MSTs analytical model And a clinical case Side

MST’s analytical model And a clinical case Side 1

Side 2

MST Treatment Principles 1. Finding the Fit The primary purpose of assessment is to understand the “fit” between the identified problems and their broader systemic context. 2. Positive & Strength Focused Therapeutic contacts should emphasize the positive and should use systemic strengths as levers for change. 3. Increasing Responsibility Interventions should be designed to promote responsibility and decrease irresponsible behavior among family members. 4. Present-focused, Action-oriented & Well-defined Interventions should be present-focused and action-oriented, targeting specific and welldefined problems. 5. Targeting Sequences Interventions should target sequences of behavior within and between multiple systems that maintain identified problems. 6. Developmentally Appropriate Interventions should be developmentally appropriate and fit the developmental needs of the youth. 7. Continuous Effort Interventions should be designed to require daily or weekly effort by family members. 8. Evaluation and Accountability Interventions efficacy is evaluated continuously from multiple perspectives, with providers assuming accountability for overcoming barriers to successful outcomes. 9. Generalization Interventions should be designed to promote treatment generalization and long-term maintenance of therapeutic change by empowering care givers to address family members’ needs across multiple systemic contexts. Side 3

Team: Case Summary for Supervision & Consultation Family: Age: Therapist: Date: Startdate: Reasons for Referral Behavioe Duration Frequency Extent Initial GoalsDesired Outcome Participant Goal Superior MST goals Side 4 Affected systems

Team: Case Summary for Supervision & Consultation Family: Therapist: Genogram: Side 5 Dato: Startdate:

Team: Case Summary for Supervision & Consultation Family: Therapist: Dato: Startdate: Systematic strengts Systemic WeaknessesNeeds Individual Family School Peers Community Side 6

Team: Weekly Case Summary for Supervision & Consultation Family: Age: Therapist: Date: Startdate: Number of calls: Number of meetings: I. OverarchingPrimary MST Goals II. Previous Intermediary Goals Met Partially Not III. Barriers to Intermediary Goals IV. Advances in Treatment V. Assessment of “fit” between identified problems and their broader systemic context. VI. New Intermediary Goals for Next Week Side 7

Team: Case Summary for Supervision & Consultation Family: Therapist: “Fit” circle: Side 8 Dato: Startdate:

GENOGRAM OLA 67 72 80 D 1961 35 48 39 40 50 30 27 24 19 11 Side 9 15 B 75 D 77

Terapeut: 1001 Familie: 0002 Dato: 15/10 2003 Behavior Drugabuse Duration The past year Frequency Ca. 2 -3 times a week Intensity Hasj, alcohol og pills Involved systems Individually, family, school, friend Truancy, no classroom work Individually, Truancy days or Reacts negativly family, school classes every when talked to. week. Does not Conflicts with participate in the class for the past 6 students and teacher. months Physically agressive towards teacher +other students. School problems Started in 7 th grade Increased the past year Verbally and physically aggressive. From 9 – 10 Daily quarreling years age. and acting out Worsening the past year. Shouting at and School, home threatening his parents and at school. Breaks things and sometimes hits and kicks parents Does not follow the family’s rules From 9 – 10 Daily years age. Ran away at night Does what he wantsl, does not follow curfew, away nights Hjem, skole, venner

Desired Outcomes of Family and key participants Participants Goal Mother Wishes Ola was happier, that he stops drugs, goes to school every day, stops physical and verbal agressiveness, does not stay away at night Father Same as mother Ola Wants his parents to leave him alone School Wants Ola moved to an institution with classes there Grandparents He must have help to stop using drugs and to stop the conflicts at home Ola to stop using drugs and to participate more at school. Lower conflicts at home, help parents to set limits for Ola. Child Welfare Side 11

A summary for supervision and consultation Terapeut: 1001 Familie: 0002 Dato: 15/10 2003 Systemic strengths Needs Individually: Ola goes well together with other people, can be polite and sociable. Cares for his little brother. Plays guitar, interested in computers and og snowboard. Is easily lead to negative activities. Use of drugs, conflicts at home. Out all night. Can be threatening or violent if he feels pushed. Interchangeable friends. Always restless and easily gets into trouble. Suspecting ADHD. Side 12

Systemic strengths Family: Mom has a permanent job, involved in the childres, caring. Dad is good with practical matters. Nice house, OK economy. Family has experience with doing positive things together (outdoor activities, holidays, eating nice meals together). Parents have some close friends and good neighbours. Side 13 Needs Mom nags a lot and is not heard. Dad is irretabe and hottempered/explosive. Disagree with the child upbringing. Mom is compliant, dad strict. Mom feels alone in the upbringing and fells she has little support. Has considred divorce. Dad is on social security because of back problems from a occupational injury. Depressed because of pain, no job. Problems with alchohol and mental sufferings in dads familiy. Little family live near.

