Paper
Process-outcome research with severe troubled children and their families in Flanders: pleading for a mixed-method model
- issue: Issue 3 / 2008
- authors: Bert Van Puyenbroeck, Gerrit Loots, Hans Grietens, Wolfgang Jacquet
- keywords: Brussel, care, youth, process-outcome
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- downloaded: 0
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abstract
Background. In this paper we give a brief overview of the outcome results of the Flemish research project (Loots, G. et al 2006; Van Puyenbroeck, H. et al 2007). Both the reached target group as the outcome results of the families first program are presented. A concept of process-outcome research is presented. The main focus of this paper is put on dealing with some methodological challenges in the development of a mixed-method evaluation design for doing research with severely troubled children and their families.
Intensive Family Preservation programs are becoming wide spread in Europe. The introduction of the Families First (Homebuilders) Program in Flanders as an intensive treatment alternative for troubled and troublesome children and their families put forward the need for a profound evidence-based research project in order to develop a solid base to implement the program in the Flemish region.
Purpose. The purpose of the present study was to examine the outcomes of the intervention of the Homebuilders program in Flanders in families were the child is at imminent risk of out home placement. Loyal to the original the Homebuilders' philosophy to keep children safe, strengthen families, and reduce the need for placing children into state-funded care the aim of building new perspectives for and together with the family members in order to stay together as a family was put forward as the 'core mission' of the family intervention program.
It is a quantitative study: as a pretest-posttest-follow up design this research project focused on four parenting domains: (1) the interaction between parent and child, as assessed by both parent and child, (2) social support as experienced by the parent, (3) family stress, and (4) strengths and difficulties of the child, as assessed by both child and parent.
We gathered data at start up moment (T1), at the end of intervention (T2) and at follow up one month after the end of the intervention (T3) from all the 146 families that received crisis intervention in the period between October 1st 2004 and September 30th 2005. The following instruments were used: NQCS questionnaire (Family Stress & Coping), SDQ questionnaire (Strengths and Difficulties of the child), the PACHIQ-R questionnaire (Parent-Child Interaction).
Target population. As an intensive family preservation service in Flanders, Crisishulp aan Huis aims to help families where a child is at imminent risk of placement. As soon as the program starts, immediately after referral, the family can reach an appointed family worker 24 hours a day. Family members have in average 10 hours of face to face contact with the family worker. The program provides in the training of problem solving and conflict managing skills as well as practical support.
Key findings and recommendations. Considering the question on parental stress there are some remarkable evolutions. Parents indicate that they feel more resilient in dealing with the family situation at follow up (Z=-2.93, p= .002, Wilcoxon signed rank test). They experience less parental problems at the end of intervention (Z=-2.73, p= .003). At the end of intervention (Z=-2.03, p= .022) parents indicate they are experiencing more fun in their parenting role. The parents' global appraisal of the child-rearing situation at the start of the IFPS intervention is considered negative and hopeless (μ = 6.54). Compared to the start up moment there is a significant difference at the end of the intervention (Z=-4.39, p= .000).
Considering the minor's strengths and difficulties, in the view of the parents there is a significant improvement during the intervention (Z= -2.296, p= .022) and at follow up (Z=-2.290, p= .022) on the subscale of emotional symptoms. Considering the minors' view, at follow up they indicate a significant change on the conduct problems subscale (Z=- 2.32, p= .020).
Considering the parents' view on the parent-child interaction in their family, they indicate a significant change on the acceptance subscale both during the intervention (Z=-3.185, p= .001) and during the post-intervention period (Z= -2.789, p= .005).
At research level, the study highlights the need for more research, focusing on 'what do family workers do in these families, and how do they make it work': what kind of helping processes are responsible for the outcomes of the crisis intervention. To find out what works we should have the opportunity to take a look on what is happening during an IFPS intervention that is helpful for these families and thus gain a profound understanding of the way in which clients and family worker work together to make it helpful. Which specific factors are most responsible for treatment success still is not very clear. In that view, the growing interest in evaluative research is in need of a more qualitative focus: what works in IFPS and how do family workers make it work? Qualitative research can provide more in-depth information about these families receiving IFP services, the conditions associated with change, the techniques used by therapists, and essentially the dynamics in the process of helping and the relationship of the therapists with these families.
Key references
Fraser, M., Pecora, P., & Haapala, D. (1991). Families in Crisis. The Impact of Intensive Family Preservation Services. New York: Aldine de Gruyter.
Loots, G., Van Puyenbroeck, H., Grietens, H., & Jacquet, W. (2006). Crisishulp aan Huis in Vlaanderen. Rapportering van een uitkomstonderzoek. Brussel: Vrije Universiteit Brussel.
Van Puyenbroeck, H., Loots, G., Grietens, H & Jacquet, W. (2007). Crisishulp aan Huis Vlaanderen: een uitkomstonderzoek. Tijdschrift voor Orthopedagogiek, 46 (2007), 78-89.
http://www.institutefamily.org/
Contacts: Bert Van Puyenbroeck, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussel, E-mail: hvpuyenb@vub.ac.be, Phone +32 494 700 727.