1 Introduction

There is an over-representation of racially marginalised young people in the criminal justice system (CJS) of England and Wales (Ministry of Justice; MoJ 2021), accounting for 51% of people in youth offending institutions in 2019 (MoJ 2021), despite reflecting 14% of the general population of 15–21 year olds. They are more likely to have endured socio-economic disadvantage and adverse childhood experiences associated with poor engagement in education or training and subsequent involvement in criminal behaviour (Junger-Tas 2001). Despite showing higher levels of need than White counterparts, racially marginalised young people are less likely to seek, access and engage in therapeutic support (O'Brien et al. 2009), perpetuating poor engagement with mental health services in racially marginalised communities (Delphin-Rittmon et al. 2015; Maura and Weisman de Mamani 2017). There is an obligation to better evidence the ability of psychosocial interventions to meet the cultural needs of these families and young people, for whom therapeutic intervention might alter life chances and trajectories.

One such intervention is Multisystemic Therapy (MST), a family and community-based treatment designed to reduce out-of-home placements for 11–17-year-olds considered ‘at risk’ of care or custody due to antisocial and/or aggressive behaviour (Henggeler et al. 2009). MST therapists are based in small teams, with a supervisor and a consultant, and work intensively for 3 to 5 months with the systems around the young person, primarily the caregivers. The aim is to empower them to support and reduce antisocial and/or aggressive behaviours—and the factors maintaining such—across settings. There are claims that MST meets the needs of culturally diverse groups based on research demonstrating effectiveness in trials with relatively high proportions of racially marginalised participants (Butler et al. 2011; Painter and Scannapieco 2009), and no moderating impacts of ethnicity on MST (Johnides et al. 2017). However, a meta-analysis (van der Stouwe et al. 2014) indicated MST was more effective for White, compared to racially marginalised, young people, a finding that was perhaps masked by the smaller sample sizes of the individual studies.

Two qualitative studies (Bunting et al. 2021; Fox et al. 2017) suggested that cultural considerations are needed in the successful delivery of MST, specifically in the referral behaviours, families feeling culturally understood by a respectful therapist, and having a therapist ‘cultural broker’ to contextualise the young person's behaviour within the dominant culture. Support for the young person to develop their own unique cultural identity is also important (Bunting et al. 2021). However, both studies sampled young people and caregivers who were either born or had resided in the UK for at least 10 years and excluded non-English speaking families, treatment non-completers (Fox et al. 2017) and young people in out-of-home placements or at risk to self or others (Bunting et al. 2021). Therefore, the acculturation experiences of those samples might not be reflective of racially marginalised families who experience difficulties in MST.

Racially marginalised people have difficulty accessing or are not referred to general mental health services (Cooper et al. 2013) due to poor awareness of the help available (Messent and Murrell 2003) or bias related to perceived language proficiency or level of cooperation (Betancourt et al. 2005). There are limited data related to the engagement of racially marginalised people in MST, other than that Black and Hispanic families in the United States were significantly more likely to experience negative case closure status (e.g., lack of engagement or further offending) than White/Non-Hispanic and Multiracial groups (Boxer 2011). However, the study sampled families who were referred to and began MST, so possibly not reflective of those who did not engage in MST.

Language and acculturation are also relevant to MST engagement and change. One study found no differences in MST outcomes between Dutch (Netherlands) native and non-native speaking families on employment and recidivism when using interpreters (van der Rijken et al. 2016), in contrast to the well-known difficulties of working with interpreters in mental healthcare (e.g., Bauer and Alegría 2010; Raval and Tribe 2014). Outcomes with family members as interpreters were not so different from professionals, thought to relate to leveraging dual roles in supporting the family (Ho 2008). However, little is known about how interpreters are used in MST (van der Rijken et al. 2016).

The current study sought to understand more about engagement and treatment challenges facing racially marginalised families in MST in England. In recognition of challenges in accessing families who did not complete MST and the challenges with interpreters, the accounts of MST practitioners were explored. This supported an understanding of families who had contact with MST but did not proceed to full engagement, who overcame challenges and completed MST, and the unique perspectives of practitioners to explore interpreter working (Raval 2003). Diversity in ethnicity of MST practitioners (therapists and supervisors) was sought, to facilitate empowerment of voice, nuanced understandings of engagement and treatment challenges faced by racially marginalised families and addressing a limitation of existing research with predominantly White therapists. The research aimed to explore the factors related to engagement and change for racially marginalised families using MST, including those referred to as ‘hard to reach’ (Begum 2006), meaning non-English speaking and who experience difficulties in engagement and treatment.

