title: Evaluation of multisystemic therapy pilot services in the Systemic Therapy for At Risk Teens (START) trial: study protocol for a randomised controlled trial.
abstract: BACKGROUND
  There is an urgent need for clinically effective and cost-effective methods to manage antisocial and criminal behaviour in adolescents. Youth conduct disorder is increasingly prevalent in the UK and is associated with a range of negative outcomes. Quantitative systematic reviews carried out for the National Institute for Health and Clinical Excellence have identified multisystemic therapy, an intensive, multimodal, home-based, family intervention for youth with serious antisocial behaviour, as one of the most promising interventions for reducing antisocial or offending behaviour and improving individual and family functioning. Previous international trials of multisystemic therapy have yielded mixed outcomes, and it is questionable to what extent positive US findings can be generalised to a wider UK mental health and juvenile justice context. This paper describes the protocol for the Systemic Therapy for At Risk Teens (START) trial, a multicentre UK-wide randomised controlled trial of multisystemic therapy in antisocial adolescents at high risk of out-of-home placement.
  
  
  METHODS
  The trial is being conducted at 10 sites across the UK. Seven hundred participants and their families will be recruited and randomised on a 1:1 basis to multisystemic therapy or management as usual. Treatments are offered over a period of 3 to 5 months, with follow-up to 18 months post-randomisation. The primary outcome is out-of-home placement at 18 months. Secondary outcomes include offending rates, total service and criminal justice sector costs, and participant well-being and educational outcomes. Data will be gathered from police computer records, the National Pupil Database, and interview and self-report measures administered to adolescents, parents and teachers. Outcomes will be analysed on an intention-to-treat basis, using a logistic regression with random effects for the primary outcome and Cox regressions and linear mixed-effects models for secondary outcomes depending on whether the outcome is time-to-event or continuous.
  
  
  CONCLUSIONS
  The START trial is a pragmatic national trial of sufficient size to evaluate multisystemic therapy, to inform policymakers, service commissioners, professionals, service users and their families about its potential in the UK. It will also provide data on the clinical and cost-effectiveness of usual services provided to youth with serious antisocial behaviour problems.
  
  
  BACKGROUND
  ISRCTN77132214.
authors: Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. p.fonagy@ucl.ac.uk
authors: Peter
authors: P
authors: Fonagy
authors: Stephen
authors: S
authors: Butler
authors: Ian
authors: I
authors: Goodyer
authors: David
authors: D
authors: Cottrell
authors: Stephen
authors: S
authors: Scott
authors: Stephen
authors: S
authors: Pilling
authors: Ivan
authors: I
authors: Eisler
authors: Peter
authors: P
authors: Fuggle
authors: Abdullah
authors: A
authors: Kraam
authors: Sarah
authors: S
authors: Byford
authors: James
authors: J
authors: Wason
authors: Rachel
authors: R
authors: Haley
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D016497:Adolescent Health Services; D019955:Conduct Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003415:Crime / Q000517:prevention & control* / Q000523:psychology; D057237:Criminals / Q000523:psychology*; D005195:Family Relations; D006801:Humans; D016014:Linear Models; D008605:Mental Health Services; D010865:Pilot Projects; D016016:Proportional Hazards Models; D011613:Psychotherapy / Q000379:methods*; D012107:Research Design; D012307:Risk Factors; D012919:Social Behavior; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
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