Upload
albernande1993
View
242
Download
0
Embed Size (px)
Citation preview
8/10/2019 The Community Oriented Programs Environment Scale
1/51
8/10/2019 The Community Oriented Programs Environment Scale
2/51
i
ReportTITLE
The Community Oriented Programs Environment Scale
(COPES)- Use of the COPES in a research project on childwelfare institutions in Norway a description, literature re-
view and reflections
Barnevernets utviklingssenter
Post adress: NTNU Dragvoll
7491 Trondheim
Visit adress: Dragvoll All 38 B
Telephone: +47 73 55 08 40
Fax: +47 73 59 62 24
E-mail: [email protected]
Web.: www.samforsk.no
Foretaksnr. NO 986 243 836
AUTHOR
Kaat Lagae
INSTITUTION
Barnevernets utviklingssenter i Midt-Norge (BUS)
The Regional Child Protection Research Unit
REPORT NR. GRADING LEVEL FUNDING
22/2012 Open Barnevernets utviklingssenter i Midt-NorgeISBN NUMBER OF PAGES
978-82-91927-20-6 (trykt)
978-82-91927-21-3 web 43
PRICE SUPERVISED BY
Jim Lurie and Torill Tjelflaat
DATE QUALITY CONTROL BY
December 2012 Torill Tjelflaat, head of department BUS
SUMMARY
In this report, the Community Oriented Programs Environment Scale (COPES) was examined asan instrument for measuring social climate in child welfare institutions in Norway. A short de-
scription of the COPES and its background are presented, followed by a literature search focused
on one of the dimensions of the COPES Relationship. The literature shows that relationship is an
important concept which should not be overlooked in child welfare institutions. The report con-
cludes with a critical reflection on the use of COPES. Some younger children may require assis-
tance in reading and comprehending the questions. It is concluded that the COPES can be seen as
a valuable and important instrument for examining the determinants of social climate in communi-
ty programs, and for identifying strengths and weaknesses in the social climate of an institution.
Key words English Norwegian
Community Oriented Programs Evaluation
Scale
Social Climate Sosial milj
Child Welfare Institutions Barneverninstitusjoner
Relationship Dimension Relasjoner mellom barn og ansatt
8/10/2019 The Community Oriented Programs Environment Scale
3/51
ii
8/10/2019 The Community Oriented Programs Environment Scale
4/51
iii
PREFACE
InthecontextofmystudyatthefacultyofEducationalStudiesattheUniversityof
Leuven,Iwas
given
the
opportunity
to
discover
the
process
of
research
in
Norway.
The last 16weeks, I haveworked at Barnevernets utviklingssenter iMidtNorge
(BUS);TheRegionalChildProtectionResearchUnit that isadepartmentat NTNU
SamfunnsforskningAS;NTNUSocialResearchAS.Formally,thisinternshipisaffiliat
edwithRegionsenterforbarnogungespsykiskehelse(RBUP),whichistheRegion
alCentreforChildandAdolescentMentalHealth.
IamverythankfultoallthepeopleatBUS,whogavemeaverywarmwelcomeat
theircentre
and
who
were
always
available
for
atalk
about
my
research
as
well
as
aboutmytrips inandaroundNorway.Aspecialwordofthanksgoestomytwosu
pervisors;JimLurieandTorillTjelflaat.Thankyoufortrustingmewithinthisbigpro
ject,givingprofessionalcontributionandsupport. Iexperiencedafabuloussenseof
hospitalityfromallofyou.
Duringmy internship, Iwasalsoable tovisit twochildwelfare institutionsand the
regionalcentreforchildandadolescentmentalhealth(RBUP).Iwanttothankallthe
peoplewhowelcomedmeduringthesetripsandwhodidntmindspeakingEnglish
throughouttheday.Iwasprovidedalotofusefulandinterestinginformationabout
theorganisationofchildwelfareinNorway.
