Paper
Strategies for improving the quality and effectiveness of services for troubled children and their families: experiences of youth care in Drenthe
- issue: Issue 1 / 2009
- authors: Mariska van der Steege, Carolien Konijn
- keywords: The Netherlands, evidence-based, practice, practice-based, evidence, interventions
- views: 4368
- downloaded: 0
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abstract
Background. Making youth care interventions evidence based is the ambition of several organizations in the Netherlands. Youth Care Drenthe. Veerman & Van Yperen (2007) have made a sequence of stages on how to reach the status of evidence based:
- describe the youth care that is carried out in the daily practice and the problems of the children and their parents that are aimed by the program (the intervention is then called 'potentially effective');
- give the program or intervention a thorough theoretical basis, formulate a hypothesis on why the intervention should work for children and parents with the described kind of problems (the intervention is 'promising');
- the intervention has positive a outcome measured by problem reduction, client satisfaction, low drop out rate, high rate of goal attainment (the intervention is 'efficacious');
- in a random controlled trial one finds positive results of the program; the intervention has better results than when doing nothing or carrying out an alternative intervention (the intervention is 'effective').
In those four stages one can climb the ladder to an evidence based intervention or program. These stages are used to design research and innovatory activities to improve the quality of youth care programs. Three strategies were used for improving the quality of the programs. First, we searched in research data for specific ingredients to improve the effectiveness for the children and parents with problems on which the program is aiming. Secondly, we implement common factors like good professional training, a good match between the needs of the clients and the program, structured supervision, carrying the program out in the way it is meant to be and so on. Programs with those factors give better results than programs that lack these, regardless of the problems of the clients. Thirdly, one should monitor the outcome of the program continuously, evaluate the results, discuss changes that improve the quality and the outcome and implement them.
Youth Care Drenthe: aiming at practice ánd evidence based programmes
Ambitions of Youth Care Drenthe. Youth Care Drenthe is an organization which offers child and youth care in Drenthe, one of the fifteen provinces (or counties) in the Netherlands. Their care contains residential care, day care, family preservation services, training for children, youth and parents and foster care. In total they offer about 25 different intervention programmes. Most of these already exist a long time, but never were known as evidence-based. They proved their value in everyday practice. The ambition of Youth Care Drenthe is to upgrade their practice-based programmes with the best available evidence. The Netherlands Yout Institute supports them in this.
Theory-based. The first step in this process is to describe the theoretical background of the programmes. One of the programmes we support, is the MKD, a day care programma for children from 1,5 to 7 years and their parents. The children have severe behaviour problems, medical problems or a diagnosis like Adhd or autism. The parents don't understand theirs child's behaviour and don't know how to handle them anymore. The children stay at the treatment centre for three to nine daily periodes, their parents get support of a social worker. With a group of key figures of the MKD we had two sessions in which we tried to explicit their practice-based knowlegde in an interactive way. Mostly, workers are led by suppositions of what works for their specific clients and the problems they have. Trying to make this implicit knowlegde explicit gives the chance to compare it with the available evidence of what works best for young children with severe problems. We supported this group, collected the avaible evidence and wrote down the theoretical basis of their programme. We described the theoretical background by expliciting the care for this specific population and the goals to be reached. This makes the programme 'potentially effective'. A side profit of this process was the reflection it stimulated at the workers and key figures of the MKD. Looking at their programme in this way made them rethink their daily practice, and collecting ideas how the quality and effectiveness of it could be improved.
Programme integrity. The second step in the process was to examine the programme in detail by describing the techniques the workers use. In a day session we filled a matrix with the techniques and acts they use in the different stadia of the care. Examples of these are for the MKD: offering the child materials and games for the development of their language, using video feedback and giving the parents information on their child's specific behaviour. Next to that we examined techniques and acts in similar programmes that matched their practice and which could be useful. Altogether this led tot a manual with a set of usuable techniques and acts for the different stages in care. Youth Care Drenthe is preparing a continuous monitoring of the integrity of their intervention programmes. They use the manuals as a basis for this. Periodically is measured which techniques and acts in the manual the workers use. This gives an idea if they offer the programme as it is meant te be offered. They also want to get an idea of the use of common factors (for example: building al relationship with the clients, consensus about goals and the techniques to use) in daily practice. Therefor they are going to use session rating scales, in which clients can easily score four questions on these subjects (translations of scales developed by Talking Cure, United States).
Monitoring outcomes. Next to measuring programme integrity Youth Care Drenthe has also implemented a monitor on the outcomes of programmes. Therefor they use a set of instruments. The CBCL en the NOSI are two validated questionnaires for problem behaviour of the children and parental stress, they are used to measure problem reduction. Next to this results of the goal attainment are collected and of client satisfaction. These instruments are at the same used by the workers in the care they give to the clients. Altogether this set gives information about the outcomes the clients experience. The experiences in Drenthe show that this kind of pre- and post-test monitoring gives information about the results of a programme and lots of suggestions for improval.
Key references
Geurts, E. & Steege, M. van der (2007). Medisch Kinder Dagcentrum (MKD). Methodiekhandleiding. Papenvoort: Jeugdzorg Drenthe. http://www.talkingcure.com.
Konijn, C., Van der Steege, M., Elderman, E., Bruinsma, W., & Van de Braak, J. (2007). Werkzame werkwijzen. Verkenning van effectieve interventies in de jeugdzorg. Utrecht/Woerden: Nederlands Jeugdinstituut / NJi/Adviesbureau Van Montfoort.
Veerman, J. W. & Yperen, T. van (2007). Degrees of freedom and degrees of certainty. A developmental model for the establishment of evidence-based youth care. Evaluation and Program Planning, 30, 212-221.
Contacts: Mariska van der Steege, Netherlands Youth Institute/NJi, Postbus 19.221, 3501 DD Utrecht, The Netherlands, E-mail: m.vandersteege@nji.nl, Phone +31 (0) 30 230 68 65.