Systemic strengths School: Ola has previously shown good work in arts and crafts and computer science. School is relatively new. Many motivated teachers and a psincipal who seems interested in Olas problems. Curious about MST. Side 14 Needs Has not worked in class for the last six months. Lots of absence. Acts out according to teachers and pupils. School means he should be placed in an institution for youths with behavior problmes. Many in the same class also has problems (drugs and disturbance). Mange i samme klasse som har problemer (uro og rus). Conflict between school and parents about situation.

Systemic strengths Friends: Has one positive friend, they play on the computer and og snowboarding. Side 15 Needs Stays in a negative youth environment. Drugs, petty crime and skip school. Parents have little control over where tjey are and what they do. Spends the night at friends the parents don’t know.

Systemic strengths Community: Residental area close to the city center with all services. Activity house open once a week for a drug and alchohol free disco for youths. Good bus service to city centre. Side 16 Needs Few activities for youth. Large mall with an arcade near by. Typical hang out place for youth from the entire district. Criminal, drug abusing youth hang out at the mall. Drug sales, older youth buy alchohol for the younger. New estate with a high level of insecurity. Many don’t know eachother.

Weekly Case Summary for Supervision and Consultation Therapist: Familiy: Date: I. OverarchingPrimary MST Goals 1. Ola will be clean. This will be confirmed by negative urine specimen and information from parents, school and police. 2. Ola will actively participate in a school sitiation adapted for him. Confirmed by information from school and parents. 3. Ola will stop both verbal and physical aggression. Confirmed by information from school and parents. 4. Ola will follow the family rules. Confirmed by information from parents. Side 17

PEER STATUS Confirmed by: child services GETS WHAT HE WANTS/GETS POWER Confirmed by: parents COMMUNICAT ION STYLE IN THE FAMILY Confirmed by: parents, Ola COVERS UP SADNESS Confirmed by: mom VERBAL AND PHYSICAL AGGRESSION LOW IMPULS CONTOL Confirmed by: school, mom INCONSITENT PARENTING Confirmed by: parents, Ola Side 18 SUBSTANCE ABUSE Confirmed by: parents UNCLEAR RULES AND CONSEQUENSES Confirmed by: parents PHYSICALLT STOPPED BY DAD IN CONFLICT SITUATIONS Confirmed by: Ola, parents

PEERS WHO USE Confirmed by: youth support team, parents SUBSTANCE ABUSE PROBLEMS IN THE FAMILY Confirmed by: parents EASY ACCESS TO DRUGS Confirmed by: youth support team, and Child Services CURBS UNREST Confirmed by: Ola, parents SUBSTANCE ABUSE NO CONSEQUENSES Confirmed by: parents THRILL/RUSH Confirmed by: Ola NO MONITORING Confirmed by: parents Side 19 CONFLICTS AT HOME Confirmed by: family NO PARTICIPATION IN AFTER SCHOOL ACTIVITIES Confirmed by: Ola

NOR FRIENDS IN SCHOOL Confirmed by: lead teacher PROBLEM CONCENTRATING, SUBJECT. Confirmed by: school, rapport from Educational. Psychological Service FRIENDS NOT ATTENDING SCHOOL/NO JOB Confirmed by: school, Ola CONFLICT SCHOOL-HOME Confirmed by: parents, school TRUANCY BAD RELATIONSHIP WITH TEACHER Confirmed by: Ola NO CONSEQUENSES AT HOME OR SCHOOL Confirmed by: school, parents NO PARENT FOLLOW UP WITH SCHOOL Confirmed by: parents PARENTS HAVE NO CONTROL OVER ACTIONS Confirmed by: parents Side 20 SUBSTANCE ABUSE; GETS HOME LATE; TIERED Confirmed by: parents

Social Support • Key particpants • Identify need/tasks to ask for in support • Make a plan for meeting participants individually or in a group • Make agenda for meeting • Therapist is secretary at the meeting and writes all agreements • Examples of tasks: • Come to the home in difficult situations • Help in search for youth • Babysit other children when parents need • Be support for parents as needed • Be support for youth with activities

II. Previous Intermediary MET PARTIALLY NOT Goals 1. Make safety plan X 2. Mom contacts neighbour and a friend to ask if they can be contacted in an emergency X 3. Parents agree on rules that will be included in the contract III. Barriers to Intermediary Goals Parents disagree on rules. They think it is hard to find privileges. They’d rather punish than reward. One serious conflict situation led to Ola hitting dad. After this he ran away and did not come home all night. Side 22 X