Thereafter,IamgratefultoprofessorHansGrietensfromtheUniversityofGroningen
whomadethisinternshippossibleandgavemealotofprofessionaladvicealongthe
way.
Duetothekindsupportofallofyou,IexperiencedthisadventureinNorwayasalife
changingevent
in
which
Iwas
taught
alot
of
self
knowledge,
independency
and
re
searchqualities.
Trondheim,Norway,December2012
KaatLagae
8/10/2019 The Community Oriented Programs Environment Scale
5/51
iv
8/10/2019 The Community Oriented Programs Environment Scale
6/51
v
TABLEOFCONTENTS
PREFACE................................................................................................................ iii
1 INTRODUCTION
................................................................................................
1
2 ABOUTTHECOPES........................................................................................... 3
2.1 WhatistheCOPES?......................................................................................................... 3
2.2 MeasuringsocialclimatewiththeCOPES........................................................................ 6
2.3 HowistheCOPESusedintheResearchProgram?........................................................... 8
3 FOCUSONRELATIONSHIPDIMENSION........................................................... 11
3.1 Involvement................................................................................................................. 12
3.2 Support......................................................................................................................... 14
3.3 Spontaneity
..................................................................................................................
16
4 THEUSEOFTHECOPESWITHCHILDRENANDYOUNG PEOPLE....................... 19
4.1 StudiesusingtheCOPESwithadolescents..................................................................... 19
4.2 CriticalreflectionofusingtheCOPESwithchildren....................................................... 28
5 DISCUSSIONANDSUMMARY......................................................................... 33
REFERENCES.......................................................................................................... 37
Listoftables.......................................................................................................... 41
Listoffigures........................................................................................................ 43
8/10/2019 The Community Oriented Programs Environment Scale
7/51
vi
8/10/2019 The Community Oriented Programs Environment Scale
8/51
1
1 INTRODUCTION
TheprojectMentalhealthinchildrenandadolescentsinchildwelfareinstitutionsis
an ongoing, large scale research, conducted by two research centres, located in
Trondheim.ThesearetheRegionalChildProtectionResearchUnitforCentralNorway,
and theRegionalCentre forChildandAdolescentMentalHealth,MidNorway.The
project isadministeredby a leader group consistingof representatives from these
twocentres,andmembersfromtheDepartmentofLaboratoryMedicine,Childrens
andWomensHealthand theCentre forDevelopmentalPsychopathology.Thepro
jectaimstoincreaseknowledgeaboutchildreninwelfareinstitutionsinNorwayand
theirmental
health.
Ithasthreemainobjectives,being1)togainknowledgeaboutchildrenandadoles
centsintheagegroup1223yearswholiveinchildwelfareinstitutions,focussingon
mentalillnessandpsychosocialadjustment;2)toidentifyinstitutionalcircumstances
thatmaybeofsignificanceforthehealth,adjustmentanddevelopmentofthechil
drenandadolescents;3)togainknowledgeaboutchildrensandadolescentsneed
for, and use of health services formental health complaints. For answering these
questions,anationwidesampleof400youngpeopleagedbetween12and23and
livinginchildwelfareinstitutionswillbestudied.Theprocedurefordatacollectionis
strictlydefinedandconsistsoftheadministrationofseveraldifferenttestsandques
tionnaires.
OneofthequestionnairesthatwillbeusedistheCommunityOrientedProgramsEn
vironmentScale(COPES),whichinvestigatestheperspectivesofusersandstaffcon
cerningtheinstitutionalenvironmentandtheprogramssocialclimate.Thisresearch
toolwillbethemainsubjectofthisreport.ThetheoreticalbackgroundoftheCOPES
isinvestigated,
using
relevant
literature
concerning
its
content
and
usefulness.
Fur
thermore,anoverviewwillbegivenofitsuseinchildwelfareinstitutions,includinga
critical reflectionon that.Abroad literature searchhasbeen conducted, regarding
oneofthethreeoverarchingdimensionstheCOPESismeasuring.