2 Method

2.1 Design and Ethics

A grounded theory methodology (Charmaz 2006) was used. Focus groups were used to encourage reflection on how racial privilege shapes reality (Laszloffy and Hardy 2000) and for participants with limited awareness, knowledge, or training to be able to add to and deliberate on points made by others (Barbour and Morgan 2017).

Ethical approval was granted from Royal Holloway, University of London. Research Ethics Committee and local approval were received from each of the research sites.

2.2 Recruitment and Participants

A purposive and theoretical sampling strategy was used. Ethnically diverse MST teams were targeted to address existing limitations in the literature (i.e., samples that consist of mostly White therapists), break down power disparities based on race in the focus groups, and to support the ethos of the research as empowering ethnic minority voices. The second author is an MST Consultant and liaised with teams across the UK to identify relevant research sites (i.e., teams delivering MST who had experience of working with ethnically diverse families, including non-English speaking families). Once appropriate teams were identified, MST site supervisors were contacted and asked to inform therapists of the research and invitation to participate.

Given debate as to whether data saturation should be considered ‘a goal or a reality’ (Willig 2013, 37), ‘theoretical sufficiency’ was adopted in the current study (Dey 1999). To achieve theoretical sufficiency, categories explain the data sufficiently but are not forced into predetermined categories, making it better suited to grounded theory (Charmaz 2006; Dey 1999).

A total of 22 MST therapists and supervisors were recruited from sites across three geographical regions of England (the Midlands, Greater London and the North-West). Demographic information is provided in Table 1. London is the most ethnically and religiously diverse region in England and is followed by the Midlands as having the highest proportion of people who identified as Asian, Black or Mixed ethnicity; the Midlands has the highest proportion of people describing their religion as Sikh, and many people identifying as Christian (Office for National Statistics 2022). The North-West has a high proportion of people who identify as being in the Pakistani ethnic group and Muslim (Office for National Statistics 2022). Participants reflected the diversity of the geographical regions sampled, including representation of British/South Asian ethnicity.

2.3 Materials

The focus group guide was informed by literature. Prompts were non-judgmental and open-ended to support authentic participant stories (Charmaz 2006). As a credibility check (Elliott et al. 1999), the guide was reviewed with a racially marginalised caregiver with limited English who had completed MST. A partial level of facilitator moderation was used to guide the discussion.

2.4 Procedure

In advance of focus groups, the broad topic was provided to consenting practitioners to maximise the value of time spent together (McLeod 2011). Seven focus groups took place at team bases, each ranging from two to five participants, lasting around 75 min, audio-recorded and transcribed verbatim.

2.5 Analytic Approach

Charmaz's (2006) social constructionist version of Grounded Theory was selected as most suitable in demonstrating separation from existing accounts and ideas. Understanding of therapeutic processes embedded within a Western cultural framework has the potential to overlook or misrepresent the experiences of racially marginalised families. This is truer still for non-English speakers or those that experience difficulties in engagement and treatment. Charmaz's (2006) grounded theory facilitates reflection of the researcher's imprint, as well as considering the layered realities of each involved stakeholder, from supervisor, therapist, interpreter, caregiver, to young person. Relatedly, systemic therapy, aligned with social constructionist principles, highlights the role of power across systems.

Initial coding was used to break data into line-by-line segments using gerunds to ensure the analysis remained data driven (Charmaz 2006). The most frequent or significant initial codes were used to synthesise and explain larger segments of data (focused codes), before concepts emerged. Only data relevant to culture, ethnicity or race were taken forward. Comparisons of codes, concepts and cases prompted revision of previous data and emerging ideas.

All transcripts were coded by the first author. One focus group transcript was independently coded by all authors, with substantial agreement obtained. The second and third authors provided a credibility check by reviewing the theoretical codes and model, providing feedback on coherence, clarity and language.

A participant and an MST service user were consulted regarding theoretical codes, who agreed that the themes broadly reflected their experience. Strauss and Corbin (1998) note that the final model may not fit a participant's experience perfectly but should be recognisable and applicable.

