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Birmingham, Nottingham, Kirklees and Sandwell: Multi-Systemic Therapy

Multisystemic Therapy (MST) is a well-established and well evidenced approach for emotional and behavioural disorders. MST is an intensive family and community based intervention for young people aged 11-17 years.

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The challenge

There was a growing awareness of a need for more provision for younger children at high risk of criminal exploitation. Staff were seeing a surge of children carrying knives in primary schools, of younger children who were associating with older peers and criminal adults, and concerns about youth violence. Not all these children would reach the threshold for children’s social care or Youth Offending Service (YOS) involvement, but preventative measures were needed to reduce their risk of criminalisation.  At the same time, lockdown saw an increase in Out of Court Disposals and Conditional Cautions.

Funding was available from the Youth Endowment Fund to fund innovation work for children aged 10-14 years at risk of becoming involved in youth violence, including criminal exploitation.

The approach

Multisystemic Therapy (MST) is a well-established and well evidenced approach for emotional and behavioural disorders. MST is an intensive family and community based intervention for young people aged 11-17 years. MST therapists work very intensively with children and young people over a 3-5 month period, and take a whole system approach considering the family, school, neighbourhood and friendship context for the young person. An important feature of MST is that therapists work with families, where they are, and 24/7 on call support is available for families.

This scheme was a partnership between MST UK and Ireland (MST-UK & I) and four Local Authorities to deliver MST to children aged 10-15 years identified as being at high risk of Child Criminal or Sexual Exploitation (CCE or CSE). The scheme launched in 2020, and recruitment was initially slower than anticipated due to Covid-19 lockdowns, however the teams continued to deliver a service during that period. Referral routes differ slightly between areas, but include Children’s Social Care and YOT/YOS referrals, Think Family and edge of care referrals, specialist exploitation hubs and panels, Pupil Referral Units, and in some cases directly from the police.  Over 60 per cent of young people receiving MST in this scheme have been aged 10-13 years old (Unpublished data provided by MST UK & I).

Local implementations

An important part of implementing MST for this group of children has been partnerships formed with other services. Schools, Pupil Referral Units, police, children’s social care and other agencies, including the voluntary sector have been included in training sessions explaining the MST approach, understanding each other’s role and perspectives, what exploitation is, and of signs that a child may be at risk of exploitation. This has been important in raising awareness of CCE and CSE in primary schools. Networking has also encouraged referrals into the scheme. This approach has also successfully delivered a cultural shift in policing. Previously, the police focus was on gathering evidence from child victims of CCE for the purpose of achieving convictions, they have begun to see their role as also referring these children to supportive services. In Sandwell the police now have a joint protocol with MST when CCE is suspected. All sites report a closer working relationship with the police, for example the police will contact therapists when a young person is found when missing and the MST team will support children and families to engage with police investigations.

Evidence of impact

Evidence from studies in the USA suggest that MST may reduce crime by up to 25%, but there has been mixed evidence from studies in the UK to date. The Youth Endowment Fund have funded a feasibility study led by the University of Warwick (examining the feasibility of completing a trial) which is due for completion in 2023. MST UK & I is monitoring completion and outcome data from the four MST sites. This is currently being analysed, but they report that initial outcome data is promising.

Those involved in the programme have been very positive:

Senior worker from Horizons (Sandwell exploitation team)

The work that MST-e do really enriches and supports the plans that we have for the young people we work with, having colleagues we trust and work collaboratively with on a day to day basis to improve the lives of the families and young people we work with is brilliant 

Social worker

She has formed an incredible relationship with [young person]’s mum, that has meant the work that has been completed has been far more successful than I had even hopefully anticipated. She has made [mum] feel empowered and more confident with dealing with a tricky teenager, giving [mum] the tools and approaches that she will be able to use long after their work has finished.


MST family member

A great deal, it helped me a lot. I am a grandmother and raised all my kids, but having the MST Therapist around opened my eyes on what I was not doing…he was getting away with way too much. The therapist put us on the right track. Especially in terms of consequences and managing behaviour.” -  MST family member

Parent / Carer

For a family to grow, there needs to be a change not only in the young person but the main carer. I have blossomed''