Fonagy, P, Butler, S, Cottrell, D orcid.org/0000-0001-8674-0955 et al. (14 more authors) (2020) Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): 5-year follow-up of a pragmatic, randomised controlled, superiority trial. The Lancet Psychiatry, 7 (5). pp. 420-430. ISSN 2215-0366
Abstract
Background
Multisystemic therapy is a manualised treatment programme for young people aged 11–17 years who exhibit antisocial behaviour. To our knowledge, the Systemic Therapy for At Risk Teens (START) trial is the first large-scale randomised controlled trial of multisystemic therapy in the UK. Previous findings reported to 18 months after baseline (START-I study) did not indicate superiority of multisystemic therapy compared with management as usual. Here, we report outcomes of the trial to 60 months (START-II study).
Methods
In this pragmatic, randomised, controlled, superiority trial, young people (aged 11–17 years) with moderate-to-severe antisocial behaviour were recruited from social services, youth offending teams, schools, child and adolescent mental health services, and voluntary services across England, UK. Participants were eligible if they had at least three severity criteria indicating past difficulties across several settings and one of five general inclusion criteria for antisocial behaviour. Eligible families were randomly assigned (1:1), using stochastic minimisation and stratifying for treatment centre, sex, age at enrolment, and age at onset of antisocial behaviour, to management as usual or 3–5 months of multisystemic therapy followed by management as usual. Research assistants and investigators were masked to treatment allocation; the participants could not be masked. For this extension study, the primary outcome was the proportion of participants with offences with convictions in each group at 60 months after randomisation. This study is registered with ISRCTN, ISRCTN77132214, and is closed to accrual.
Findings
Between Feb 4, 2010, and Sept 1, 2012, 1076 young people and families were assessed for eligibility and 684 were randomly assigned to management as usual (n=342) or multisystemic therapy (n=342). By 60 months' of follow-up, 188 (55%) of 342 people in the multisystemic therapy group had at least one offence with a criminal conviction, compared with 180 (53%) of 341 in the management-as-usual group (odds ratio 1·13, 95% CI 0·82–1·56; p=0·44).
Interpretation
The results of the 5-year follow-up show no evidence of longer-term superiority for multisystemic therapy compared with management as usual.
Funding
National Institute for Health Research Health Services and Delivery Research programme.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2020 Elsevier Ltd. All rights reserved. This is an author produced version of an article accepted for publication in The Lancet Psychiatry. Uploaded in accordance with the publisher's self-archiving policy. |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Psychiatry and Behavioural Sciences (Leeds) |
Funding Information: | Funder Grant number Department of Health MST PROJECT Anna Freud Centre START RA NIHR National Inst Health Research CRJK |
Depositing User: | Symplectic Publications |
Date Deposited: | 24 Mar 2020 16:26 |
Last Modified: | 01 Nov 2020 01:38 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/S2215-0366(20)30131-0 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:158672 |