2.6 Reflexivity

The first author is British South Asian, a second-generation immigrant from the north of England. The project development was largely informed by the author's experiences growing up. Understanding the mental health and relational impacts of being caught between two, often deeply opposing, cultures held personal resonance for the first author. Similarly, watching many young Pakistani and Bangladeshi men in the local community embark on a path towards criminality and poor mental health evoked a strong emotional tie to the work. The author's experiences relating to social justice, culture and identity informed the research. This position was considered periodically, and a critical lens adopted by the second and third authors was particularly helpful in managing the research process. The second and third authors are White British, living in regions of England with diverse populations, and cognisant of ethnic minority disproportionality in the criminal justice system and some of the challenges experienced in accessing psychologically informed interventions. The authors did not aim to engage in a hermeneutic process of making sense of participant experiences of working with racially marginalised families but were open to and engaged with discussions about culture and identity and were mindful of problems relating to cross-cultural applications of Western therapeutic modalities. Throughout the research process, the authors sought to be mindful of their own positions and how this might impact on the analysis and interpretation of the data.

3 Results

Ten theoretical codes were generated, composed of focused and initial codes (See Table 2). The grounded theory model of factors influences engagement and change for racially marginalised families, from the perspective of MST practitioners, is presented in Figure 1. The processes of engagement and change were not distinct, as the theoretical codes that emerged (with the exception of access) were relevant to both processes. Engagement formed the basis from which to build change, but the relationship was interdependent and bidirectional such that work in treatment could strengthen or weaken engagement.

‘Accessing MST’, ‘the family's relationship to help’ and ‘building a therapeutic relationship’ appeared to be instrumental in providing the foundations of engagement upon entering and starting treatment. Dependent on this foundation and once in treatment, conceptualising: ‘the family structure and functioning’, ‘identity and acculturation’, and ‘the disempowered family context’, emerged as important considerations. These factors constituted the content and challenges of the work undertaken by the therapist acting as a ‘cultural broker’, and the process of change was initiated, dependent on active engagement. The reciprocal processes in the centre included conceptualisation of the disempowered family context underpinning attempts to ‘empower the family’ system. For non-English speaking families, considerations of power and language in ‘working with interpreters’ were needed to determine progress. The data showed that the family's relationship to help and the therapeutic relationship served as the backdrop to effective engagement and change.

There are similarities with grounded theories modelling second-generation young people's (Bunting et al. 2021) and racially marginalised caregiver (Fox et al. 2017) perspectives on MST. Specifically, families feeling culturally understood by a respectful therapist, having a therapist ‘cultural broker’ to contextualise the young person's behaviour within the dominant culture and support the young person to develop their own unique cultural identity. Only material that extends previous research is presented in detail here.

3.1 Access

Participants recognised that racially marginalised families were under-represented in MST UK services—‘not getting the referrals in the first place’ (pt. 21, group 7)—and this might be ‘how social care perceives the families … they don't see them as fitting’ (pt. 14, group 5). Building relationships and connections in a local community overcame a challenge of poor accessibility and led to an increase in referrals.

3.2 The Family's Relationship to Help

Systemic racism seemed to impact on racially marginalised families throughout their experience of MST, to the extent that families were referred to as ‘anti-professional’ (pt. 17, group 6). Practitioners described families feeling ‘let down by the system’ (pt. 11, group 4) and a longstanding hostility with the police and social services. This lack of trust was considered instrumental in racially marginalised families' reluctance to share information and fully engage in the process:

I remember when we were doing a genogram and exploring family members, it was like ‘well why do you need to know about that family member, why do you need to know about aunt and uncle…and where they live and that sort of thing’, they see it as quite intrusive […] why do you need to know about x, y and z’ (pt. 2, group 1)

Therapist ethnicity was also reflected upon with reference to engagement: ‘She's quite angry with her mum for working with White people … she sees White people as being like part of the system … they're her teachers … they're her social workers, and they're the police […] “like, why are you bringing these White people to our house?”’ (pt. 16, group 6).

There was a sense that help seeking attitudes within communities were shaped by cultural values for privacy which conflicted with the approach of MST; for some practitioners, home visits were stigmatising and MST was intrusive.

3.3 Building a Therapeutic Alliance

The focus on engagement in MST—‘doing whatever it takes’—readily led to consideration of culture and the importance of being attuned and responsive to a lack of trust in the system: ‘…it took us a good 12 weeks to get through the door … and I think because of the therapist's determination and real consideration of the family's background […] other services would have given up’ (pt. 22, group 7).