8/10/2019 The Community Oriented Programs Environment Scale
9/51
2
8/10/2019 The Community Oriented Programs Environment Scale
10/51
3
2 ABOUTTHECOPES
2.1 WhatistheCOPES?
TheCommunityOriented Programs Environment Scale (COPES;Moos, 1974,1988,
1996,2003) isoneof thenineSocialClimateScalesdevelopedbyRudolfH.Moos.
These Social Climate Scales were developed gradually in the United States. The
COPESarearesultofavery longandcomplexresearchprocessofRudolfH.Moos.
Thisprocessisnicelysummarized inajournal interviewfrom2008.Inthis interview
(Journal Interview,2008),Moos states thathewas fascinatedby thepersonality
theoryandpsychoanalytical thinkingwhichposited thatone couldunderstandand
predictwhat
individuals
would
do
on
the
basis
of
their
personal
predilections
and
characteristics.Moos,however,doubtedthesetheories.Hethoughtthatthesetheo
riesoverlookedtheroleofenvironmentandsocialcontextasakeyinfluenceonhu
manbehaviour.TheseideasformedthebasisofMoosdevelopmentofmeasuresto
assess treatment environments. His first focus was on hospitalbased substance
abuseandpsychiatric treatmentprograms.Another importantdecisionMoos took
during thedevelopmentof themeasureswas toassess treatmentenvironmentsas
patients and staff perceived them. Quickly, the research expanded to community
programs,in
which
was
found
that
residents
and
staff
perceived
apparently
similar
communityprogramsquitedifferently.Themain ideaofthewholeresearchproject
was that treatmentenvironmentsarecomposedof threemainsetsofdimensions:
relationshipdimensions,personalgrowthorgoalorientationdimensionsandsystem
maintenancedimensions.Soon, itbecameclearthatthesethreesetsofdimensions
couldalsobeusedtocharacterizeothertypesofsocialsettings,likefamiliesorresi
dentialsettingsforolderadults.
Inthe
context
described
above,
Moos
thus
developed
the
Social
Climate
Scales
in
the
late1960sandthe1970s.TheseSocialClimateScalesoperationalizeandmeasurethe
underlyingdimensionsofdifferentkindsofsocialsettings.ThenineScales,whichare
partofthisassessment,arelistedbelow(figure1).
8/10/2019 The Community Oriented Programs Environment Scale
11/51
4
Figure1.TheSocialClimateScales.
TheCOPES isthefirstscale inthisfigure,situated inthe listofCommunitysettings.
The intentionoftheCOPES istomeasuretheactual,preferredandexpectedtreat
mentenvironment
or
social
climate
of
community
treatment
programs.
Moos
(1972)
himselfsummarizesitasascalewhichattemptstosystematicallyassessthepsycho
social environments of transitional community oriented psychiatric treatment pro
gramssuchashalfwayhouses,rehabilitationcenters,daycarecentersandcommuni
tycarehomes.Itisusedtomeasuretheopinionsofbothserviceusersaswellasstaff
involvedincommunitytreatments.TheCOPESconsistofthreedimensions,eachcon
sisting of underlying subscales. The Relationship Dimension consists of three sub
scaleswhichmeasureInvolvement,SupportandSpontaneity.ThesubscalesAutono
my,Practical
Orientation,
Personal
Problems
Orientation
and
Anger
and
Aggression
makeupthePersonalGrowthDimension.Threeothersubscales,OrderandOrganiza
tion,ProgramClarityandStaffControlarethesubscalesoftheSystemMaintenance
Dimension. Important inthiscase is thatMoosandSchwartz (1972)andMoosand
Petty (1971)have shown that thedimensionsare related toobjective indicatorsof
treatmentoutcomesuchasdropoutrate,releaserateandcommunitytenure.Inthe
tablebelow,thereisanoverviewofthementioneddimensionsandsubscales.
