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Paper

Intensive home visiting programme for multiproblem families. Back-ground and implementation of effectiveness study

abstract

Background. Many of the treatments available for multiproblem families have never been properly evaluated in the Netherlands, and thus non-evaluated treatments continue to dominate the field. The present study focuses on an intensive home-based treatment for multiproblem families with children aged 4 to 18. Intensive home based treatment can be labelled as promising because it incorporates several characteristics that have been shown to increase the effectiveness: it is multi-faceted, intensive, strength-based treatment and the services are delivered to families in their own homes. Indeed, recent meta-analysis of home visiting programs in the USA showed that parents received benefit from home visits in terms of their parenting attitudes and behaviour and children in families who were enrolled in home visiting programs fared better than did control group children (Sweet & Appelbaum, 2004). It must be pointed out, however, that there are many differences between the USA and The Netherlands in organization of mental health services, availability of different treatments, type of clients etc., so the question remains whether these positive results will be obtained. Although there has been some evaluation of similar interventions in The Netherlands, the poor quality of most studies' designs does not allow reliable and valid conclusions about effectiveness of these interventions.

Our presentation is about the Intensive home-based treatment for multiproblem families. It is therefore closely related to the focus of this conference: interventions for vulnerable children and their families. In our poster we will present de results of a pilot study on differences between these families and families from general population. Moreover, we will describe the design of our ongoing study that aims to evaluate the effectiveness of this treatment as well as challenges encountered when implementing this design. We believe that this information is relevant not only for researchers involved in with similar studies, but also for clinical practitioners and policy makers.

 

Purpose of the study. The aims of this project are the following:

-        to examine short and long term effects of Intensive home based treatment on parents (changes in parenting behaviour, family functioning and parent-child relationship) and children (changes in problem behaviour, quality of life, social and academic competence) compared to 'care as usual' as currently executed in the Netherlands;

-        to understand the processes through which the this treatment works by testing the hypothesized mediators of beneficial treatment (parental beliefs, parental confidence, parenting behaviour and parent-child relationship);

-        to understand differential pathways to change by determining circumstances in which intensive home based treatment yield or does not yield beneficial outcomes (family characteristics and treatment characteristics).

 

Method. The present study concerns a randomized clinical trial, including a pretest­posttest control group design, randomized assignment to conditions (treatment vs. control group) and a 6 month follow up. The sample will consist of multiproblem families with children aged 4 to 18 years old. Families will be assigned at random into either treatment group (intensive home based treatment, n = 100) or control group (care as usual, n = 100). Pretest assessment (T1) will take place immediately prior to the beginning of treatment, posttest assessment (T2) will take place immediately after treatment (on average 12 months), and follow up (T3) will be conducted 6 months after the end of treatment.

The identical assessment battery will be administered to both groups at T1, T2, and T3. The assessment includes multi methods (interviews, questionnaire, observation) and multi sources of information (parent, child, therapist, observer, teacher). Families (in both conditions) will be paid 20 euros for each completed assessment battery. In addition, a two-monthly assessment will take place in IPT group only to investigate mediators. Through telephone interviews that will last about 20-minutes information will be obtained from participants and from the therapist on several central concepts of this study.

 

Key findings and recommendations. This study has started only recently. Therefore no data are available (yet) on effectiveness. In our poster we will present the results of a pilot study in which we investigated differences between multi-problem families and families from the general population. This pilot was conducted in order to test theoretical assumptions of Intensive home based treatment and to identify the main problems those families experience as compared to families from general population. Next, we will present the design of the evaluation study (randomization procedure, times of assessment, concepts that we plan to assess and instruments etc.). Finally, we will describe the challenges and obstacles that we encountered when implementing a randomized clinical trial in clinical practice and offer some suggestions how to overcome them, that might be useful for other researchers involved in such studies.

 

Key references

Clingempeel, W. G. & Hengeler, S. W. (2002). Randomized Clinical Trials, developmental theory, and anti-social youth: Guidelines for research. Development and Psychopathology, 14, 659-711.

Kazdin, A. E., & Nock, M. K. (2003). Delineating mechanisms of change in child and adolescent therapy: methodological issues and research recommendations. Journal of Child Psychology and Psychiatry and Allied Disciplines, 44, 1116-1129.

Sweet, M.A., & Appelbaum, M.L.(2004). Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child-Development, 75, 1435-1456.

 

Contacts: Denise Bodden, University of Utrecht, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands, E-mail: D.Bodden@uu.nl Phone +31 30-2534744.

 

 

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