Therapists thought that ethnic similarity with families supported stronger rapport through mutual understanding and respect. Many recognised that families thought therapists from a different background could not understand their experience. Conversely, there was acknowledgement that difference could support a curious approach ‘without assumed knowledge’ (pt. 16, group 6), mitigated judgement according to cultural standards, and avoided aligning with the young person or parents. In mixed-race families, one ethnic minority therapist reflected: ‘I really did feel that it changed the dynamics of the relationship when [White] Mum was there. Whether she thought … that it was a threat or felt judged because of feeling excluded somehow from that aspect of her family, and especially when you're talking about issues around culture’ (pt. 7, group 3).

3.4 Family Structure and Functioning

Traditional family structures—fathers responsible for decision making and mothers for parenting, authoritarian, strict expectations of their child—challenged alignment of parents in the MST model: ‘Mum actively said “I'm not British … and wanted to get across that ‘I'm not British and you're trying to make me sort of, pamper him” so, there was a clear jarring …’ (pt. 4, group 2).

Practitioners found that parents referred to their own upbringing, creating a generational and cultural divide, described as ‘a mirror in some ways [to] what the young person is dealing with’ (pt. 13, group 4). Parents seem to experience threat to their cultural identity:

Mum was really angry about the system in the UK […] and she said, ‘my mum was able to’ … essentially referring to physical chastisement…’ but I can't do anything here, I don't have any power, I can't do anything, I can't do anything….the system will take the child's point of view and I'll get in trouble’…” (pt. 4, group 2)

Participants described finding it difficult to tread the line between respecting culture and implementing change: ‘We end up at loggerheads… it's like you just get stuck and they're like “no, that's not how our family works, we're not doing that”…’ (pt. 8, group 3). Therapists were also mindful of privacy, shame and secrecy as challenges to engagement, located with the stigma of working with professionals.

3.5 Acculturation and Identity

Often linked to the referral behaviours, practitioners found that differences in acculturation between parents and young people led to family conflict. Behaviours considered culturally unacceptable, such as using alcohol and drugs left parents feeling ashamed and resentful. Conversely, young people appeared angry and embarrassed by their parents: ‘… if the parent is non-English speaking … in meetings … young people will sit there and look furious with their parents, or … they might find it funny that their parents don't seem to understand things or can't communicate with social workers or teachers’ (pt. 1, group 1).

Participants also spoke about young people as ‘torn’ (pt. 17, group 6), having to ‘negotiate’ (pt. 3, group 2), something many Black and Asian therapists could identify with. Some queried whether struggles with identity led young people to become involved in gangs.

For some mixed-race families, the young person's identity was inherently linked to the family context and the therapist's ethnicity intersected with this dynamic:

[The] girl was mixed race, but she was in a totally White family, and this issue came up around hair and hair products, because the kids had Afro-Caribbean hair … and it was funny the dynamics with Mum and the Grandparents with me, thinking that I sort of … knew best kinda thing, but in a bad way. They were like ‘it shouldn't really matter about hair types … that doesn't matter to us, we don't see that as an issue’” (pt. 7, group 3)

3.6 The Disempowered Family Context

In addition to shaping the family's relationship to help, systemic racism impacted the young person, and led to a sense of disillusionment, with change seeming futile, ‘they're damned if they do and damned if they don't’ (pt. 15, group 5): ‘The police targeted that kid more than any other kid I've ever worked with … We don't know how that's impacted that young person’ (pt. 3, group 2).

3.7 Working as a Cultural Broker

Facilitating conversations about the acculturation issues causing tension in the family was important, including the young person in sessions and promoting understanding between parents of differing ethnicities:

[Dad] considered himself a Kurd, and he'd faced quite a lot of racism in his life … and I think the best thing he got out of MST … was being able to converse better with his wife who was White British, about those issues … and how they affected him in terms of his parenting. (pt. 20, group 7)

Taking a neutral position alongside the family was sometimes helpful in overcoming value differences. Therapists used research and outcome measures to show improvement to parents, and reported working within the frame of the family's culture:

It was about not discounting her parenting style and those traditions but trying to adapt them […] she would say … ‘he's not respecting me, no respect’ … he wouldn't do what Mum would ask straight away. There would be a little argument … they would clash … then a couple of minutes later he would, and I called it ‘delayed respect’, ‘see, look he's showing.

you delayed respect’, and she and him really latched on to this term’” (pt. 10, group 4).

