Stopping the inter-generational transmission of violence and aggression

Child and adolescent conduct disorders include aggression, violence, rule-violation and anti-social behaviours. Untreated, these disorders predict substance use, adult mental health problems, chronic unemployment, inter-personal difficulties, adult and family violence, criminality and incarceration. Although conduct disorders are common, many families with these children are poor, marginalised and difficult to engage. However engagement is important to help interrupt the inter-generational transmission of trauma, abuse, criminal behaviour, mental illness, violence, aggression, and prison.

Multi-systemic Therapy (MST) is an intensive home-based intervention to help families with young persons (11-16 years) having severe behavioural problems. This program is operated under license in many countries, and 20 years of published research indicates this program is usually effective when implemented correctly. This 4-5 month intensive intervention teaches parent/caregivers appropriate communication skills and strategies, monitoring and problem-solving skills, to better manage their children’s behaviours and improve communication styles between systems, (e.g. family, community and school). The program operates within a “family preservation” framework, prioritising youth at high risk of out-of-home placement, and/or school expulsion. Allied health clinicians visit each client families about three times each week in the family home (often after normal work hours), and are available 24/7 to support the parents and carers by phone at difficult times during the intervention.

This licensed intervention was implemented in the WA Mental Health service in 2005, and has since operated two small clinical teams within Perth’s metropolitan area. This program is unique within Australian Mental Health Services, and has won the leading national awards for crime and violence prevention, substance use prevention, and mental illness treatment in recent years. A recently published longitudinal research study of the client outcomes of this WA Mental Health program indicates most families complete the intervention, achieve significant and enduring improvements in the mental health and functioning of all family members; maintain the young person living at home, engaged in school, and involved in pro-social activities. This is robust evidence of the effectiveness of implementing early targeted interventions for young persons at predictable high risk of adult violence (including domestic violence), and very high costs to our Health, Social and Justice systems.

The Western Australian Department of Health, MST Program’s recently published research paper is:  Porter, Mark & Nuntavisit, Leartluk. (2016). An Evaluation of Multisystemic Therapy with Australian Families. The Australian and New Zealand Journal of Family Therapy, 37, 443 – 462. This paper describes the W.A. Department of Health MST program’s client outcomes over 9 years of operation. This paper attracted favourable commentary by two of the world’s leading investigators in this area, Professor Scott Henggeler (Medical University of South Carolina, U.S.A.) and Professor Mark Dadds, (Child behaviour Research Clinic, University of Sydney, Australia). There is now increasing evidence that leading evidence-based interventions that are carefully implemented and supported, can successfully improve the lives of high risk Australian populations, and reduce the incidence and cost of mental illness, criminal behaviour, substance use, violence and family violence in our community.

Dr Mark Porter (MST Programme Manager and lead Investigator)
Dr Leartluk Nuntavisit (MST Senior Research Officer).
Western Australia Department of Health,
Child and Adolescent Mental Health Service (CAMHS)

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