Multisystemic therapy with conduct-disordered young people: stability of treatment outcomes two years after intake

BACKGROUND Multicomponent digital interventions offer the potential for tailored and flexible interventions that aim to address high attrition rates and increase engagement, an area of concern in digital mental health. However, increased flexibility in usage makes it difficult to determine which components lead to improved treatment outcomes. OBJECTIVE This study aimed to identify user profiles on Horyzons, an 18-month digital relapse prevention intervention that incorporates therapeutic content and social networking, along with clinical, vocational and peer support, and to examine the predictive value of these user profiles for treatment outcomes. A secondary objective was to compare each user profile with young people receiving treatment as usual (TAU). METHODS Participants comprised 82 young people (16-27 years of age) with access to Horyzons and 84 receiving TAU, recovering from first-episode psychosis. Six-month usage data from the therapy and social networking components of Horyzons were used as features for K-means clustering for joint trajectories to identify user profiles. Social functioning, psychotic symptoms, depression and anxiety were assessed at baseline and six-month follow-up. General linear mixed models were used to examine the predictive value of user profiles for treatment outcomes, and between each user profile with TAU. RESULTS Three user profiles were identified based on system usage metrics including: (a) low usage; (b) maintained usage of social components; and (c) maintained usage of both therapy and social components. The maintained therapy and social group showed improvements in social functioning (F (2, 51) = 3.58; P = .04), negative symptoms (F (2, 51) = 4.45; P = .02) and overall psychiatric symptom severity (F (2, 50) = 3.23; P = .048) compared to the other user profiles. This group also showed improvements in social functioning (F (1, 62) = 4.68; P = .03), negative symptoms (F (1, 62) = 14.61; P = <.001) and overall psychiatric symptom severity (F (1, 63) = 5.66; P = .02) compared to TAU. Conversely, the maintained social group showed increases in anxiety compared to TAU (F (1, 57) = 7.65; P = .01). No differences were found between the low usage group and TAU on treatment outcomes. CONCLUSIONS Continued engagement with both therapy and social components might be key in achieving long-term recovery. Maintained social usage and low usage outcomes were broadly comparable to TAU, emphasizing the importance of maintaining engagement for improved treatment outcomes. Although the social network may be a key ingredient to increase sustained engagement, as users engaged with this more consistently, it should be leveraged as a tool to engage young people with therapeutic content to bring about social and clinical benefits.

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Therapeutic Alliance and Anorexia Nervosa Treatment Outcomes: Experiences of Young People and Their Families

Community Mental Health Journal ◽

10.1007/s10597-018-0327-8 ◽

2018 ◽

Vol 54 (8) ◽

pp. 1259-1265 ◽

Cited By ~ 1

Author(s):

Giuliana Mogorovich ◽

Nerina J. Caltabiano

Keyword(s):

Anorexia Nervosa ◽

Young People ◽

Therapeutic Alliance ◽

Treatment Outcomes

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What works for whom? Gender differences in intake characteristics and treatment outcomes following Multisystemic Therapy

Journal of Adolescence ◽

10.1016/j.adolescence.2009.06.006 ◽

2009 ◽

Vol 32 (6) ◽

pp. 1425-1435 ◽

Cited By ~ 13

Author(s):

Terje Ogden ◽

Kristine Amlund Hagen

Keyword(s):

Gender Differences ◽

Treatment Outcomes ◽

Multisystemic Therapy ◽

What Works

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The transportability of multisystemic therapy to Sweden: Short-term results from a randomized trial of conduct-disordered youths.

Journal of Family Psychology ◽

10.1037/a0012790 ◽

2008 ◽

Vol 22 (4) ◽

pp. 550-560 ◽

Cited By ~ 104

Author(s):

Knut Sundell ◽

Kjell Hansson ◽

Cecilia Andrée Löfholm ◽

Tina Olsson ◽

Lars-Henry Gustle ◽

...

Keyword(s):

Randomized Trial ◽

Multisystemic Therapy ◽

Short Term ◽

Conduct Disordered

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Multisystemic Therapy as an Intervention for Young People on the Edge of Care: Table 1

The British Journal of Social Work ◽

10.1093/bjsw/bcu054 ◽

2014 ◽

Vol 45 (7) ◽

pp. 1968-1984 ◽

Cited By ~ 5

Author(s):

Simone Fox ◽

Zoë Ashmore

Keyword(s):

Young People ◽

Multisystemic Therapy

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Multisystemic therapy compared with management as usual for adolescents at risk of offending: the START II RCT

Health Services and Delivery Research ◽

10.3310/hsdr08230 ◽

2020 ◽

Vol 8 (23) ◽

pp. 1-114

Author(s):

Peter Fonagy ◽

Stephen Butler ◽

David Cottrell ◽

Stephen Scott ◽

Stephen Pilling ◽

...

Keyword(s):

Cost Effectiveness ◽

Young People ◽

Multisystemic Therapy ◽

Self Report ◽

Second Phase ◽

Secondary Outcomes ◽

Start Trial ◽

The Cost

Background The Systemic Therapy for At Risk Teens (START) trial is a randomised controlled trial of multisystemic therapy (MST) compared with management as usual (MAU). The present study reports on long-term follow-up of the trial (to 60 months). Objectives The primary objective was to compare MST and MAU for the proportion of young people in each group with criminal convictions up to 60 months post baseline. Secondary outcomes included group comparisons of psychological and behavioural factors. An economic analysis was carried out to determine the cost-effectiveness of MST compared with MAU. Two qualitative studies were conducted to better understand the subjective experiences of the participants. Design Primary outcomes (collected up to 60 months) were collected using a centralised police database. Secondary outcomes were evaluated using self-report questionnaires completed by both young people and parents or carers at the 24-, 36- and 48-month follow-ups. Research assistants were blind to treatment allocation. Setting Participants were recruited from participating MST sites in nine areas of England. Secondary outcomes were typically collected within the family home. Participants A total of 684 families were recruited into the START trial and allocated randomly to a treatment group. Of these, 487 remained in the second phase of the trial. Young people were aged, on average, 13.8 years at baseline, with 63% male and 37% female. Interventions MST is a manualised programme for young people exhibiting antisocial behaviour and their families that uses principles from cognitive–behavioural and family therapy to provide an individualised approach. MAU content was not prespecified, but consisted of the standard care offered to young people who met eligibility for the trial. Main outcome measures Young people’s offending was evaluated using the Police National Computer. Secondary measures included validated self-report measures completed by both the young person and their parent or carer. The economic evaluation took a broad perspective and outcomes were assessed in terms of quality-adjusted life-years and offending. Results No significant differences were found in the proportion of offending between the groups (hazard ratio 1.03, 95% confidence interval 0.84 to 1.26; p = 0.78). No differences were found between the groups on secondary outcome measures, with a few exceptions that did not hold up consistently across the follow-up period. The economic analysis did not find evidence to support the cost-effectiveness of MST compared with MAU. Outcomes from the qualitative studies suggest that families mostly felt positive about MST, and that MST was associated with greater maturity in young men. Limitations Some intended evaluations were not possible to deliver. Selective attrition may have influenced the nature of the sample size. It is also unclear how representative the MAU services were of reality. Future research Recommendations are made for the evaluation of MST in populations with more severe behavioural problems, as well as for identifying and testing new moderators. Conclusions The results of the second phase of the START trial do not support the long-term superiority of MST to MAU, but elements of the intervention may be adapted successfully. Trial registration Current Controlled Trials ISRCTN77132214 and London South-East REC registration number 09/H1102/55. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 23. See the NIHR Journals Library website for further project information.

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