fondazione e. zancan onlus risk for children and solutions for contrasting it in collaboration with...

Fondazione E. Zancan onlus

Risk for children and solutions for contrasting it

In collaboration with the Ministry of Labour and Social Policy

RISC

Cinzia Canali and Tiziano Vecchiato, Fondazione Zancan, ItalyISCI Conference, July 27-29 2011

COMBINING QUALITATIVE AND QUANTITATIVE METHODS FOR ASSESSING

THE WELLBEING OF CHILDREN IN NEED


Goals of the RISC study

1) To explore approaches and care pathways for supporting families and preventing placements, at national and international level.

2) To “test” a personalised care model for taking care of children at risk of placement.

Sections of the RISC study

Section 1 – Approaches in other countries

Section 2 – Review of Italian literature

Section 3 – Laws and norms in different regions

Section 4 – Costs of children and family services

Section 5 – The point of view of professionals

Section 6 – A multi-site research

A multi-site research


Ulss 9 Treviso

Comune di Cesena e Distretto Langhirano

Comune di Firenze e Zona Valdarno Inf.

Comune di Torino

Comune di Potenza e Ambito Basento-Bradano

Ambito 29 e Ambito 33

127 children

The model S-P (polar scheme)

The polar scheme represents the synthesis of problems and strengths of the child.Each ray represents an assessment tool: more colour indicates strengths, less colour means problems and requires interventions.


Social and relationships domain

Physical domain

Cognitive and behavioural domain

Rationale underlying the polar scheme

The voice of professionals

“The image obtained from the polar scheme immediately suggests the areas in which the child has the higher difficulties.

It allows a deeper knowledge of the child and it is useful for intervening and planning interventions”



The research aims to

1) To identify thresholds for placement2) To assess outcomes3) To assess the effectiveness of a research

protocol based on personalised plans4) To look for solutions for supporting

professionals in taking decisions about the child


Main steps of the research

First step: Selection of families following some inclusion criteriaSecond step: Research protocols for the selected casesThird step: Assessment at 3 and 6 months (qualitative and quantitative assessment)

H0: the usage of a personalised approach will give better results in terms of effectiveness


Step 1 – Selection of families

1° criterion: the condition of adults and the factors of the environmental context that describe their difficulties and strengths

2° criterion: the condition of children and possible harms (conflicts between parents or neglect)


Pre-assessment mapL

eve

l of

ina

de

qu

ate

pa

ren

ting

Level of child suffering

Step 2 - Research protocols

• Control group: it takes care of the child “as usual” but assesses changes using the polar scheme model.

• Experimental group: it takes care of the child following recommendations that support the decisions for interventions and connecting actions and expected results. It also assesses changes using the polar scheme. Fondazione E. Zancan onlus


A software for supporting professionals


Step 3 – Assessment methods1. S-P assessment: comparison among polar schemes in different times (T0, T1, T2) using assessment tools pertaining to different domains (and different disciplines)2. F-O assessment: comparison among observed condition at T0, expected condition at T1, observed condition at T1 and following times, with definition of the personalised plan based on measurements.


Measurements and comparison between T0-T2

Apprendimento

Comunicativa

Lpsvr

Sr

AffettivoSocio-relazionale

Autonomie

Neuromotoria

Organica

T0

T2Apprendimento

Comunicativa

Lpsvr

Sr

AffettivoSocio-relazionale

Autonomie

Neuromotoria

Organica

T0

T2

Experimental (all cases) Control (all cases)

S-P assessment

Outcomes in terms of “observable factors” at T0-T1


Expected results

NOT reached

Expected results

PARTIALLY reached

Expected

results FULLY

reached

Effectiveness 5,2% 79,3% 15,5%

Indice di efficacia PO - Funzionale Organico

40,0%

60,0% 0,0%

Indice di efficacia PO - Cognitivo Comportamentale

10,2%

75,5% 14,3%

Indice di efficacia PO - Socioambientale Rel.

16,3%

67,4% 16,3%

Examples:N. of visits of the father in 3 monthsN. of telephone calls with his father in one monthN. of times he/she attend the gym in 3 monthsHow many time he/she refuses to respect the rules (weekly)N. of times he/she accepts the activities proposed by social worker…

F-O assessment

Each professional is asked to take decisions about observations to use (qualitative approach) and then to transform them in measures (quantitative approach). Measurements are then evaluated through a professional judgement (qualitative approach) that leads to a new plan or to confirm the same plan.


Qualitative and quantitative measures

“The personalised protocol gives to us the possibility to think about our decisions and to ‘image’ the care pathways that it will be monitor and assess in its development”


The voice of professionals

Effectiveness

1) Effectiveness based on measurement taken with assessment tools (Ev)

2) Effectiveness based on observable factors (Eo)


Polar scheme

Observablefactors


Did we meet our H0?

At the first glance of data, we DID NOT find differences between experimental and control groups considering the effectiveness reached through assessment tools.


Fidelity index

It measures how much professionals followed the methodological recommendations of the protocol, documenting the steps:

1. intake,

2. assessment of the problem,

3. personalised plan,

4. outcome assessment

respecting the assessment times.


Research units and their fidelity

Fidelity index > 60%

The group of children was reduced by the 25%, from 127 children (74s, 53c) to 96 (51s, 45c).

Professional, even good and motivated, did not followed the research protocol as recommended. This fidelity index highlights the need of supporting professionals in being more adherent to such recommendations.



Social and affective domain

- The effectivess T0-T2 is higher in the experimental group for children who have a more severe situation at T0

- The effectivess T0-T2 is higher in the control group for children who have a less severe situation at T0


Social and affective domain

Profile T0

Effectiveness T0-T2

Experimental

Control

0,64 0 1 Severe Not severe

This result shows the higher capacity of the experimental group to reach a positive outcome (and a reduction of risk) for children who have a high level of suffering (and for this reason at higher risk of placement).


Conclusion


Future perspectivesD

ove

si p

osi

zio

na

in u

na

sca

la d

a 1

a 1

0 l’

ind

ice

di

ina

de

gu

ate

zza

ge

nito

riale

e d

i co

nte

sto

re

lazi

on

ale

?

Dove si posiziona in una scala da 1 a 10 il grado di sofferenza (da abbandono, maltrattamento…) che sta vivendo il bambino?


Strengths1. This approach facilitates the information sharing among professionals of different disciplines

2. It allows a global vision of the child obtained through measurement tools

3. It highlights non only problems but also strengths of the child

4. It helps professionals in taking decisions if they monitor and document correctly the care pathways

5. It helps to highlight the effectiveness of work (and the cost/effectiveness)


Some critical elements that can be transformed in strenghts

1. It forces professionals to think together for defining a personalised plan

2. It requires some time to devote to assessement

3. It requires thedaily usage of a software

4. It needs the collaboration of different professionals in terms of integration

5.It needs a structured and regular documentation


Developments1. The Fondazione Zancan is implementing this outcome-based approach (S-P and F-O methods) in different need areas (children at risk, young adults with severe disabilities, families with multiple problems...)

2. We are working with groups of professionals interested in developing such an approach in a common platform called PersonaLAB (“Personalised Environment for Research on Services, Outcomes and Needs Assessment”) for comparing problems and solutions (15 research units in different Regions and a research unit in New Zealand)

Thank you for your attention

www.fondazionezancan.it

[email protected]


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