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

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

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

IFPS in Europe & USA

• IFPS programs in USA (Seattle) (Homebuilding)

• Netherlands (Families First)• U.K.• Germany ( FAM; FIM)• Luxemburg• Finland• Flanders (Crisishulp aan Huis)

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’

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%

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)

Questions

• What are the procesess behind these results?

• What difference can an IFPS program make for the family?

• What is our basic objective?

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?

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?

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?

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?

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?

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

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)

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)

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

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

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

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

Conclusion OKIV-R parent

• Parents experience their relationship with minor as very problematic

• This does not change/ improve during or after the crisintervention

OKIV-Reducational relationship (minor)

OKIV-R schalen

-3

-1

1

3

Confl icthanter ing Acceptatie T otaal

CaH

KNM

KNV

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

Conclusion OKIV-R minor

• Minors experience their relationship with their parents as very problematic

• This doesn’t change/ improve during or after the crisisintervention

SDQStrengths & Difficulties Minor

(parent)T otal diffi culties scor e

0

5

10

15

20

T 1 T 2 T 3

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

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

SDQStrengths & Difficulties Minor

(minor)Total difficult ies score

0

5

10

15

20

25

T1 T2 T3

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

Conclusions SDQ minor

• Total difficulties score is: borderline range• This changes significantly during & after

crisisintervention (T3 – T1)• Most important changes

– Hyperactivity

• Trend:– Conduct problems

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

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

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 »

NVOS, part 2ID of situation (parent)

0

1

2

3

4

5

6

7

T1 T2 T3

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

Conclusions NVOS

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

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)

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.

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?

EUSARF 2007

• Presentation on both quantitative and qualitative research programs

[email protected]

Thank you.

Please contact me for further discussion