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Paper

Instrument for divided and shared planning: the experience of the Regional Centre “I Girasoli” of Padua

abstract

Background. The centre "I Girasoli"("Sunflowers") in Padua, is one of the five regional centres involved in the care and the protection of children, young people and their families. The centre was set up thanks to the Region of Veneto, as part of  the regional Action Plan on child abuse and maltreatment. It started in October 2004 and operates as a specialist second level service in response to requests from the social and health services of the area. I Girasoli starts by clarifying the presenting problem and gives time to the involvement of other institutions and services also engaged in the development of children, including infants. The centre works in a micro-planning setting in which each situation can be completely redefined. It works within a stage of intervention that is, "one of the most demanding but least studied" (Zeira et al. 2007).

Purpose. The use of a shared method of evaluation helps the working group to be effective, concentrating on the stages in which there may be particular needs, defined through the use of various diagnostic tools. Interventions can be implemented both for, and with, children and families in difficulties. By May  2007, the centre had already dealt with 137 situations involving children, with a slightly higher prevalence of females (56%), all involving maltreatment, abuse and serious deprivation. Of the 137 notified cases, 80 have been closed.

Tab. 1 - Age at the time of
referral

 

Tab. 2- Typology of requests (At the time of the request for intervention, the cases were classified as follows)

<6 years

36

 

sexual abuse and suspected sexual abuse

56

6-10

44

 

incest

3

11-15

37

 

therapy for the abuser

1

16-17

17

 

maltreatment

64

>18

4

 

multi-problem

9

Sources of information. It is essential to stress the need for an evaluation path that can be undertaken with different professionals working together, using different kinds of diagnostic tools, to reach conclusions only following an analysis of the various alternatives. (Foti, 2003). The conclusions can be drawn by following a constructivist, dialogic and participatory model (Pozzobon 2004) through a plan defined as "constructive dialogue" (d'Agnella et al. 1997). In this planning, the interaction between those involved who bring their respective knowledge of the presenting problems and their own projects is crucial (Brunod et al. 1998).

Tools. Given that the services are dominated by a culture that discourages professionals from recording their different interventions and the outcomes of their work (Zeira et al. 2007), the centre I Girasoli, decided to develop its own tailored approach for its interventions. Over three years of work a "project sheet" has been elaborated that supports a multi-disciplinary and inter-institutional approach.

The first objective of the sheet has been to define the different roles, competences and specific responsibilities. The sheet also includes some normative factors for group work (Qualino, Casagrande, Castellano 1992) including the choice of a professional in the role of "tutorship", who has to guarantee the protection of  the child.

The sheet allows every participant to elaborate, implement and evaluate plans for the child. Objectives/actions and subjects are agreed at the outset but can be re-verified at each follow-up meeting, linking individual interventions with the services responsible for implemenation. All changes have to be noted.  At the end of each interdisciplinary meeting, all the workers involved have to sign the updated work plan.

The monitoring of progress can be seen as "types of punctuation marks in the course of the therapeutic journey involving change" (Sartorello 1999); and as acknowledgements of responsibility, given that in social services  standardized work is difficult (Maurizio 2004), and, "cannot always be measured in everyday work" (Zeira et al. 2007). Particularly for this reason the outcomes of evaluation of interventions can be used to manage, on the basis of explicit criteria, future decisions including those relating to care pathways" (Vecchiato 2000).

Given "the necessity of paying considerable attention to communication, to relationships, and not just to the contents or the objectives of the plan and the interventions" (Maurizio 2004), it was thought that a shared tool would avoid the possible repetition of past maladaptive relationships and/or of conflicts of the families in difficulty; and  support new models of relationships based on sharing and coherence.

Key findings. As can be seen in Table 3, the decision to combine the objectives and actions, while methodologically wrong, has in fact clarified respective roles and the responsibilities. It allows you to see the major diagnostic function of the centre and the stage at which the centre becomes involved in the cases, supporting the clinical/therapeutic activities and making links between the different services. This can be clarified by analysing the reports and the dynamics of the work group using the sheet as an instrument of verification.

From an analysis of the 72 records (Note: for siblings only one record was used) one can see in Table 4 that there has been continuity in the participation of those involved in offering protection (residential care, municipality and local social and health departments) and in the involvement of experts. The educative aspects of the protective services are, however, tackled elsewhere.


Tab. 3 - Objectives and

achievements

 

Tab. 4 - Participants

 

Participants to be

involved

 

Participants

actively involved

Links between services

10

 

Municipality

11

21

Evaluation and diagnosis

17

 

Local social and health departments

30

64

Meetings between mother and child 

2

 

Paediatricians and  General Doctors

1

2

Feedback meeting on reunification

3

 

Protective organisations

7

0

Psychological help

2

 

Foster care families

3

0

Pharmacological therapy

2

 

Girasoli staff

38

72

Validation of suspected sexual abuse

2

 

Others

3

9

 Implications. The continuity of participation and the sharing of responsibilities and roles can be found when the mandate referring to the Centre's services is clear and the skills of individual professionals in different services are coordinated, with their consequent assumptions of responsibility and collaboration, and when the Centre works exclusively with local services. In more complex situations, in particular those that involve educational aspects, it appears that the vision offered by the sheet is not yet shared. Precisely to bridge this gap, we are in the process of developing a scheme of collaboration that will be integrated in the project framework proposed by the services. In some cases this will also include e individualised development plans (PEI=Progetti Educative Individualizzati), identified by the residential setting.

While mindful that this framework is only one option (Maurizio 2004), we believe that its development as a tool for verification and evaluation must be achieved through the production of a tool that can be understood immediately and easily. This is because grids and protocols within theoretical frameworks, even when impeccably constructed, often  meet with hostility from workers.

Key references

Foti, C. (Ed.). (2003). L'ascolto dell'abuso e l'abuso nell'ascolto. Abuso sessuale sui minori: contesto clinico, giudiziario, sociale. Milano: Franco Angeli.

Quaglino, G.P., Casagrande, S., & Castellano, A., (1992) Gruppo di lavoro, lavoro di gruppo. Milano: Raffaello Cortina.

Rovetto, F., & Moderato, P. (Eds.). (2006). Progetti di intervento psicologico. Idee, suggestioni e suggerimenti per la pratica professionale. Milano: McGraw-Hill.

Contacts: Andrea Frosi, Centro Regionale per la protezione e la cura dei bambini, dei ragazzi e delle famiglie "I Girasoli" - Padova, c/o SPES - via Ognissanti, 70 35129 Padova, E-mail: igirasoli.ulss16@sanita.padova.it, Phone 0498697744.

 

 

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