Multisystemic Therapy for Child Abuse and Neglect

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) is an intensive intervention for families who have recently been reported to Child Protection Services for physically abusing and/or neglecting a child between the ages of 6 and 17.

MST-CAN is delivered by an MST-CAN therapist (typically a social worker with a master’s level qualification) who provides the family with a tailored package of support that includes individual and family support and therapy. The therapist is available to the family on a 24/7 basis and carries a caseload of three to four families at a time. Therapists typically work with families for an average of six to nine months, and commonly see families around three times a week, although these visits will vary according to the level of need. A hybrid model of support delivered by keyworkers is also available in cases that are less severe, including those involving unsubstantiated neglect.

Referrals typically come from child protection services following concerns involving abuse or neglect occurring within the past 180 days. Child protection first contacts the family to ensure that the family is in agreement with the referral, and then refers the family to the MST team.

Within 48 hours of acceptance of the referral, the MST-CAN supervisor or the therapist assigned to the case will contact the family to explain the treatment and invite them to participate. When parents agree, a detailed intake assessment begins, which is carried out over a series of visits to the family’s home.

The primary aim of the first session is to engage family members and establish a collaborative partnership between the MST therapist, child protection services and the family. In some cases, it will become clear that the family is in crisis, so the first priority is to stabilise the family situation. If the child is out of the home at the time of referral, the MST-CAN worker will meet with foster parents or kinship carers to make sure that the child’s placement is stabilised until the child can return home.

A second aim of the initial sessions is to gain an understanding of the severity of the family’s circumstances and the multiple risks that may be contributing to the maltreating behaviour. This understanding is gained through meetings with child protection services, as well as meetings with the family.

At the beginning of the intervention, the MST-CAN worker and family work collaboratively to identify family-specific goals for positive change. These goals should be clearly linked to parenting behaviours that would be considered abusive and neglectful, with a primary aim of increasing the child’s safety. In the short term, it is expected that:

• The parent will no longer abuse or neglect the child
• There will no longer be a need for an out-of-home placement
• The child will live in a safer home environment
• Any family crises will be stabilised
• Parents will use more effective parenting skills
• Family relationships will improve
• The family will have improved their network of informal supports
• The child and parent’s mental wellbeing will improve.

By the conclusion of the intervention, it is expected that:

• Abuse and neglect will be eliminated
• Out-of-home placements will be prevented
• There will be improvements in parental mental health functioning
• There will be observable improvements in parenting behaviours.

MST-CAN therapists are trained and supervised to identify the risks associated with abuse and neglect, and are thus able to tailor the intervention to directly address these risks. MST therapists are also trained to treat a wide variety of mental health problems experienced by children and adults. MST teams are embedded well within the local system so that additional treatments, including pharmaceutical treatments prescribed by the NHS, can be used to address specific mental health conditions.