Dr Mark Porter1
1W.A. Child and Adolescent Health Service, Fremantle, Australia, 2University of Western Australia, Perth, Australia
Child and adolescent conduct disorders include behaviours such as aggression, violence, rule-violation and anti-social behaviours. Untreated, these disorders predict substance use, adult mental illness, chronic under-employment, inter-personal difficulties, criminality, violence and incarceration. Although conduct disorders are common, families with these children are usually poor, marginalised and difficult to engage with services; hence these high-cost disorders have low intervention rates. However effective engagement with this population is critically important to decrease high levels of criminality, substance use, mental illness and dysfunction within many Australian communities.
Multi-systemic Therapy (MST) is a licensed, home-based intervention typically used to help families with children (12-16 years) having severe behavioural disorders, or juvenile delinquency. This 4-5 month intensive intervention teaches parents monitoring, communication and problem-solving skills to better manage their children’s behaviours, and improve communication between systems, (e.g. family, community and school systems) in the child’s environment. The program operates from a “family preservation model”, prioritising youth at imminent risk of out-of-home placement, and/or school expulsion. Clinicians visit each client family three times every week (often after normal work hours), and are available 24/7 via a phone roster to support the family throughout the intervention.
This specialist intervention was implemented within the W.A. Mental Health system in 2005, and operates two small clinical teams within Perth’s metropolitan area. This program is unique within Australian Health services, and has won leading national awards for crime and violence prevention, substance use prevention, and mental illness treatment. A longitudinal research study indicates most families achieve significant and enduring improvements in the mental health of all family members; and maintain the young person living at home, engaged in school and pro-social activities. This is robust evidence of the effectiveness of implementing evidence-based interventions for young persons at very high risk of criminal involvement, substance abuse, mental illness and early death.
Mark Porter is a clinical psychologist and programme manager of the W.A. Department of Health’s Multisystemic Therapy program. Mark has been continually managing this program since January 2006 soon after it was implemented. He previously implemented and managed the leading residential therapeutic Community in W.A. for complex substance abuse and mental illness.