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Effectiveness conditions in out-of-home placement of children and adolescents


Background and research goals. Just like any other intervention in a social and clinical setting, even those based on the out-of-home placement of children need to identify increasingly shared instruments of assessment, able to meet both the external demands of social recognition, transparency and visibility, and the internal need of an evaluation of the efficacy of the work itself.

This work presents the principal elements of an extensive research aimed at pointing out the assessment criteria capable of: 1) describing the functioning of residential communities for children; 2) checking their actual capacity to play a reparatory and protective role for their development.

Theoretical framework. The study was based on the ecological theory of Bronfenbrenner (1979) and on the contributions provided by the developmental psychopathology in understanding the developmental outcomes of children from clinical as well as normal populations. Indeed, developmental psychopathology is characterized by the intention to combine mental health and mental illness in a single approach, explaining how the individual and the context work together to produce patterns of adaptive or maladaptive functioning, and relating how such past or present functioning influences the future (Cicchetti & Cohen, 1995).

On the basis of these references, the residential community has been defined as an ecological niche: a setting that may turn out to be particularly favorable (or unfavorable, as is the case with institutionalizing settings) for individual development as a consequence of the synergies between forces deriving from the setting's and the person's characteristics.

Formulating a judgment on the quality of interventions therefore means recognizing and clarifying all the variables involved and that can be set within the four environmental systems described by Bronfenbrenner (micro-, meso-, eso- and macro-system) in order to understand the complex system of relationships that connects the interventions to the resulting outcomes.

Method. Qualitative and quantitative data were gathered in two phases:

-  In the first phase an ad hoc questionnaire was distributed among social workers and professionals working in 80 residential communities and in 45 Social Services, for a total of 570 participants belonging to eight different Italian Regions. The research topics refer to what has been defined as a "meso-system" (the work carried out by the community in relation to contexts concerning children), the "eso-system" (the system of relationships between institutions that decide and plan the out-of-home placement) and the "macro-system" (the socio-cultural context in which the intervention is carried out).

-  In the second phase we analyzed the "micro-system" of residential care in terms of daily organization of activities, relational internal climate and processes of change activated in children. Here too, the questionnaire was formulated ad hoc and distributed to 132 participants (residential staff and adolescents) in 19 residential communities.

Findings. The methodology has permitted the exploration of the points of view of the different subjects involved at different levels in the model: children, front-line workers, social workers. For each of the four levels taken into consideration (micro-, meso-, eso- and macro-system) it was possible to define criteria of quality, some of whom received great evidence of their impact on the whole process of the out-of-home placement.

The first, and indeed one of the preeminent, is the presence within the residential staff of a clear and shared theoretical and methodological approach to the intervention. This macro-system indicator, whatever the theoretical framework is, is not only correlated to a more articulated and rich representation of the professional intervention; but it is also associated to a better inter-institutional functioning (eso-system level), to higher work satisfaction for the staff, and to evaluation of better outcomes for children in care. This criteria is seldom fulfilled in the investigated sample (2 residential staff out of 3 have no theoretical orientation that drives the work).

Moreover, our data show that a clear and shared theoretical approach is associated with the participation of the entire staff to a frequent supervision.

Clear recommendations for policy managers and professionals emerge from these evidences: the quality of residential care and the probability of a good functioning of the whole process of out-of-home placements lies on an explicit and shared theory of change and intervention as well as a supervision on regular base.

With reference to micro-system level, the results corroborate the hypothesis according to which the relational climate in a community is a good predictor of the efficacy of residential care; as a matter of fact, adolescents' perception of the community's relational climate is closely associated with the effects of the intervention.

Finally, the results indicate that the quality of residential care is related to the capacity of its professionals to understand and operate coordinately in all the four environmental systems. In particular, the reflexive and auto-reflexive capacity that the social workers have in relation to each of the four levels is a favorable prognostic element of the quality of the interventions.

Conclusions. The ecological model assesses the multidimensional quality of residential care, where multidimensionality does not simply assume a descriptive function of different structural and procedural aspects of the service (unlike what happens in authorization, credit and certification systems), but points towards the interdependence of the systems (according to the Lewinian notion of interdependency) in the search for relationships between parties. Moreover, this work is an example of theory-driven evaluation (Chen, 1990), where topics and methods of assessment derive from an explicit theory or model of how the evaluated program causes the intended or observed outcomes. This is an essential condition if we really want to refine our understanding of risk and protective mechanisms that act in out-of-home placements, helping workers to identify and adopt best practices.

Key references

Bronfenbrenner, U. (1979). The ecology of human development. Experiments by nature and design. Cambridge: Harvard University Press.

Chen, H. T. (1990). Theory-driven evaluations. Newbury Park: Sage.

Cicchetti, D., & Cohen, D. J. (Eds.). (1995). Developmental psychopathology. New York: Wiley-Interscience.

Contacts: Laura Palareti, Dipartimento di Psicologia, Università degli Studi di Bologna, viale Berti Pichat, 5. 40100 Bologna, E-mail: laura.palareti2@unibo.it, Phone 051-2091839.



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