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Systemic Therapy for At Risk Teens (START)

  • Research Project Team

    • Peter Fonagy – Chief Investigator
    • Stephen Butler – Project Coordinator
    • Liz Simes – Trial Coordinator (maternity cover)
    • Rachel Ellison – Trial Coordinator


    • University College London
    • University of Cambridge 
    • University of Leeds,


  • 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 (MST), 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 MST 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. The Systemic Therapy for At Risk Teens (START) trial is a multicentre UK-wide randomised controlled trial of multisystemic therapy (MST), as a treatment for young people and their families who are experiencing difficulties at home, at school and sometimes with the law.

  • Aims

    • We aim to compare Multisystemic Therapy (MST) with other services that are currently offered to young people and their families who are considered to be at ‘high risk’ of requiring out-of-home care such as fostering, social care or custody if associated with antisocial behaviour such as conviction as a young offender.
    • MST as a treatment for young people and their families is new to the UK and so we aim to answer the question of whether it will be as effective here as it has been in the United States where it was developed and has gathered a wide evidence base.
  • Methodology

    The trial has randomised a nationally representative sample of 684 young people and their caregivers to MST or management as usual (MAU) provided by social care and mental health services. The primary outcome of the initial phase of the trial 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 is 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.

    The follow-up period has been extended and the primary outcome window is continuing to 60 months. The trial will carry out an evaluation of a broadened range of outcomes of both MST and MAU to 48 months and conduct annual full-blind outcome evaluations up to 48 months.

  • Results

    To Be Announced