Finance | MST

Funding

The unit cost of MST is £8-£12,000 per family versus a cost of out of home placement for a young person of between £20,000 per year for a foster placement and up to £200,000 for a secure children’s home bed. Some local authority partnerships implementing the MST programmes receive funding for the Department for Education through the Evidence Based intervention Programme for looked after children, children on the edge of care or custody and their families. Other local authorities fund their MST programmes locally and have embedded this invention as part of their wider services available to children and families.

There is increasing evidence that where local authorities are able to effectively identify the children, young people and families who appropriately fit the criteria for MST and deliver the intervention according the model (maintain model fidelity), data from the existing MST teams in the UK has shown that it is posible to replicate the positive outcomes of international MST sites and keep children at home, in school and out of trouble.

Cost-effectiveness

International and UK evidence indicates that MST is a cost-effective intervention as evidence suggests it reduces the cost of placing children out of home and also costs associated with offending and anti-social behaviour.

Data from the Washington State Institute for Public Policy indicates that the savings from implementing MST are between $12 and $28 for every $1 of spend (Aos et al 2001). Data also indicates that the outcomes of MST are sustained over time, with the longest follow up study now following people up to 22 years post intervention.

Audit data from existing MST sites in England supports these findings from the USA, suggesting that MST provides cost savings in terms of out of home placement, offending costs, police time and educational provision.

An Economic Evaluation of Multisystemic Therapy for Young People at Risk for Continuing Criminal Activity in the UK was carried out by Maria Cary & Sarah Byford at King’s College London, based on data from a randomised controlled trial conducted at the Brandon Centre in North London. Focusing on costs and savings in terms mainly of offending costs, they found that, in comparison to usual care:

MST reduced criminal activity and saved £2290 per young person over two years of follow-up;
MST reduced the need for youth justice services and saved £1217 per young person over two years;
MST cost £2285 per young person, but saved a total of £3,507, resulting in overall (net) savings of £1222 per young person over two years.

These findings were consistent over time, and showed the same pattern of results when 3-year data were analysed.

This study presented some methodological limitations as data were limited to youth justice related costs and the analysis was limited to cost savings, ignoring the impact of MST on outcomes for young people.

The Department of Health, in conjunction with the Department for Education, is funding a pragmatic multi-centre randomised controlled trial (the START trial) to evaluate the effectiveness and cost-effectiveness of MST in a UK context. This trial involves nine pilot sites and 684 participants have been recruited. The final results will be available in 2015.