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Multisystemic Therapy in The Netherlands: Implementation and Effectiveness


- candidate number3691
- NTR NumberNTR1390
- ISRCTNISRCTN wordt niet meer aangevraagd
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR24-jul-2008
- Secondary IDs08-004/K METC
- Public TitleMultisystemic Therapy in The Netherlands: Implementation and Effectiveness
- Scientific TitleMultisystemic Therapy in The Netherlands: Implementation and Effectiveness
- ACRONYMN/A
- hypothesisThis project aims to examine the implementation and effectiveness of MST in The Netherlands.

IMPLEMENTATION STUDY
The aim of Implementation Study (a multi-site, non experimental, one-group-only design) is to determine the degree to which MST is implemented as intended at different sites in The Netherlands.
Following questions are asked:
1a. What is the degree of treatment integrity, as perceived by clients (adolescent and parents), MST therapist and MST supervisor?
1b. Are all components of multilevel quality assurance system (training, supervision and consultations by MST supervisor on the site and by MST consultant) included?
1c. Is the targeted population of MST recruited and retained? What are the referral paths? What are the reasons for case discharge/drop-out?
1d. Is treatment integrity affected by organizational and service system characteristics, client- and therapist characteristics?

EFFECTIVENESS STUDY
The aim of Effectiveness Study (a multi-site RCT) is to determine short and long term effects of MST.
Following questions are asked:
2a. Does MST yield to better outcomes (decrease in recidivism and in rate and seriousness of antisocial behavior, increase in adolescent competence, improvement in family relations and relations with peers) in chronic juvenile offenders than “treatment as usual” (TAU)?
2b. To what degree is effectiveness of MST affected by treatment integrity, characteristics of MST therapists and characteristics of clients?
- Healt Condition(s) or Problem(s) studiedImplementation, Efficacy, Treatment effectiveness, Randomized Controlled Trial (RCT), Multisystemic therapy (MST)
- Inclusion criteria1. Youth (and their families) who show serious, violent, and chronic antisocial behavior between 12 and 18 years - There is enough family commitment to apply MST
- Exclusion criteria1. IQ below 70
2. Acute psychiatric problems that places adolescent and his or her family at risk
3. Dominant sexual problems
- mec approval receivedyes
- multicenter trialyes
- randomisedyes
- masking/blindingNone
- controlActive
- groupParallel
- Type2 or more arms, randomized
- Studytypeintervention
- planned startdate 1-mei-2007
- planned closingdate1-mei-2010
- Target number of participants200
- InterventionsMultisystemic Therapy (MST)
The MST is based on social ecological and family systems theories, and on research on the causes and correlates of serious antisocial behavior. It addresses several key systems in which adolescent is embedded: family, school, peer group, neighborhood. Intervention strategies include strategic family therapy, structural family therapy, behavioral parent training, and cognitive therapies. Treatment is typically delivered for 4 to 6 months and it is individualized to address specific needs of clients. Therapists are available 24 hrs/day and, 7 days/week. MST uses a home-based model of service delivery which model helps to overcome barriers to services access and increases family retention in treatment. In consultation with family members, the therapist identifies a well-defined set of treatment goals, assigns the tasks required to accomplish these goals, and monitors the progress in regular family sessions at least once a week.

Treatment as Usual (TAU)
The adolescents in the control group will receive “treatment as usual”, a selection of the treatments that are already available for the treatment of antisocial behaviour, including juvenile justice services, child welfare services, individual adolescent counseling and home-based social services (parental counseling). The counseling focuses on personal, family and school-related issues, which were found to be related to the development and persistence of antisocial behavior. The exact content of TAU will be decided upon together with the local referrers.
- Primary outcome- Recidivism
- Antisocial behavior
- Agressive behavior
- Secondary outcome- Family functioning (parental competence, acceptance, attachment, social isolation, perception of influence, responsivity, reinforcement, harsh discipline, inductive discipline, punishment, consistency, behavioral control, monitoring, negativity, communication and cohesion)

- Characteristics client (psychopathy, personality, anxiety, depression, withdrawn, psychosomatic complaints, drug use, school competence, relation with peers)

- Characteristics treatment (expectations, treatment integrity, treatment satisfaction, relation with therapist, cooperation, organization structure and climate, efficiency, effectivity, case discharge)
- Timepoints- T1 (pretest assessment)
- T2 (posttest assessment)
- T3 (follow up)
- Trial web siteN/A
- statusopen: patient inclusion
- CONTACT FOR PUBLIC QUERIESPhD W.A. Manders
- CONTACT for SCIENTIFIC QUERIESPhD W.A. Manders
- Sponsor/Initiator Utrecht University (UU)
- Funding
(Source(s) of Monetary or Material Support)
ZON-MW, The Netherlands Organization for Health Research and Development
- PublicationsN/A
- Brief summaryMultisystemic Therapy (MST) is an intensive home- and community-based treatment for youth who show serious, violent and chronic antisocial behavior. Since 2004, MST has been implemented on a small-scale basis in The Netherlands. From 2006, in order to ensure availability of a (potentially) successful treatment all over The Netherlands, a large-scale implementation of MST will be conducted. The reasons for the choice of this treatment are first, its strong theoretical foundation and second, empirical support for its effectiveness from controlled clinical trials in the USA. Notwithstanding these positive indications, there are also reasons for caution. A recently published review by Littell (2005) has questioned the conclusion that MST is effective by pointing out that inconsistent and incomplete reports have been published. Also, with few exceptions, most of the empirical support comes from studies conducted by the same group of researchers who also developed and implemented MST. There is a clear need for confirmation of these results by an independent team of researchers. Even more importantly, due to the differences between the two countries in social and political climate, organization of mental health services, availability of different treatments, type and ethnic background of clients, etc., it is not known whether the same positive results will be obtained here. Many of the treatments available for adolescents who show serious and persistent antisocial behavior have never been properly evaluated in The Netherlands. Moreover, the poor quality of most evaluation studies does not allow reliable and valid conclusions. This fact has been repeatedly emphasized as an important obstacle in development and refinement of evidence-based interventions. This concerns an evaluation study in which a new, promising treatment for juvenile delinquents, Multisystemic Therapy, is compared to Treatment as Usual in The Netherlands.
- Main changes (audit trail)
- RECORD24-jul-2008 - 22-aug-2008


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