Implementering och korttidsuppföljning av multisystematisk terapi: En svensk randomiserad multicenterstudie angående Multisystemisk terapi

This thesis focuses on three areas: 1. the implementation of Multisystemic Therapy (MST) as a treatment method in social services in Sweden, 2. the implementation of a research project that has the aim to evaluate MST as a treatment method, 3. the evaluation of MST as a treatment method compared to traditional social services for antisocial adolescents in Sweden. The first study reports on the implementation of a Swedish research project that evaluated Multisystemic Therapy. All investigating social workers in local work practice (potential referrers to this project) and their supervisors completed a questionnaire concerning attitudes toward the research project as well as attitudes toward MST as a treatment method. A large majority of the participants were positive toward the research project, felt sufficiently informed, and thought that the implementation occurred at an appropriate pace. Likewise, participants felt positively toward the adoption of MST as a treatment method, toward evidence-based research in general, and toward community-family-based services. Study II examines some of the factors that may have affected the tendency for social workers to refer adolescents to a randomized controlled study of Multisystemic Therapy. The study concluded that the treatment ideology of the social worker was associated with referral rate. Social workers who sympathized with the ideology on which MST is based referred patients to the project to a greater extent. Also the perception of a good work climate and good social support correlated positively with the referral rate from the unit. Study III analyses symptom load in youth groups in research studies. The programmes were the three Blueprint programmes, Functional Family Therapy (FFT), Multisystemic Therapy (MST), and Multidimensional Treatment Foster Care (MTFC). Youth in FFT, MST, and MTFC were also compared with in- and outpatients from child and adolescent psychiatry and a normal comparison group on symptom load as measured by the Achenbach System of Empirically Based Assessment (ASEBA). Symptom load among their mothers was measured by the Symptom Checklist 90 (SCL-90). There seems to be a reasonable correspondence between the offered resources and the symptom load among youth and parents; treatment methods with higher intensity have been offered to youth with higher symptom load. Study IV assessed the short-term effectiveness of MST in the Swedish setting with a group of youths (n = 156) fulfilling the diagnostic criteria for conduct disorder. These youths were randomly assigned to MST or Traditional Services. Data were gathered from youths, parents, caseworkers, and teachers at time of randomization as well as at six months after randomization. There was no significant difference in treatment effects between the two groups of youths. In a Swedish sample MST is not more effective than traditional social services at producing short-term improvements in youth problem behaviour and mental health. The results of this thesis show the importance of successful implementation of a treatment method as Multisystemic Therapy and the importance of successful implementation of a research project. The results also address the importance of conducting transportability studies before decision to disseminate on larger scale.

Key words: Adolescents, Multisystemic Therapy, Implementation, Evidence Based Practice, Randomized Trial, Evaluation, Social Research, Antisocial behaviour, Referral Rate, Symptom Load.