what do we learn from proces- outcome research? paris, september 23th, 2005 bert van puyenbroeck -...
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What do we learn from proces-outcome research?
Paris, september 23th, 2005Bert Van Puyenbroeck - Programme leader IFPS
Flanders Gerrit Loots, phd, Vrije Universiteit BrusselHans Grietens, phd, Katholieke Universiteit
Leuven
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IFPS-program
• Intensive Family Preservation: Crisishulp aan Huis• Crisis = minor is about to be placed out of home
(residential care; foster care; ..)
• At home service• Short term programme, during 4 to 6 weeks• Family can reach IFPS team or family worker 24h/day, 7d/
week ; family worker can also reach supervisor at any time• Intensive: 8h/week, 10 meetings/ week at home
• To prevent unnecessary out of home placement
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IFPS in Europe & USA
• IFPS programs in USA (Seattle) (Homebuilding)
• Netherlands (Families First)• U.K.• Germany ( FAM; FIM)• Luxemburg• Finland• Flanders (Crisishulp aan Huis)
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Research items former research
1. What’s the target group reached by IFPS?
2. What are the results of an IFPS program?
= outcome based research, focused only on an ‘out of home placement index’
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Basic results international literature
• It seems that:– Comparable results of these
‘homebuilding based IFPS programs’ in the Netherlands, Flanders, Seattle = in different cultures?
• ‘succesratio’ of 73% up to 91%
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Critical thinking about these research items
• How does that come?• What is ‘result’: outcome based,
quantitative research: index of out of home placement?
• OHP isn’t necessary negative (safety issue)
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Questions
• What are the procesess behind these results?
• What difference can an IFPS program make for the family?
• What is our basic objective?
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Proces-outcome research: what’s the impact of an IFPS
program• The research program is based on
– an integration of quantitative and qualitative research methods to relate:
• outcome data to the intervention processes and the experiences of the family members.
– Quantitative research data• What are the outcomes of an IFPS in Flanders?
– Qualitative research• What are the processes behind these outcomes?• What are the changes we are able to introduce in the
family system?
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Major question
• « does a family has any perspective on how to go on as a family, how to raise the children, how to stay together in this family, how to keep up? »
• During the intervention, and afterwards?
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Perspective of the parent
• focuses on the impact of Families First Flanders on parents’ experiences of parental stress, their relationship and interaction with their child/children, and their impressions of the strengths and difficulties of the minor.
– Can I bear the stress? Are there a lot of stressfactors?
– How is my relationship with my child?– Where can I find social support?
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Perspective of the minor
the minors’ experiences of the parent-child interaction and their impressions of their own strengths and difficulties.
– Do I feel myself competent as minor in this family, at school?
– How is my relationship with my mother, my father?
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Focus of IFPS Flanders
• If we want to make any difference, than:– Competence: what do I have in my pocket to keep
up = competence-based model– Stress: how stressful is this situation for me?– Educational relation: how’s the relation with my
child/ my parents– Social isolation/ support: can I relay on a supportive
system/context?
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Research design
• Within subjects / pretest-posttest-follow up design:
• All families involved in a crisis intervention service (IFPS): – Minor– Parent (mother/ father)
• Three moments– Beginning of the crisisintervention– At the end– One month after ending
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Instruments
Competence Strenghts and Difficulties Questionnaire (SDQ)
Stress Nijmeegse Vragenlijst Opvoedingssituatie (NVOS)
Educational Relationship Ouder-Kind Interactievragenlijst (OKIV-R)
Social Support Nijmeegse Ouderlijke Stressindex (NOSI)
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Procedure
• Family workers– 2 Feedback & Training moments (before starting/ after 3
months)
• Referal service– Standardised letter: short introduction to the research
project
• Family– Referal service: first introduction– Family worker: first questionnaires at the start & short
acknowledgement from both researchers – at the end – after one month
– Closed envelopes back to FW (+ send to university Brussels)
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Overview: questionnaires
Informant Start End Follow up
Parent SDQ
OKIV-R
NVOS
NOSI
SDQ
OKIV-R
NVOS
NOSI
SDQ
OKIV-R
NVOS
NOSI
Feedback Quest
Minor SDQ
OKIV-R mother
OKIV-R father
SDQ
OKIV-R mother
OKIV-R father
SDQ
OKIV-R mother
OKIV-R father
