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Objective: To evaluate whether Multisystemic Therapy (MST) is more effective in reducing youth offending and out-of-home placement in a large, ethnically diverse, urban U.K. sample than an equally comprehensive management protocol; and to determine whether MST leads to broader improvements in youth sociality and in mediators believed to be responsible for change in MST. Method: 108 families were randomized to either MST (n=56) or the comprehensive and targeted usual services delivered by youth offending teams (YOT, n = 52). Results: Although young people receiving both MST and YOT interventions showed improvement in terms of reduced offending, the MST model of service-delivery reduced significantly further the likelihood of nonviolent offending during an 18-month follow-up period. Consistent with offending data, the results of youth-reported delinquency and parental reports of aggressive and delinquent behaviors show significantly greater reductions from pre-treatment to post-treatment levels in the MST group. In this study MST was observed to have some delayed impact on offending, the nature and causes of which will require further study. Conclusions: The superiority of the MST condition in reducing offending and antisocial behavior suggests that MST adds value to current U.K. statutory evidence-based youth services. The provision of MST does not supplant existing services but is best used to facilitate the appropriate and cost-effective organization of statutory services for young persons and their families. (Contains 2 figures and 4 tables.)

Part one presents the case for school-based mental health services in terms of low utilization of community-based clinics and the high dropout rate among adolescents attending clinics. Part two discusses lessons learned from delivering psychotherapy services in mainstream and special schools to tackle mental health problems presented by troubled pupils. (BF)