Exploring the tension between adherence and cultural fit when delivering Multsystemic Therapy in England

Abstract

Multisystemic Therapy (MST) provides intensive short-term interventions for young people with antisocial behaviour and the systems that surround them. A wealth of research over the past 30 years has demonstrated the efficacy of MST. Its success has led to it being transported to many countries and this prompted investigations into the need for cultural adaptation. Despite these investigations highlighting the importance of tailoring MST to new countries, when MST was transported to England in 2001, it did not undergo a formal process of cultural tailoring. This study employed a qualitative approach using a Grounded Theory methodology to explore the assumption that all transported programmes require a level of adaptation and aimed to identify the processes and rationale behind informal ‘cultural tailoring’ undertaken by therapists. It aimed to explore areas in MST that might benefit from ‘cultural tailoring’ to improve the effectiveness of its implementation in England. Eight MST therapists from across three MST teams in England participated in semi-structured interviews. Analysis of the data generated a theoretical model of adherence: the Post Implementation Model of Adherence (PIMA). The PIMA model seeks to explain how therapists in England experience and manage adhering to MST. It proposes that MST therapists strive to adhere to all aspects of the MST model whilst ensuring that it is acceptable and workable for the families and systems they work with. The PIMA model comprised four theoretical codes: Facilitators to therapists staying faithful to the MST model; barriers to therapists implementing MST, overcoming barriers to implementing MST; and the therapist holding the tension. The findings highlight important cultural adjustments to improve MST’s ‘fit’ in England. Findings also extend Schoenwald’s (2008) recommendations for successful transportation of MST, by drawing attention to how a lack of cultural tailoring can be overcome or experienced as stressful by therapists.