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Crossing the quality chasm?: The short-term effectiveness and efficiency of MST in Sweden: An example of evidence-based practice applied to social work
School of Social Work, Lund University.ORCID iD: 0000-0002-7351-9140
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this dissertation is to evaluate the effectiveness and cost-effectiveness of Multisystemic Therapy (MST) in Sweden. This evaluation is set against the background of evidence-based social work practice and is organized around four separate but interrelated studies. The first of these studies used program theory reconstruction to investigate three conceptualizations of evidence-based practice (EBP). Here it is argued that evidence-based practice is not a homogeneous concept, and that interested parties within research, practice and policy may not have a shared vision of EBP, even though they may use the same terminology. The second study, a randomized trial, assessed the effectiveness of MST within the normally operating social services system for 156 youths who met the diagnostic criteria for conduct disorder. Youth were randomly allocated between MST and treatment-as-usual (TAU) groups. Assessments were conducted at intake and seven months after referral. Results from mulitagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behaviors among participants across treatments. There were no significant differences in treatment effects between the two groups. The third study assessed the costs of treating conduct disorder with MST and TAU. From the perspective of the municipal social welfare system, all intervention costs were collected for the six-month period starting at randomization to treatment group. MST was not found to reduce the extent to which youth were placed outside of their homes. In addition, the costs of out-of-home placement were the same for both MST and TAU group youth. MST was, however, associated with a reduction in the use and costs associated with other non-placement services. This reduction was not found to offset the additional cost of MST. The fourth and final study investigated the treatment outcomes and costs associated with MST versus TAU for intervention with substance abusing and non-substance abusing conduct disordered youth. This study found no differences in treatment outcome between these two groups. This dissertation found MST to be equally effective but less cost-effective than TAU. 

Place, publisher, year, edition, pages
Lund: Lund University , 2009. , p. 135
Series
Lund dissertations in social work, ISSN 1650-3872 ; 34
National Category
Social Work
Identifiers
URN: urn:nbn:se:hj:diva-59152ISBN: 978-91-89604-41-4 (print)OAI: oai:DiVA.org:hj-59152DiVA, id: diva2:1719770
Opponent
Supervisors
Available from: 2022-12-16 Created: 2022-12-16 Last updated: 2022-12-16Bibliographically approved
List of papers
1. Reconstructing evidence-based practice: an investigation of three conceptualisations of EBP
Open this publication in new window or tab >>Reconstructing evidence-based practice: an investigation of three conceptualisations of EBP
2007 (English)In: Evidence & Policy: A Journal of Research, Debate and Practice, ISSN 1744-2648, E-ISSN 1744-2656, Vol. 3, no 2, p. 271-285Article in journal (Refereed) Published
Abstract [en]

This article uses programme theory reconstruction to investigate three conceptualisations of evidence-based practice (EBP). The first two are taken directly from the literature and contrasted with a third taken from a relevant policy programme. The article argues that 'evidence-based practice' is not a homogeneous concept, and that interested parties within research, practice and policy may not have a shared vision of EBP even though they may use the same terminology. It is important for the successful implementation of EBP within practice and policy that there is a clear understanding of what EBP is and how EBP is supposed to work if research, policy and practice are to work together toward common goals.

Place, publisher, year, edition, pages
Policy Press, 2007
Keywords
Evidence-based practice; Programme theory; Public policy; Reconstruction; Sweden
National Category
Social Work
Identifiers
urn:nbn:se:hj:diva-58880 (URN)10.1332/174426407781172153 (DOI)2-s2.0-34250192491 (Scopus ID)
Available from: 2022-11-10 Created: 2022-11-10 Last updated: 2022-12-16Bibliographically approved
2. The transportability of multisystemic therapy to Sweden: Short-term results from a randomized trial of conduct-disordered youths
Open this publication in new window or tab >>The transportability of multisystemic therapy to Sweden: Short-term results from a randomized trial of conduct-disordered youths
Show others...
2008 (English)In: Journal of family psychology, ISSN 0893-3200, E-ISSN 1939-1293, Vol. 22, no 4, p. 550-560Article in journal (Refereed) Published
Abstract [en]

