & Kingston, Peterborough, Plymouth, Reading, Sheffield & TraffordBuilding on the experience of the two existing licensed MST sites in England (Cambridgeshire & Brandon Centre in North London) and of programmes in Northern European Sites are funded over four years by Department of Health, Department for Children Schools and Families and Youth Justice Board

MST in Hackney

Service opened in October 2008

Staff team:

MST Supervisor/Manager (plus 2x backup supervisors)

4 x MST Therapists

MST Administrator

MST: the intervention

What does it actually involve?

The ecological model

Child

Family

Peers

School

Neighborhood

How does MST differ from other available interventions?

Prioritising evidence-based interventions Delivered in a way that engages families Focus and quality control Emphasis on long term sustainability

Referrals from 1/10/08 – 1/10/09

58 referrals 33 families worked with

Families worked with over the last year

Of the 33 who went on to treatment:

16 closed and completed 5 closed without completion 12 in progress

And what about the outcomes..?

Outcomes in terms of family satisfaction

‘I loved MST, it’s a really great service and it helped my family loads. It taught me the techniques of doing the fit circles and things to do in different situations and this has really helped, I’m missing MST’

‘You are the only thing (Service) we’ve ever stuck with’

‘MST – Support when no one else did, made a difference when nothing else did.’

Outcomes in terms of living at home

Outcomes in terms of education

Outcomes in terms of offending