What do we learn from proces-outcome research?

1. What do we learn from proces-outcome research? Paris, september 23th, 2005 Bert Van Puyenbroeck - Programme leader IFPS Flanders Gerrit Loots, phd, Vrije Universiteit Brussel Hans Grietens, phd, Katholieke Universiteit Leuven

2. 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

3. IFPS in Europe & USA • IFPS programs in USA (Seattle) (Homebuilding) • Netherlands (Families First) • U.K. • Germany ( FAM; FIM) • Luxemburg • Finland • Flanders (Crisishulp aan Huis)

4. Research items former research • What’s the target group reached by IFPS? • What are the results of an IFPS program? = outcome based research, focused only on an ‘out of home placement index’

5. 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%

6. 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)

7. Questions • What are the procesess behind these results? • What difference can an IFPS program make for the family? • What is our basic objective?

8. 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?

9. 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?

10. 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?

11. 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?

12. 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?

13. 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

14. Instruments

15. 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)

16. Overview: questionnaires

17. 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

18. OKIV-Reducational relationship (parent)

19. OKIV-Reducational relationship (parent)

20. Conclusion OKIV-R parent • Parents experience their relationship with minor as very problematic • This does not change/ improve during or after the crisintervention

21. OKIV-Reducational relationship (minor)

22. OKIV-Reducational relationship (minor)

23. Conclusion OKIV-R minor • Minors experience their relationship with their parents as very problematic • This doesn’t change/ improve during or after the crisisintervention

24. SDQStrengths & Difficulties Minor (parent)

25. SDQStrengths & Difficulties Minor (parent)

26. 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

27. SDQStrengths & Difficulties Minor (minor)

28. SDQStrengths & Difficulties Minor (minor)

29. Conclusions SDQ minor • Total difficulties score is: borderline range • This changes significantly during & after crisisintervention (T3 – T1) • Most important changes • Hyperactivity • Trend: • Conduct problems

30. NVOS, part 1 Stress, Opvoedingsbelasting (parent)

31. NVOS, part 1 Stress, Opvoedingsbelasting (parent)

32. 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 »

33. NVOS, part 2ID of situation (parent)

34. NVOS, part 2 ID of situation (parent)

35. Conclusions NVOS • ID of the situation changes from « I experience quiet a lot of problems » to « sometimes I (still) experience problems in education »

36. 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)

37. 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.

38. 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?

39. EUSARF 2007 • Presentation on both quantitative and qualitative research programs

40. hubert.vanpuyenbroeck@vub.ac.be Thank you. Please contact me for further discussion