3.8 Empowering Families

Participants empowered families by helping them to have a voice and communicate effectively and linking with other professionals where needed: ‘how the social care system works, how services work in the UK and what services were available … helping them to understand what meeting they were expected to attend … what they should do to prepare’ (pt. 2, group 1). However, poor trust and fear undermined families' willingness to use the police system: ‘Mum wouldn't call the police when the child was going missing … She was giving me all these experiences, saying like, “we are not English, they will do nothing for us”’ (pt. 19, group 6). Challenge of oppressive practice was also short-lived: ‘it was amazing how the headteacher changed his perspective when I was there … but as soon as I wasn't there it reverted back so, you know, what power do you have in that situation?’ (pt. 5).

3.9 Acculturation Differences for Language Minorities

Some participants reflected on power imbalance; fathers spoke English, translated, and held power, whereas active parenting mothers did not. Therapists found themselves inadvertently aligning with and relying on the English-speaking parent, excluding the non-English speaking parent. It was difficult to engage involved parents with a language barrier:

Getting a translator out during the day to work with Mum, then hoping Mum would pass on that message [to Dad] didn't really happen … because there was a big power imbalance as well […] so even though we were working with Mum and trying to get through to Mum, we kind of couldn't get there. (pt. 8, group 3)

3.10 Working With Interpreters

Sessions in the family home with an interpreter created unhelpful dynamics, with families feeling judged. For example, ‘it was a male … interpreter and the mum and older sister felt they were being talked down to’ (pt. 5, group 2) and ‘families can be quite anxious because they may know them from their community’ (pt.9, group 4) highlight the gendered and close community considerations in managing shame. However, the responsivity of MST (managing crisis situations, sessions at short notice) meant that interpreters were often unavailable. Family members translated but participants were mindful of conflicts of interest and safeguarding concerns were challenging to address in this context. However, therapists thought that using a family member to interpret under the right circumstances was helpful:

the daughter translated […] She was raised British, so she understood culturally where we were coming from, but she also knows what her culture is saying and can see it that way too … she understood where her parents were coming from (pt. 7, group 3)

4 Discussion

This research aimed to explore practitioner (therapist and supervisor) perspectives on factors related to MST engagement and change for racially marginalised families in England. Across the 10 theoretical codes, there were similarities with grounded theories modelling second-generation young people's (Bunting et al. 2021) and racially marginalised caregivers' (Fox et al. 2017) perspectives on MST, but the perspectives from practitioners extended the understanding.

4.1 The Context: Structural Inequality and the Family's Relationship to Help

Bias among professionals able to refer families to MST was identified as a potential barrier to access. This is in line with racial disparities in the identification and offer of mental health support for young offenders (Spinney et al. 2016), with mental health concerns less likely to be recognised among Black youth (Dalton 2009), and delinquent and criminal behaviour among racially marginalised young people considered not amenable to intervention (Mansion and Chassin 2016). Lack of access adds to the disadvantage already experienced by racially marginalised young people (and caregivers), and increases developmental risk (Baglivio and Epps 2016), perpetuating a cycle of health inequality.

Cultural mistrust and systemic racism were relevant to family engagement in MST, and enhanced fearfulness among families, leaving them unwilling to engage the police or share information (e.g., da Silva Rebelo et al. 2018). The findings are in keeping with Bunting et al. (2021) who identified feelings of societal marginalisation among young people, but the findings here suggest the impacts of systemic racism may be more immediate and profound as considerations for MST. In line with Mulvey (2010), participants noted the importance of being attuned to a lack of trust in the system and sought to empower families to navigate systems and challenge racism, acting as advocates where necessary. However, the findings here highlight the role of MST therapists ‘doing whatever it takes’ to understand, engage and support families, and being mindful of ethnic similarity or difference between therapist and each family to support the building of trust and engagement in MST. Using education, reflection and training for therapists to become skilled in facilitating conversations which help families to situate experiences in the social and historical context may represent opportunity to develop explicit antiracist practices in MST.

4.2 Cultural Differences in Family Structure, Hierarchy, Functioning and Identity

Cultural value differences emerged strongly in this research, but less so in Bunting et al. (2021) and Fox et al. (2017), which might be due their samples including only UK-born individuals or those residing here for at least 10 years, likely to be more accustomed to the individualistic UK culture. Participants reflected on the challenge of balancing respect for the family culture and pushing for change. This represents a wider debate between cultural relativism versus cultural absolutism; the right to be different versus the right to equal protection from harm. Sawrikar and Katz (2014) argue that, to negotiate these poles effectively is to educate staff surrounding the risks attached to each. To lean too far towards cultural absolutism is to be ‘colour blind’ and risks shaming families by seeing problems that can be explained by cultural difference (e.g., perceiving stricter discipline as child maltreatment). Conversely, cultural relativism risks failing to intervene and perpetuating harm as issues are explained away by cultural difference. The precariousness of making these judgements is demonstrated when considering the existing context; many families already feel blamed as a consequence of their involvement with child welfare (Cunningham and Henggeler 1999), whereas others may seek to protect their heritage and cultural identity from attack within a hostile host country (McGoldrick and Hardy 2008).