8/10/2019 The Community Oriented Programs Environment Scale
12/51
5
Table
1.
The
COPES:
Dimensions
and
Subscales.
Relationship Dimensions
1. Involvement (I)
2. Support (S)
3. Spontaneity (Sp)
Personal Growth Dimensions
4. Autonomy (A)
5. Practical Orientation (PO)
6. Personal Problems Orientation (PPO)
7. Anger and Aggression (AA)
System Maintenance Dimensions8. Order and Organization (OO)
9. Program Clarity (PC)
10. Staff Control (SC)
Inorder tomeasure theactual,preferredandexpected treatment, theCOPEShas
threedifferent formsofassessment.TheRealFormmeasuresmembersandstaffs
viewofthecurrenttreatmentprogram.Toassessindividualspreferencesaboutideal
communityoriented treatmentprograms, the IdealForm isused.The third form is
theExpectationsForm,whichmeasures individualsexpectationsaboutatreatment
programtheyareabouttoenter.Eachoftheformsconsistsof100questions,which
aretobeansweredwithtrueorfalse.Theformsaretobefilledoutbyusersandstaff
oftheprogram.
TheCOPES canalsobeused formore variedpurposes.Moos (1972) says that the
COPESmayidentifythoseindividuals,bothusersandstaff,whoshowdeviantpercep
tionsoftheirenvironment.OtherpurposesoftheCOPESaredescribedinthemanual
(Moos,2003):
Inaddition, researchers use the COPES to describeand compare treatment
programs,examinethedeterminantsoftreatmentclimates,andfocusonthe
connectionsbetweentreatmentclimatesandoutcomesforindividualmembers
andstaffandgroupsofmembersandstaff.
8/10/2019 The Community Oriented Programs Environment Scale
13/51
6
2.2 MeasuringsocialclimatewiththeCOPES
AstheCOPESisoneoftheSocialClimateScales,itsmaingoalistoexaminethesocial
climate inacommunitytreatmentprogram.TheauthoroftheCOPES (Moos,1974;
1988;
1996;
2003)
constructed
a
conceptual
framework
about
the
relation
between
programandpersonal factorsand clientsoutcomes (figure2). From themodel, it
becomesclearthattherearedifferentdomainsofvariablesthatshouldbe included
inacomprehensiveevaluation.
Themodelisbasedontwomainconcepts(panelIandpanelII),whichareinfluenced
bythreeintermediatefactors.Thefirstpanelcontainstheobjectivecharacteristicsof
theprogram.These includetheaggregatecharacteristicsof residentsandstaff,the
programsinstitutionalcontext,thephysicaldesignofthesetting,andtheprograms
policies and services. In panel II, there are personal factors such as clients socio
demographic characteristics,health, cognitive status, functionalability, andprefer
ences.As shown in themodel, these twomain concepts influenceeachother.For
example,inthecontextofchildwelfareinstitutions,childrenwhoareatalowercog
nitive levelwillbe inanothereducationalprogramthanpeerswithmoreadvanced
cognitiveabilities.
Thesocialclimateisanoutgrowthofobjectiveenvironmentalfactors,butitalsome
diatestheir
impact
on
clients
function.
Still,
social
climate
is
placed
in
aseparate
panel,forhighlightingitsspecialstatus.Inaddition,accordingtoMoos,socialclimate
canbeassessedatboththeprogramandtheindividuallevel.
8/10/2019 The Community Oriented Programs Environment Scale
14/51
7
Figure
2.
A
model
of
the
relationship
between
program
and
personal
factors
and
resident
stability
andchange.
Theobjectiveenvironmental factorsandpersonal factorsalsocombineto influence
clients inprogramoutcomes(panel IV)andtheiradaptation(panelV).Examplesof
inprogramoutcomesareclientssatisfaction, interpersonalbehaviourandprogram
participation.Theseoutcomesinfluencethecommunityadaptationasclientshealth
status,socialandworkskillsandpsychosocialfunctioning.Inturn,clientsadaptation
isalsoaffecteddirectlybystablepersonalfactors.