Feedback Quest
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This overview today
• Quantitative data-analysis of the families involved in the programme during the first six months will be presented and discussed:– SDQ– NVOS– OKIV-R
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OKIV-Reducational relationship
(parent)
-4-3,5
-3-2,5
-2-1,5
-1-0,5
00,5
11,5
22,5
33,5
4
Confl icts Acceptation T otal
OK I V - R s c hal en
CaH
CNM
CNF
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OKIV-Reducational relationship
(parent)
-4-3,5
-3-2,5
-2-1,5
-1-0,5
00,5
11,5
22,5
33,5
4
T 1 T 2 T 3
Confl icts
Acceptation
T otal
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Conclusion OKIV-R parent
• Parents experience their relationship with minor as very problematic
• This does not change/ improve during or after the crisintervention
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OKIV-Reducational relationship (minor)
OKIV-R schalen
-3
-1
1
3
Confl icthanter ing Acceptatie T otaal
CaH
KNM
KNV
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OKIV-Reducational relationship (minor)
-3,5
-2,5
-1,5
-0,5
0,5
1,5
2,5
T1 T2 T3
Confl icthantering
Acceptatie
Totaal
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Conclusion OKIV-R minor
• Minors experience their relationship with their parents as very problematic
• This doesn’t change/ improve during or after the crisisintervention
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SDQStrengths & Difficulties Minor
(parent)T otal diffi culties scor e
0
5
10
15
20
T 1 T 2 T 3
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SDQStrengths & Difficulties Minor
(parent)
0
1
2
3
4
5
6
7
8
T1 T2 T3
Emotional
symptoms
Conduct problems
Hyperactivity
Peer problems
Prosocial behaviour
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Conclusion SDQ parent
• Total difficulties score is: problematic range• This changes significantly during & after
crisisintervention (T3 – T1)• Most important changes
– Emotional symptoms– Hyperactivity
• And trend:– Conduct problems
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SDQStrengths & Difficulties Minor
(minor)Total difficult ies score
0
5
10
15
20
25
T1 T2 T3
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SDQStrengths & Difficulties Minor
(minor)
0
1
2
3
4
5
6
7
8
T1 T2 T3
Emotional
symptoms
Conduct
problems
Hyperactivity
Peer problems
Prosocial
behaviour
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Conclusions SDQ minor
• Total difficulties score is: borderline range• This changes significantly during & after
crisisintervention (T3 – T1)• Most important changes
– Hyperactivity
• Trend:– Conduct problems
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NVOS, part 1 Stress, Opvoedingsbelasting
(parent)
0
0,5
1
1,5
2
2,5
3
3,5
Acc Aan Pro And Bel All Ple Goe
residential group
IFPS
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NVOS, part 1 Stress, Opvoedingsbelasting
(parent)
0
1
2
3
4
T 1 T 2 T 3
Acceptatie
Aankunnen
P r oblemen
Ander s wi l len
Belasting
Al leen
P lezier
Goede omgang
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Conclusions NVOS
• IFPS families experience the situation as problematic as families where minor is placed in residential care (norm group)
• This is: target group of IFPS (trying to prevent an unnecessary OHP)
• This improves in some ‘domains’ of the educational situation– Significantly: « situation can’t go on like this » and
« I’m standing alone » and « experiencing some fun »
– Trend: « I can(not) handle the situation »
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NVOS, part 2ID of situation (parent)
0
1
2
3
4
5
6
7
T1 T2 T3
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NVOS, part 2 ID of situation (parent)
0
5
10
15
20
25
30
35
B08 B07 B06 B05 B04 B03 B02 B01
T1
T2
T3
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Conclusions NVOS
• ID of the situation changes from « I experience quiet a lot of problems » to « sometimes I (still) experience problems in education »
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First conclusions
• IFPS reaches the target group: trying te prevent unnecessary out of home placement of a minor, given their is a serious risk of OHP (NVOS)
• During the intervention and afterwards, parents and minor experience the situation as less perspectiveless/ problematic (SDQ)
• Parents identify the educational situation als less ‘demanding’ (NVOS)
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First conclusions
• But:
– Still, IFPS does not make a difference in the problematic relationship between parent and child
– Hypothesis: IFPS helps to deminish the ‘crisis’ in the situation, while their is still a need for further family therapy.
– Hypothesis: since family has again more ‘hope’, perspective on how to go on as a family , they’re more willing te accept/ go to further helping services.
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Further research
• Reporting 12 months (october ’04 – september ’05)
• also: domains of– Social support– Their evaluation of the programme
• Qualitative research, based on these first quantitative research results– Hypotheses?– What helps them to get out of the crisis?– What didn’t help them?
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EUSARF 2007
• Presentation on both quantitative and qualitative research programs