Paper
Implementing randomized experiments: an evaluation of multisys-temic therapy in The Netherlands
- issue: Issue 2 / 2009
- authors: Willeke Manders, Maja Dekovic, Jessica Asscher
- keywords: multisystemic therapy, randomized experiments, implementation, effectiveness, The Netherlands
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abstract
Background. Multisystemic Therapy (MST) is an intensive home- and community-based treatment for youth who show serious, violent and chronic antisocial behaviour. Since 2004, MST has been implemented on a small-scale basis in The Netherlands. From 2006, in order to ensure availability of a (potentially) successful treatment all over The Netherlands, a large-scale implementation of MST has be conducted. The reasons for the choice of this treatment are first, its strong theoretical foundation and second, empirical support for its effectiveness from controlled clinical trials in the USA. Notwithstanding these positive indications, there are also reasons for caution. A review by Littell (2005) has questioned the conclusion that MST is effective by pointing out that inconsistent and incomplete reports have been published. Even more importantly, due to the differences between countries in social and political climate, organization of mental health services, availability of different treatments, type and ethnic background of clients, etc., it is not known whether the same positive results will be obtained in The Netherlands. Many of the treatments available for adolescents who show serious and persistent antisocial behavior have never been properly evaluated in The Netherlands. Moreover, the poor quality of most evaluation studies does not allow reliable and valid conclusions. This fact has been repeatedly emphasized as an important obstacle in development and refinement of evidence-based interventions. This paper concerns an evaluation study in which a new, promising treatment for juvenile delinquents, Multisystemic Therapy, is compared to Treatment as Usual in The Netherlands.
Our paper describes the implementation of a randomized experiment to evaluate a promising intervention for serious juvenile delinquents, multisystemic therapy (MST) in the Netherlands, as well as the challenges encountered when implementing this design. It is closely related to the focus of this conference because it concerns an evaluation study for delinquent adolescents and their families, the challenges of implementing a randomized controlled trail, and of examining cultural differences with respect to treatment implementation and outcomes. We believe this information is relevant not only for researchers involved in similar studies, but also for clinical practitioners and policy makers.
Purpose of the study. The aims of this project are the following:
- to examine short and long term effects of multisystemic therapy compared to 'treatment as usual' as currently executed in the Netherlands (decrease recidivism, rate and seriousness delinquent behaviour);
- to understand the processes through which this treatment works by testing the hypothesized mediators of beneficial treatment (parenting behaviour, parent-child relationship, peer relationships);
- to understand differential pathways to change by determining circumstances in which this treatment yield or does not yield beneficial outcomes (client and treatment characteristics).
The method of this project is the following: a randomized clinical trial will be conducted. Clients will be randomly assigned into either treatment group (MST group, n = 100) or control group ('treatment as usual' group - TAU, n = 100). The sample will include youth (and their families) who show serious, violent, and chronic antisocial behavior between 12 and 18 years motivated for treatment and willing to participate in the study. Pretest assessment (T1) will take place immediately prior to the beginning of treatment, posttest assessment (T2) will take place immediately after treatment (on average 12 months), and follow up (T3) will be conducted 6 months after the end of treatment. The identical assessment battery will be administered to both groups at T1, T2, and T3. The assessment will include multi methods (interviews, questionnaires, observation) and multi sources of information (parent, child, therapist, observer, teacher). Families (in both conditions) will be paid 20 euros for each completed assessment battery. In addition, monthly telephone interviews will be obtained from participants on several central concepts of this study.
Key findings. This study has started only recently. Therefore no data are available (yet) on effectiveness. We will present the issues we encounter when implementing a randomized experiment to evaluate a promising intervention for serious juvenile delinquents, multisystemic therapy (MST) in the Netherlands. Problems that we expect to encounter are the complexity of the referral process in this type of intervention, legal issues and the ethical concerns raised by clinicians. Our experiences might be useful to others planning to carry out a randomized efficacy study. Firstly, other researchers might feel supported if they realize that others experience similar problems, and, secondly, we provide some concrete suggestions concerning the following: selecting the procedures and determining the moment of randomization, dealing with and overcoming the resistance of institutions involved, maintaining the cooperation of both the institution and the sample, and keeping turnover of research staff to a minimum.
Key references
Asscher, J.J., Deković, M., Laan, P.H. van der, Prins, P., & van Arum, S. (2007). Implementing randomized experiments in criminal justice settings: An evaluation of Multisystemic Therapy in the Netherlands. Journal of Experimental Criminology, 3, 113-129.
Henggeler, S. W., Schoenwald, S. K., Swenson, C. C., & Borduin, C. M. (2006). Methodological critique and meta-analysis as Trojan horse. Children and Youth Services Review, 28, 447-457.
Littell, J. H. (2005). Lessons from a systematic review of effects of multisystemic therapy. Children and Youth Services Review, 27, 445-463.
Contacts: Willeke Manders, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands, E-mail: W.A.Manders@uu.nl, Phone +31 30-2539299.