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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
Fondazione E. Zancan onlus
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
Fondazione E. Zancan onlus
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.
Fondazione E. Zancan onlus
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”
Fondazione E. Zancan onlus
Fondazione E. Zancan onlus
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
Fondazione E. Zancan onlus
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
Fondazione E. Zancan onlus
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)
Fondazione E. Zancan onlus
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
Fondazione E. Zancan onlus
A software for supporting professionals
Fondazione E. Zancan onlus
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.
Fondazione E. Zancan onlus
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
Fondazione E. Zancan onlus
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.
Fondazione E. Zancan onlus
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”
Fondazione E. Zancan onlus
The voice of professionals
Effectiveness
1) Effectiveness based on measurement taken with assessment tools (Ev)
2) Effectiveness based on observable factors (Eo)
Fondazione E. Zancan onlus
Polar scheme
Observablefactors
Fondazione E. Zancan onlus
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.
Fondazione E. Zancan onlus
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.
Fondazione E. Zancan onlus
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.
Fondazione E. Zancan onlus
Fondazione E. Zancan onlus
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
Fondazione E. Zancan onlus
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).
Fondazione E. Zancan onlus
Conclusion
Fondazione E. Zancan onlus
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?
Fondazione E. Zancan onlus
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)
Fondazione E. Zancan onlus
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
Fondazione E. Zancan onlus
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)