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Multidimensional family therapy - helping adolescents with behavioural difficulties and their families

"In the face of any difficulties, it is important to believe, to trust, and change is always possible", say the practitioners of the unique Multidimensional Family Therapy (MDFT) Programme in Lithuania. The State Child Rights Protection and Adoption Service, in cooperation with the Ministry of Social Security and Labour and the Norwegian Association of Local and Regional Authorities has been implementing the programme for more than two years, thanks to the European Economic Area (EEA) Financial Mechanism. During this period, 199 Lithuanian families have been and are still being worked with, and more than 90 families have been able to achieve positive changes.
The MDFT programme, developed in the United States more than 50 years ago, is designed to help children and young people who are experiencing extraordinary behavioural challenges, such as truancy, delinquency, substance abuse, suicidal or suicidal behaviour, or aggressive behaviour.
Significant changes for the "inconvenient"
"Unaddressed problems are only getting worse. That's why it's so important to seek professional help when traditional parenting methods are not enough. For families facing extraordinary difficulties, family therapists are there to help. They help to understand the causes of the problems more clearly, to overcome them more effectively and to return to normal life rhythm more quickly," says Sandra Remeikienė, Head of the European Economic Area and Norway Programme Unit at the Central Project Management Agency (CPVA).
MDFT services in Lithuania are currently offered by teams in Vilnius, Kaunas and Klaipėda and in regions around 100 km around these cities. There are 6 coordinators and 17 specialists in total. The services are provided free of charge to children and young people aged 11 to 17 years, within the framework of the project "Multidimensional Approach to Children and Youth Behavioural Problems through Implementation of the MDFT Programme", funded by the EEA financial mechanism Health Programme, with a budget of more than EUR 1 million. The project is supervised by the CPVA.
"The Multidimensional Family Therapy programme is creating significant change for children and young people who are often written off in society as "uncomfortable", "unwanted", "bad". The programme enables children, their families and the whole environment to discover the reasons that lead to such risky, aggressive behaviour and to change this behaviour together, changing not only the child but also the whole environment. This programme is a good example of how many children and young people who we want to see as having "gone down the wrong path" actually want to be heard, accepted unconditionally, loved and helped because of the difficult life events they have experienced," says Monika Navickienė, Minister of Social Security and Labour.
According to the Minister, this programme is a concrete tool that allows us to provide real help in cases that often seem hopeless, and to protect children from social exclusion and the deepening of their challenges. The Ministry of Social Security and Labour therefore plans to continue the implementation of this programme.
Working not only with the child, but also with the whole environment
Families experiencing the difficulties identified, as well as professionals working with children and families (case managers, social workers, social educators, etc.), can be referred to the MDFT specialists who will assess whether they are able to help in their particular case.
"Each time, we assess whether our programme is the most appropriate in one or another situation. Family therapy cannot always help. If we see that a child is sexually abused or at high risk of suicide, if a child is deeply depressed and needs medication, or if basic needs need to be taken care of first, for example, because the child does not have adequate sleeping conditions, then we will refer them to more appropriate professionals," says Nika Panavė, the project leader.
During the two-year period, 199 families were worked with, while a further 180 families were either referred to other professionals or stopped working themselves. The reasons for discontinuing therapy are varied: families emigrate, experience bereavement, lack of motivation, the child is placed in institutional care, etc. Currently, 111 families are waiting in line.
The MDFT programme is distinguished by the fact that it works not only with the child, but also with the whole environment that influences the child's behaviour or where he/she faces challenges: family, school, community.
"The programme introduces the attitude that it is not the child who has the problem, but we as a family who have the problem and we are all equally responsible for improving family relationships. Parents usually come to us with the attitude that they need to 'fix' the child, but change has to happen in the whole family before we can achieve results. We work on four levels - individually with the child, individually with the parents, together with the whole family, and also with the child's other close environment", says Panavė.
The work is coherent and highly structured. A lot of work is done before the family meeting and after the sessions. The programme focuses not on the family's difficulties, but rather on what the family is doing well and where its strengths lie, what the family can do rather than what it cannot do.
Goals help to bring positive change
To achieve change, we need to measure change. It is equally important that the goals are logical and achievable. We cannot expect, for example, that after five years of regular use of psychotropic substances, a teenager will suddenly be fine.
"We aim for behavioural change gradually. For example, a child has been out of school for a year. In this situation, we could set a target of the child attending more than 50% of his/her lessons within six months. And in the sessions, we analyse the reasons why the child is absent - whether it's a bullying problem, maybe the teaching is not in line with the young person's development, sometimes it's a problem with one teacher. Often it happens that children prefer to attend a vocational school. So changing schools can be a solution", says Panavė.
It is also important to agree on appropriate ways of communicating within the family - to learn to listen to each other, to express our needs, to respect each other's opinions, to manage our emotions, and to avoid blaming each other. According to Panavė, it is important for the family to agree on who is responsible for what and where the boundaries lie. Once there is agreement, it is important to go back, evaluate and discuss.
"It happens, for example, that a child belongs to a group involved in criminal activities, and we notice that the family does not spend time together at all. Then one of the goals could be to spend more time together. In many cases, when the family comes together, the situation starts to change", shares the project leader.
Consultations does not have to be in a specialist's office
Every family is unique and the time it takes to achieve positive change varies. However, according to Panavė, most of the time, families participating in the programme work for up to half a year. In exceptional cases, up to 8 months, if it is seen that there is very little to change, or if the work has been interrupted for important reasons during the course of the project.
Professionals aim to adapt to the family's needs as much as possible: organising meetings according to the family's needs, availability and timing, choosing meeting places that are convenient for the family, always being available and responding quickly when needed.
"Consultations do not have to take place in a specialist's office. Often the meeting places are informal. Sometimes we talk to the family in the car, have a coffee together or go for a walk. Sometimes we spend time with young people on the basketball court or even at the beach, because the most important thing is to connect with the young person," says N. Panavė.
More about the Health Programme
The European Economic Area Financial Mechanism Health Programme projects in Lithuania aim to strengthen mental health services in communities and improve the well-being of children and young people. The programme's various measures include the development of psychosocial support, youth-friendly health services, support for vulnerable children and young people, the establishment of one-stop help centres for children and families, training for parents under the 'Incredible Years' programme, cooperation between families and health professionals, and the development of services and support for pregnant women, mothers in labour, and mothers of children up to the age of two. In total, more than €17.9 million has been earmarked for the Health Programme for 2014-2021.
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