his randomized clinical trial assessed the effectiveness of multisystemic therapy (MST) for 156 youths who met the diagnostic criteria for conduct disorder. Sweden's 3 largest cities and 1 small town served as the recruiting area for the study. A mixed factorial design was used, with random allocation between MST and treatment as usual groups. Assessments were conducted at intake and 7 months after referral. With an intention-to-treat approach, results from multiagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behaviors among participants across treatments. There were no significant differences in treatment effects between the 2 groups. The lack of treatment effect did not appear to be caused by site differences or variations in program maturity. MST treatment fidelity was lower than that of other studies, although not clearly related to treatment outcomes in this study. The results are discussed in terms of differences between Sweden and the United States. One difference is the way in which young offenders are processed (a child welfare approach vs. a juvenile justice system approach). Sociodemographic differences (e.g., rates of poverty, crime, and substance abuse) between the 2 countries may also have moderating effects on the rates of rehabilitation among young offenders. 

Place, publisher, year, edition, pages
American Psychological Association (APA), 2008
Keywords
multisystemic therapy; conduct disorder; randomized trial; child behavior; checklist; cultural context
National Category
Social Work
Identifiers
urn:nbn:se:hj:diva-58879 (URN)10.1037/a0012790 (DOI)000258582500007 ()18729669 (PubMedID)2-s2.0-51249121345 (Scopus ID)
Funder
Swedish National Board of Health and Welfare
Available from: 2022-11-10 Created: 2022-11-10 Last updated: 2022-12-16Bibliographically approved
3. Intervening in youth problem behavior in Sweden: a pragmatic cost analysis of MST from a randomized trial with conduct disordered youth
Open this publication in new window or tab >>Intervening in youth problem behavior in Sweden: a pragmatic cost analysis of MST from a randomized trial with conduct disordered youth
2010 (English)In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 19, no 2, p. 194-205Article in journal (Refereed) Published
Abstract [en]

Within the context of a randomized trial, this study assessed the costs of treating conduct disorder with multisystemic therapy (MST) or treatment as usual (TAU) for 156 youth in Sweden. From the perspective of the municipal Social Welfare Administration, all intervention costs were collected for the 6-month period starting at randomization. MST was found to cost, on average, US$8,847 per youth. A course of intervention including MST was found to cost significantly more (US$5,038 per youth) than TAU. Although MST was found to reduce the use of and costs associated with non-placement interventions, MST was not found to reduce the use of or costs associated with placement interventions. This is contrary to findings reported from studies undertaken in the USA. Intent-to-treat (ITT) and treatment-of-treated (TOT) analyses are presented.

Place, publisher, year, edition, pages
John Wiley & Sons, 2010
Keywords
MST (multisystemic therapy), Sweden, economic analysis, randomized trial, conduct disorder, youth
National Category
Social Work
Identifiers
urn:nbn:se:hj:diva-58878 (URN)10.1111/j.1468-2397.2009.00653.x (DOI)000274952000008 ()2-s2.0-77950308222 (Scopus ID)
Available from: 2022-11-10 Created: 2022-11-10 Last updated: 2022-12-16Bibliographically approved
4. Effective services for alcohol and drug abusing youth: perspectives from Sweden
Open this publication in new window or tab >>Effective services for alcohol and drug abusing youth: perspectives from Sweden
2008 (English)In: Crossing frontiers: international developments in the treatment of drug dependence / [ed] A. Stevens, Brighton: Pavilion Publishing, 2008, p. 35-52Chapter in book (Refereed)
Place, publisher, year, edition, pages
Brighton: Pavilion Publishing, 2008
National Category
Social Work
Identifiers
urn:nbn:se:hj:diva-59153 (URN)978-1-84196-217-7 (ISBN)
Available from: 2022-12-16 Created: 2022-12-16 Last updated: 2022-12-16Bibliographically approved

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