A child welfare program for children and families who have recently come under the guidance of Child Protection Services.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
- Targeted and specialist
- Continuing care
Australian Study
Risk of Bias
Cost
Target Age Group
About
Multisystemic Therapy for Child Abuse and Neglect® (MST-CAN®) is a treatment for high-risk children aged 6 to 17 years and their families that have come under the guidance of Child Protection Services due to physical abuse and/or neglect. MST-CAN® therapists provide families with tailored individual and family support in their homes to target specific risk factors that contribute to child physical abuse and neglect. MST-CAN® treatment strategies include safety planning, Cognitive Behavioural Therapies for managing anger and addressing the impact of trauma, Reinforcement-Based Therapy for adult substance misuse and family therapy focused on communication and problem solving.
Aims
- Reduce parent-to-child aggression
- Prevent out-of-home placement
- Improve parent mental health
- Improve child mental health
- Increase parenting skills.
Impact
Evidence shows that MST-CAN® was effective in reducing neglect and parents’ maltreating behaviour, out-of-home placements and psychological aggression and severe assault, with some outcomes observed at 16 months or more post-baseline. Evidence for parenting skills was mixed.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Child protection system contact | Yes | Not found | Not found |
| System | Out-of-home care | Yes | Not found | Not found |
| Child | Mental health/behaviour | Yes | Not found | Not found |
| Parent/caregiver | Mental health/functioning | Yes | Not found | Not found |
| Parent/caregiver | Parenting skills | Yes | Not found | Yes |
| Parent/caregiver | Social support | Yes | Not found | Not found |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
MST-CAN® has an evidence rating of Supported+.
This means that MST-CAN® has evidence from one randomised controlled trial (RCT) or quasi-experiment (QE) demonstrating positive, long-term impact on at least one child and family outcome.
This assessment is based on one research output of RCT design. Another RCT (Brunk et al., 1987) was identified but did not count towards the evidence due to concerns with study quality. MST-CAN® has not received a Well-supported rating as it has not yet replicated its results in another RCT or QE with a different population or setting.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 1 |
| Quasi-experiment | Not identified or included |
The evidence has low concerns with risk of bias.
We can be confident about the results and quality of the evidence from the included study.
The study was conducted in the United States and does not include Aboriginal children and families. MST-CAN® is delivered in Australia to Aboriginal children and families but local studies may not have met the inclusion criteria to be included on the Menu.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- This study was conducted in South Carolina, United States.
Sample
- A total of 90 families (45 intervention, 45 control) implicated in Child Protective Services due to physical abuse participated in this study. Families in the control group received standard outpatient treatment for physical treatment abuse.
- Participants identified as Black (69%), White (22%) and other (9%). Black families are overrepresented in the Child Protection Services system.
Implementation
Delivery model, mode and setting
- MST-CAN® is delivered in-person, over the phone and online to the parent only, child only and/or parent and child together.
- Services take place in the client's home or the community.
Target cohort
- Children aged 6 to 17 and their families who have experienced physical abuse and/or neglect.
Program delivery
- MST-CAN® therapists and the family set treatment goals and conduct ongoing assessment and safety planning.
- Therapists conduct a comprehensive assessment of the strengths and needs of individuals and family system.
- MST-CAN® therapists also work closely with child protection to ensure decisions are informed by clinical need or progress.
Duration and intensity
- MST-CAN® is an intensive program with regular contact (from 3 times a week to daily) for a duration of 6 to 9 months, from therapists with relatively low caseloads (generally 4 to 6 families).
Manuals and guides
- We were unable to locate any manuals or guides specific to MST-CAN®. The program adheres to the Multisystemic Therapy program and its quality assurance activities supporting fidelity and adherence to the 9 principles of the MST treatment model.
- Pre-implementation materials measure organisational or provider readiness for MST-CAN®. The tools include a review of the feasibility of the program, goals, guidelines for implementation and program practice requirements that must be met.
- Each site must pass a formal Site Readiness Review conducted on site. These tools are not available to the general public and are only used when a site is moving forward with the implementation of an MST-CAN® program.
Additional information
- The MST Services website has more information about MST-CAN®.
Staffing
- Each MST-CAN® team consists of 5 full-time staff plus 20 per cent of the time of a psychiatrist or psychiatric nurse practitioner.
- Therapists work as a team of 3 with a crisis case worker and a full-time supervisor with psychiatrist support, with an average of 5 family members per case.
- At a minimum, MST-CAN® therapists should have a master’s degree and case workers should a bachelor’s degree in counselling, social work or a related field and a background in child development and knowledge of the child welfare system. MST-CAN® supervisors should have a PhD or master’s degree in counselling, social work or related field and background in child development and knowledge of the child welfare system.
- Supervisors should be assigned to MST-CAN® full-time and have experience implementing standard MST or MST-CAN®.
Training
- The MST Services website details the range of training options available, such as a 5-day MST Orientation, 4-day MST-CAN® Orientation and 4-day MST-CAN® Trauma. MST Services also offers quarterly on-site booster training conducted by a MST-CAN® expert, and weekly telephone conversations with a MST-CAN® expert.
- Organisations can access the initial 5-day MST orientation training and participate in 1 of the quarterly open-enrolment trainings provided by MST Services. MST-CAN® Orientation and MST-CAN® Trauma training are provided on site by MST-CAN® experts.
To our knowledge, MST-CAN® is available in Victoria and New South Wales (NSW).
In Victoria, Ozchild is funded by the Department of Families, Fairness and Housing to deliver MST-CAN®.
In NSW, delivery of MST-CAN® is commissioned by the NSW’s Their Futures Matter.
Cost
The annual cost of MST-CAN® is likely to range from approximately USD$500,000 to USD$700,000 on an all-inclusive basis, including the costs associated with staff hiring assistance, staff training, ongoing program support and quality assurance oversight. The MST-CAN® website has information about the cost-effectiveness of the program.
References
Studies identified and included in the review
- Swenson, et al. (2010). Multisystemic Therapy for Child Abuse and Neglect: A Randomized Effectiveness Trial, Journal of Family Psychology, 24(4), 497-507.
Studies identified but not counted towards the evidence rating due to study quality
- Brunk, et al. (1987). Comparison of Multisystemic Therapy and Parent Training in the Brief Treatment of Child Abuse and Neglect, Journal of consulting and clinical psychology, 55(2), 171-178. DOI 10.1037//0022-006x.55.2.171
Australian studies identified but not counted towards the evidence rating due to study quality
- Heriot, S. and Kissouri, M. (2018), Moving Toward an Evidence‐based Family and Community‐based Approach to Improve the Lives of Children and Young People Who Have Experienced Abuse and Neglect. Aust N Z J Fam Ther, 39: 294-302. doi:10.1002/anzf.1320
- Stallman HM, Walmsley KE, Bor W, Collerson ME, Swenson CC, Mcdermott B. (2010), New directions in the treatment of child physical abuse and neglect in Australia: MST-CAN, a case study. Adv Mental Health 9: 148-161.
- Ainsworth F, Hansen P. (2018) Coaching Parents About Children's Needs and Navigating the Child Protection and Other Systems. Children Australia 43: 181-185.
- Herbert S, Bor W, Swenson CC, Boyle C. (2014) Improving collaboration: A qualitative assessment of interagency collaboration between a pilot Multisystemic Therapy Child Abuse and Neglect (MST-CAN) program and a Child protection team. Australasian Psychiatry 22: 370-373.