Multi-Systemic Therapy (MST) was developed to provide scientifically validated, cost-
effective, community-based treatment for young people aged 10 to 17 with serious behaviour disorders who are at high risk of out-of-home placement. Rigorous evaluation and replication in clinical and community settings in the United States mark it out as a particularly effective intervention for adolescents with conduct disorders. MST views individuals as living within a complex social network encompassing individual, family, and extra-familial (peer, school, neighbourhood) factors. MST uses the strengths in each young person’s social network to promote positive change in his or her behaviour. The overriding purpose of MST is to help parents deal effectively with their child’s behavioural problems; help them cope with family, peer, school and neighbourhood problems; and reduce or eliminate the need for out-of-home placements. To empower families, MST also addresses identified barriers to effective
parenting (e.g. parental drug abuse, parental mental health problems) and helps family members build an indigenous social support network involving friends, extended family and neighbourhoods. Despite its high cost, MST has been demonstrated as a cost-effective treatment for decreasing the antisocial behaviour of violent and chronic juvenile offenders. MST cost approximately $3,500 per young person in one replication site in South Carolina, which compared favourably with the average cost of the State’s institutional placement at approximately $18,000 per young person for a time period of about 59 weeks post referral.115 Against this backdrop Islington has developed the Adolescent Multi Agency Support Service (AMASS) which enables young people to remain at home or in foster placement, through utilising some of the approaches common to MST. The Islington service differs from MST in several ways, most distinctly in its jointly delivered intervention with social workers, and the co-located wraparound multi-agency team that supports the family. As noted in chapter 7, an evaluation by the University of Bedfordshire has validated the effectiveness of the service in terms of reducing the use of care and improving family functioning for many of the families supported. For the age group directly supported by the service, the number of young people aged 10 to 16 entering care fell from 63 in 2006/07 to 40 in 2007/08, a reduction of 36%; and, over the same period, the number of young people entering residential care fell from 38 to 14, a reduction of 63%. The University of Bedfordshire estimates that each £1 invested in the service produces a saving to the care system of £1.46, with reduced future costs the saving per £1 invested is estimated at £1.80. In 2009/10, 38 families were supported at a cost of £780,000, equating to £20,526 per family. Estimated savings to the local authority over 1 year are around £372,188 through preventing young people entering care, with savings set to increase to £522,000 as the cost of the service reduces.
Conclusion
This chapter has sought to provide a steer for both national and local policy-makers in
deciding where best to allocate scarce resources, especially in the current economic climate, since “investment in proven interventions…is the prudent way to ensure positive outcomes for children and their families” (Utting 2004, p 95).116 By drawing on a combination of international evidence, mainly from the United States and, to a lesser extent, Scandinavia, and effective local practice, a small cluster of areas and interventions emerges as spending priorities: children’s centres and early years (in particular breastfeeding initiatives and the
Nurse Family Partnership); speech, language and communication needs; parenting programmes; targeted family support; and young people on the edge of care. This cluster strikes a balance between intervening early and recognising the reality of still needing to support vulnerable older children, young people and families.
Key messages
• The temptation to cut back on investment in early intervention in times of austerity needs to be resisted, as governments often regret, with hindsight, the long-term costs of
making such short-term savings. The challenge is not, therefore, deciding whether to maintain spending on early intervention, but working out how to get better value out of the money already being invested.
• The powerful body of research (home and abroad) showing that what a child
experiences during the early years (starting in the womb) lays the foundation for the whole of their life, makes a compelling case for prioritising investment in this area. • In general, targeted approaches tend to be judged more cost effective than universal
approaches. Yet there is little comparative evidence to determine which approach might be most ‘cost effective’. The evidence suggests that it is unlikely to be a question of one or the other. What is needed is a range of interventions able to provide support at different levels of need.
• Spending should be prioritised on children’s centres and early years (in particular breastfeeding initiatives and the Nurse Family Partnership); speech, language and communication needs; parenting programmes; targeted family support; and young people on the edge of care.
• Three of the recommended interventions – Nurse Family Partnership, Incredible Years and Multi-Systemic Therapy – are among the 11 ‘Blueprint’ programmes identified by the Center for the Study and Prevention of Violence at the University of Colorado to meet high standards of effectiveness, as part of a review of 800 early intervention
programmes.117
• The OECD suggestion that expenditure on children should be regarded as if it were an investment portfolio, and be subjected to a continuous iterative process of evaluation, reallocation and further evaluation to ensure child well-being is actually improved, poses a formidable but necessary challenge to this nation. Learning from international
experience in particular can be invaluable in helping us to move forward, though, ultimately, tough decisions need to be taken at a national and local level in the best interests of children, families and, indeed, the long-term prosperity of the country.