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

Gustle, Lars-Henry LU (2007)
Abstract (Swedish)
Popular Abstract in Swedish

Avhandlingen behandlar tre områden: 1. implementeringen av Multisystemisk terapi (MST) som en behandlingsmetod inom socialtjänsten i Sverige, 2. implementeringen av ett forskningsprojekt vars mål är att utvärdera MST som behandlingsmetod, 3. utvärdering av MST som behandlingsmetod i jämförelse med traditionell behandling inom socialtjänsten för antisociala ungdomar. Studie I redogör för implementeringen av ett svenskt forskningsprojekt vars mål var att utvärdera Multisystemisk terapi. Samtliga utredande socialsekreterare i de för projektet aktuella kommunerna (de potentiella remittenterna till projektet) och deras arbetsledare fyllde i ett frågeformulär. Frågorna behandlade attityder till... (More)
Popular Abstract in Swedish

Avhandlingen behandlar tre områden: 1. implementeringen av Multisystemisk terapi (MST) som en behandlingsmetod inom socialtjänsten i Sverige, 2. implementeringen av ett forskningsprojekt vars mål är att utvärdera MST som behandlingsmetod, 3. utvärdering av MST som behandlingsmetod i jämförelse med traditionell behandling inom socialtjänsten för antisociala ungdomar. Studie I redogör för implementeringen av ett svenskt forskningsprojekt vars mål var att utvärdera Multisystemisk terapi. Samtliga utredande socialsekreterare i de för projektet aktuella kommunerna (de potentiella remittenterna till projektet) och deras arbetsledare fyllde i ett frågeformulär. Frågorna behandlade attityder till forskningsprojektet samt attityder till MST som behandlingsmetod. En klar majoritet av deltagarna var positiva till forskningsprojektet, kände sig tillräckligt informerade samt tyckte att implementeringen av projektet skett i en lagom takt. Likaså var deltagarna positiva till införandet av MST som behandlingsmetod, till evidensbaserade metoder i allmänhet och till familjebaserade insatser inom kommunen. Studie II undersöker några av de faktorer som kan ha påverkat socialarbetarna att remittera ungdomar till en randomiserad studie angående Multisystemisk terapi. I studien framkom att socialarbetarnas behandlingsideologi var korrelerad till remitteringsfrekvens. Socialarbetare som sympatiserade med den ideologi som MST är baserad på remitterade ungdomar i större utsträckning. Även upplevelsen av ett gott arbetsklimat och socialt stöd i arbetsgruppen korrelerade positivt med remitteringsgraden från enheten. Studie III analyserade symptombelastning hos ungdomsgrupper i forskningsstudier. Programmen var de tre ?Blueprint? programmen, Funktionell Familjeterapi (FFT), Multisystemisk terapi (MST) och ?Multidimensional Treatment Foster Care? (MTFC). Ungdomar i FFT, MST och MTFC jämfördes också med ungdomar från barn- och ungdomspsykiatrisk öppen- respektive slutenvård samt jämfördes med normalgrupper med ?Achenbach System of Empirically Based Assessment? (ASEBA). Symptombelastning hos mödrarna mättes också med ?The Symptom Checklist 90? (SCL-90). Det föreföll att finnas en rimlig överensstämmelse mellan de erbjudna insatserna och symptombelastning hos ungdomar och föräldrar; behandlingsmetoder med högre intensitet hade erbjudits ungdomar med högre symptombelastning. Studie IV utvärderade korttidseffekten av MST- behandling hos en grupp svenska ungdomar (n=156) som uppfyllde de diagnostiska kriterierna för uppförandestörning (DSM IV). Ungdomarna randomiserades till MST eller till traditionella insatser inom socialtjänsten. Data insamlades från ungdomar, föräldrar, socialarbetare och lärare vid tidpunkten för randomiseringen samt sex månader efter randomiseringen. Det fanns ingen signifikant skillnad i behandlingseffekt mellan de två grupperna av ungdomar. I ett svenskt urval är inte MST effektivare än traditionella insatser inom socialtjänsten vad gäller ungdomars problembeteende och mentala hälsa. Resultaten av avhandlingen visar på vikten av framgångsrik implementering av en behandlingsmetod som Multisystemisk terapi samt på vikten av framgångsrik implementering av ett forskningsprojekt. Resultaten identifierar också vikten av att genomföra ?transportability? - studier innan beslut fattas att genomföra disseminering i större skala.



Sökord: Ungdomar, Multisystemisk terapi, Implementering, Evidensbaserad praktik, Randomisering, Utvärdering, Social forskning, Antisocialt beteende, Remitteringsgrad, Symptombelastning. (Less)
Abstract
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... (More)
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. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Associate professor Wrangsjö, Björn, Child and adolescent psychiatry, Stockholm, Sweden
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Psychology, psykosomatik, klinisk psykologi, Psykiatri, psychosomatics, Psychiatry, clinical psychology, Randomized Trial, Evidence Based Practice, Implementation, Adolescents, Multisystemic Therapy, Social psychology, Socialpsykologi, Psykologi
pages
156 pages
publisher
Department of Psychology, Lund University
defense location
Edens hörsal, Paradisgatan, Lund
defense date
2007-02-16 13:00
ISBN
978-91-628-7065-2
language
Swedish
LU publication?
yes
id
56a4f64f-c4e5-40a5-b23c-b184c7b31627 (old id 547993)
date added to LUP
2007-09-10 14:28:15
date last changed
2016-11-23 10:26:19
@misc{56a4f64f-c4e5-40a5-b23c-b184c7b31627,
  abstract     = {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.<br/><br>
<br/><br>
Key words: Adolescents, Multisystemic Therapy, Implementation, Evidence Based Practice, Randomized Trial, Evaluation, Social Research, Antisocial behaviour, Referral Rate, Symptom Load.},
  author       = {Gustle, Lars-Henry},
  isbn         = {978-91-628-7065-2},
  keyword      = {Psychology,psykosomatik,klinisk psykologi,Psykiatri,psychosomatics,Psychiatry,clinical psychology,Randomized Trial,Evidence Based Practice,Implementation,Adolescents,Multisystemic Therapy,Social psychology,Socialpsykologi,Psykologi},
  language     = {swe},
  pages        = {156},
  publisher    = {ARRAY(0x85019a8)},
  title        = {Implementering och korttidsuppföljning av multisystematisk terapi : En svensk randomiserad multicenterstudie angående Multisystemisk terapi},
  year         = {2007},
}