Moos&Lemke(1996)statethatthemodelhighlightsthefactthatanenvironmental
featurecanvary intheway itaffectsdifferentresidents. Inpanel I, themodelalso
incorporatesthecharacteristicsofthestaffandhowstaffinfluencethesocialclimate
andclientsinprogramandcommunityadaptation.
Panel I
OBJECTIVE CHAR-
ACTERISTICS OF
PROGRAM
Panel II
PERSONAL FAC-
TORS
Panel V
CLIENTS
COMMUNITY
ADAPTATION
Panel IV
CLIENTS
IN-PROGRAM
OUTCOMES
Panel III
SOCIAL CLI-
MATE
8/10/2019 The Community Oriented Programs Environment Scale
15/51
8
2.3 HowistheCOPESusedintheResearchProgram?
In theprojectdescribed in the introduction, Mentalhealthofchildrenandadoles
cents inchildwelfare institutions,theCOPES isoneofthequestionnairesthat isto
be
completed
by
the
participating
adolescents
and
leaders
of
the
institutions.
The
list
ofallusedinstrumentscanbefoundbelow(table2).
Table2.Overviewoftoolsusedintheresearchproject.
Tests and questionnaires Area Informant
CAPA Child psychiatric interview Young person
CANTABeclipse Neuropsychology Young person
WASI Intellectual ability test Young person
Supplementary interview of
the young person
Care/school/treatment Young person
Questionnaire SDQ Emotional/behavioural
problems
Young person
SPPA Self-image Young person
DERS Emotion regulation Young person
KINDL Quality of life Young person
SSQ Social support Young person
SSRS Social functioning Young person/teacher
COPES Institutional environment The young person/institution
represented by head
Questionnaire about the insti-
tution
Objective information Institution represented by head
Interview about the young
person
ADHD/attachment disturbance/
Asperger
Institution represented by head
Questionnaire CBCL Mental health Institution represented by head
KINDL adult Quality of life Institution represented by head
Questionnaire TRF School - mental health Teacher
SSRS/Social Coping Social skills Teacher
Psychosocial difficulties Psychosocial difficulties Teacher
TSRI Teacher/student relationship Teacher
8/10/2019 The Community Oriented Programs Environment Scale
16/51
9
Asnotedabove,therearethreeformsoftheCOPES(real,idealandexpected).Inthis
project,onlytherealformoftheCOPES isused.This isbecausetheprocedurealso
includesalotofotherquestionnaireswhicharetobeansweredbythechildrenand
the institution leaders.Therealform,which isabouttheperceivedsocialclimate in
theinstitution
at
that
particular
moment,
is
of
most
relevance
for
the
project.
TheCOPESwasoriginallydevelopedinEnglishbuthasnowbeentranslatedtoother
languages,includingNorwegian.TheNorwegiantranslationwasdoneasapartofthe
researchprojectonmentalhealthofchildreninchildwelfareinstitutions.Thetrans
lationfollowsascloselyaspossibletheoriginalEnglishversion.
ThechoiceofusingtheCOPESintheprojectwasmadebyprofessorMathewColton,
whowasthenaresearcherattheRegionalCentre forChildandAdolescentMental
Health.Hehasdoneextensive researchabout socialenvironmentsand considered
theCOPEStobeanadequatetoolfor investigatingchildrenandstaffsperspectives
about their institutional environment. In his research about foster and residential
childrens perceptions about their social environment,Colton (1989) used a Social
ClimateQuestionnaire (Heal, Sinclair& Troop, 1973) to investigate childrens per
spectives. This questionnaire was similar to the COPES. It is a bit shorter and
measuresslightlydifferent,yetrelateddimensions.Theauthorsofthisquestionnaire
alsoexplain
that
16
of
the
47
items
have
been
taken
more
or
less
verbatim
from
Moosquestionnaire.TheSocialClimateScaleofHeal,SinclairandTroop(1973)also
have other similaritieswithMooswork. The instrument consists of simple state
ments thatmustbe ratedwith trueor falseandthequestionnaire ismeasuringsix
subscales, including Staff Support, Strictness, Satisfaction,Boy Friendliness,Behav
iourandWork.
