Evaluating Service Provision for Physical Abuse and Neglect in England and Wales: Feasibility of a Pilot Multisystemic Therapy Trial

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) is an intensive, trauma informed intervention for families where children are at risk due to physical abuse or neglect. Adapted from MST, which targets antisocial youth, MST-CAN offers a broader, systemic approach addressing both child and caregiver needs. This mixed-methods pre-pilot study explored the feasibility of conducting a randomised controlled trial (RCT) of MST-CAN in England and Wales. An online survey mapped the availability of ‘service as usual’, the existing statutory and commissioned children's social care provision for physical abuse and neglect, across England and Wales, revealing significant variation and limited access to MST-CAN (3% of local authorities). While many services aimed to be family-focused, provision was often fragmented and constrained by resources. Semi-structured interviews with senior and frontline professionals highlighted challenges, including inconsistent multi-agency coordination and uneven access to evidence-based, trauma-informed interventions. Qualitative analysis identified six key themes, including clear distinctions between MST and MST-CAN, the diversity of current interventions, and the importance of relational, flexible practice. Findings indicate that MST-CAN offers a more integrated and consistent model than typical provision. The study concludes that a pilot RCT is feasible and recommends a small-scale internal pilot with process evaluation to assess implementation, acceptability and inform progression to a definitive trial.