• By Dartington SRU
  • Posted on Friday 19th June, 2009

US therapy falls on stony ground in Stockholm

The unsuccessful trial in Scandinavia of an evidence-based intervention imported from the US, has raised questions about transferring programs across national borders. Does it make sense to try to replicate a program developed in a country where the investment in public services is low, in the cities of one of the world’s most extensive welfare states?Presenting at the Campbell Collaboration Colloquium in Oslo, Knut Sundell from the Swedish Board of Health and Welfare, described how a randomized controlled trial of Multisystemic Therapy performed no better than standard arrangements. Based on a socio-ecological model, MST is a family and community based treatment for teenagers with serious conduct problems. It is tailored to the needs of each young person and their family, and makes therapists available around the clock for up to six months. Sundell explained how the two-year follow-up had confirmed their preliminary findings, published last year in the Journal of Family Psychology. MST did not improve behavior any more than the standard services offered by the Swedish state. Although children who received MST improved across a range of indicators, so did those receiving state services. There were no significant differences in anti-social behavior, arrests, drug abuse, mental health or service use between the two groups.  The study drew its participants from Sweden’s three largest cities – Stockholm, Goteborg and Malmo – and one small town, Halmstad. The teenagers had been diagnosed with conduct disorder and their parents were willing to take part. The young people who did not receive MST simply carried on with the services they would have received anyway. Examples included individual counseling and family therapy, mentoring and residential care. Some received no services at all. Sundell and her co-authors put forward a number of explanations for why, for all its research-based credentials, MST failed to have any impact in Sweden. First, it was not delivered exactly as directed. Program fidelity was well below the standard recorded in US studies. The quality of delivery may also have been compromised by the use of an interpreter whose first language was not Swedish. They also drew attention the differences between treatment as usual in Sweden, compared with the US. In Sweden, teenagers are routinely referred to social services without punishment before any court appearance. Also, services delivered in the home are already much more common. The social environment may also have had an effect. Levels of drug abuse, delinquency, poverty and other stressors across the population are lower in Sweden than in the US.However, other evidence-based programs have successfully made the trip to Scandinavia. Researchers have demonstrated the impact of The Incredible Years, Functional Family Therapy and Multidimensional Treatment Foster Care there. A recent study showed that MST itself had a positive effect on teenagers in neighboring Norway. Sundell and company. stress the importance of social context to the work of transporting programs from other countries. See: Sundell K, Hansson K, Lofholm C A, Olsson T, Gustle L H and Kadesjo C, “The Transportability of Multisystemic Therapy to Sweden: Short-Term Results from a Randomized Trial of Conduct-Disordered Youths,” Journal of Family Psychology, 22, 3, pp 550-560 and  Sundell K, Campbell Collaboration Colloquium, “The Transportability of US Evidence-Based Programs to other Social Systems’. May 19 2009, Oslo, Holmekollen Park Hotel.• For more about Multisystemic Therapy’s travels outsuide the US, see for example, $14m for UK pilots of Multisystemic Therapy Services Inc., Making sure the benefits aren’t lost in transit and Therapy passes test but has yet to stand trial

Back to Archives