Similar to Fox et al. (2017) and Bunting et al. (2021), therapist as ‘cultural broker’ was important and, here, thought to mitigate experience of blame. Not limited to the role of contextualising a child's behaviour within UK culture, this study emphasised the importance of working within the frame of the family's culture and being congruent with existing authority structures and role.

4.3 The Power of Language; Family Dynamics and Interpreting Challenges

There were challenges associated with using interpreters, including loss of communication and inaccuracies (e.g., Bauer and Alegría 2010) but also possible barriers to engagement when families perceived judgement from within their culture. Some therapists reported that using family members (other than parents) to interpret could be beneficial to mediate between different cultures and generations, in keeping with research which indicated no difference in outcomes when using a professional or family interpreter in MST (van der Rijken et al. 2016). Nonetheless, concerns were raised about the ethics and risks involved in using young people to interpret, and young people who interpret for their families are known to feel the heavy weight of having to support them to adapt and function within the host community (Morales et al. 2012).

Furthermore, within-family English language proficiency, often with fathers speaking with more fluency than mothers, was thought to add to systemic discord, unhelpful aspects of hierarchy, and negatively impact co-parenting style. There is particular concern about the influence of monolingual therapists embedding power differences within multilingual families, making it difficult for all to partake (Ali 2004). Softas-Nall et al. (2015) suggest that it is vital for monolingual therapists to use interpreters consistently and to discuss the role and purpose of language and multilingualism within the family, including the impacts on therapy. Bilingual or bi-cultural therapists might alleviate some of these challenges, but this is unlikely to be feasible in small MST teams and in areas where people from numerous ethnicities and cultures live (and as reflected in the sampling for this research).

4.4 Limitations and Future Research

MST practitioners self-selected to participate and may have endeavoured to avoid negative judgement around their work or competence. Although it is important to consider the influence of Whiteness—the structural advantage and internalisation of White culture as normative—in silencing racially marginalised participants, the study was able to achieve six ethnically diverse focus groups, which is likely to have reduced power disparities based on race.

A further limitation is the assumption that racially marginalised people are a homogeneous group. Cultural and ethnic variation in England and across the regions sampled in this research is vast; different cultures are subject to different social and political power structures, likely to dictate equally varied responses to MST. However, this study adheres to the view that ethnic minorities in Western societies share a social and political identity (Bhui et al. 2007) that is needed to work towards a common goal of reducing inequality in mental healthcare.

Further quantitative studies are needed to substantiate access and dropout rates among racially marginalised families using MST. To further improve practice, qualitative research would be useful to explore how non-English speaking families engage with MST, and how cultural competence is engaged with in a therapist-supervisor context.

4.5 Implications for Training and Delivery

The model produced from this research should inform implementation and practice at various stages of the family journey through MST. Regarding difficulties accessing MST and the family's relationship to help, the MST UK&I Network partnership can work with their service delivery partners to address barriers to referrals for racially marginalised families. The network partnership has since developed specific training for all teams around working with families from diverse cultural backgrounds. This training considers themes that have been generated around engagement and change. All teams are required to complete this training. An Equality and Diversity working group has also been set up which includes representation from the MST Network Partnership and delivery partners from a range of ethnic backgrounds. This group aims to address and respond to the themes that have been raised in this research with a clear action plan.

5 Conclusion

In using a focus group design to explore the experiences of MST practitioners working with racially marginalised families, this study led to findings highlighting the central roles of power, cultural difference and language in shaping engagement and change. Many of the findings build on MST interventions and practices that are individualised to the needs of a particular family, where the model is attuned to engaging marginalised groups with complex needs. This study embeds cultural detail and specifics about how to work with ethnic minorities within the MST model. Evidencing cultural considerations represents an appropriate middle ground between cultural relativism and cultural absolutism; social and cultural diversity is valued alongside the benefits of universal practices to protect family wellbeing.