IV Advances in Treatment Safetyplan is in place. Both neighbour and moms friend are willing to be available in a conflict situation. Both their names and numers are on the safety V Assessment of “fit” between identified problems and their broader systemic context. Side 23

Safety plan for Ola and his family LEVEL SITUATION WILL DO 1. Someone starts to yell at eachother Remove yourselves Everyone in the form the situation, give a family. stop message (agree on a sign) Don’t start a discussion 2. Someone threatens another family member Notify the person on Person feeling whats to come in level 3 threatened. and 4 in a calm voice. Don’t start a discussion 3. Distroyed somethin in the house, breaks or destroys something. Call friends or other family to ask for help. Name/no: ………………………… Mom or dad. 4. Physically attacks someone. Calls the police and MST therapist. Mom or dad. Side 24 RESPONSIBILI TY

Family Cohersion • Identify strengths • Help parents to rebuild warmth and support • Establish clear expectations and rules • Make family contract with predictable rewards and consequences • Plan for family activities

VI New Intermediary Goals for Next Week 1. Review of possible rules, privileges and negative consequences with parents. 2. Map this weekends episode of violence. Make a Fit circel on what happened and make a plan to make sure this does not happen again. 3. Make an action plan on how to handle a situation where Ola is gone all night. 4. Dad contacts the school to set up a meeting. Side 26

School interventions • Identify strengths and needs • Plan meeting with school with the parents • Parents contact school for meeting • Plan for comunication flow between parents and school • Plan for implementation of rewards and consequences are made • Plan for school routines • Particpants in meeting: (Principle) Class teachers, social support teacher, parents and therapist

Family contract RULE PRIVELIGE NEGATIVE CONSEQUENCE Ola will come to school at the right time and stay all day. 2 points (=20 kr) per No points on days day to comply with he breaks the rule. If he comply to the rule a whole week he gets two hours with the computer group on the last two hours on Friday. Ola will og straight home afteer school and do his homework. Gets to use the Loses access on computer/og online days he breaks the two hours every rule. afternoon/night Ola will stop 2 points (=20 kr) per Failure to comply threatening, yell at day to comply with the rule loses and hassle other the rule him access to TV family members and phone the rest of the day. Side 28

RULE PRIVELIGE NEGATIVE CONSEQUENCE Ola will be home by 10 pm on a weekday and 1 am on Friday/Saturday. He will inform his parents on where he is going, who he is going with and what he is doing when he goes out. 2 points can be exchanged to a mobile cash card when he has enough points. When he comply with the rule for 1 week he gets to chose his favorite meal at a family dinner. Ola must be home earlier the day after, equivalent to the time he was late the previous day. If he does not come home and his parents have to go and find him he has to home by 6 pm the following weekend. Ola will not use any illegal drugs. He will submit one urine sample a week. A refusal to give a urine sample is considered a positive test. With a negative test he will receive 5 points (=50 kr) that he can save for snowboarding. In addition the travel expences to get to the ski slope will be covered. With a positive test Ola will loose his privileges. He must come home earlier and prepare unexpected urine test. Side 29

Peer interventions • Identify peers • Who, when and what they do • Decide desired contact level • Monitoring interventions • Examples: • Contact parents of negative peers • Establish a collaborative approaches: Try to make agreements on limits and rules • Plan for activities with prosocial peers

Plan for finding Ola Behavior What happens Ola fails to appear/does not keep his curfew 1. 2. 3. 4. 5. 6. Side 31 Responsibilty Calls Olas cell Mom and dad phone Calls his friends’ parents Drives around to find him Mom and dad calls friend to help with the search Call s MST, consider if the police should be contacted

Physical and verbal aggression • Make security plan • Identify strengths and needs • Rebuild family bonding • Identify clear rules • Identify triggers for aggresion • Decide rewards for reducing verbal aggression (which is always covered in the family contract)

DAD YELLED AT OLA DID NOT RECEIVE MONEY OLA KNOWS IT HELPS -HE GETS WHAT HE WANTS CONFLICT BETWEEN OLA AND PARENTS ALREADY PRESENT OLA HIT DAD PHYSICALLY HELD HIM BACK VAGUE RULES DID NOT FOLLOW THE SECURITY PLAN PARENTS GAVE CONFLICTING INSTRUCTIONS Side 33 OLA WAS INTOXICATED

Drug Abuse Interventions • Identify level of addiction • Identify peers who also use, what, when and where • Plans urine tests • Make contract for stopping drug use