Data collection in the project has been done by research assistants, who travel
aroundNorwaytointerviewchildrenininstitutions.Therewereoriginallythreeassis
tants,butonenolongerworksontheproject.Theyadministerallthequestionnaires
intwodaystobesurethechildrenarefocusedduringthewholetest.TheCOPESis
thesecondinstrumentusedbecauseitisoneofthelongestinstruments.Theproce
dureismostlythesamewithallthechildren.First,theassistantstrytohelpthechil
drentofeelcomfortableandtalkalittlebitwiththemabouttheirlifeintheinstitu
tion.Theythengiveashort introductiononthetests. In this introduction,theyex
plainthatthequestionnaireisabouttheinstitutionandtheyclarifythetrueorfalse
answer
choices.
Most
of
the
children
fill
in
the
questions
by
themselves.
If
they
are,
however,notabletoreadthestatementscarefullyenough,theassistantsreaditfor
8/10/2019 The Community Oriented Programs Environment Scale
17/51
10
them.Duringthetest,childrenareallowedtoasktheresearchassistantsquestions.If
theydontunderstandaparticularwordorquestion,theassistanttriestoexplainit
forthem.Also,ifthechildrenarestruggling,theassistantstrytomotivatethem.They
clarifythatitsabouttheviewofthechildhimself,notaboutgeneralfeaturesofthe
institution.If
the
children
dont
want
to
answer
acertain
question,
the
assistants
dont force them.Thoseblankquestionswillbeanalysedasmissing variables.The
leadersofthe institutionsarealsoaskedtofill intheCOPES. Inthiscase,theassis
tantsarenotpresentduringthetest.The leadersreceivethequestionnairebymail
andhave to send itbackwhencompleted.Theydonthave theopportunity toask
questions,ortogivecomments. Ittakesapproximately15to20minutestoanswer
therealformoftheCOPES.
8/10/2019 The Community Oriented Programs Environment Scale
18/51
11
3 FOCUSONRELATIONSHIPDIMENSION
Intheprevioussection,theCOPESanditsuseintheresearchprojectweredescribed.
Aspreviously
discussed,
Moos
sees
the
three
dimensions
of
the
COPES
as
acharac
teric featureofdifferentsocialsettings.The firstdimensionof theCOPESconcerns
staffandchildrensviewsondifferentaspectsof relationships in the institution. In
thissection,wewillfocusonthisdimensionbyreviewingrecentliteratureaboutits
underlyingconcepts,situatedinthecontextofresidentialcareandinstitutions.There
are threemainsubscales in theCOPES thatconstitute the relationshipdimensions.
TheseareInvolvement,SupportandSpontaneity.QuestionsintheCOPESconcerning
Involvementaresupposedtomeasurehowactiveandenergeticyoungpeoplearein
theprogram.Anexampleofaquestioninthissubscaleisifmembersputalotofen
ergyintowhattheydoaroundtheinstitution.ThesubscaleSupportintendstoassess
howmuchyoungpeoplehelpandsupporteachotherandhowsupportivethestaff
are towardsyoungpeople.Oneof thequestions in this subscale is if thehealthier
youngpeoplehelptakingcareofthelesshealthyones.Anotheraspectthatismeas
uredishowmuchtheprogramencouragestheopenexpressionoffeelingsbyyoung
peopleandstaff.ThisthirdsubscaleiscalledSpontaneity.Anexampleofaquestion
inthissubscale is ifyoungpeopletendtohidetheirfeelingsfromoneanother.We
willdiscussthesethreesubscales(table3)below.
Table
3.
The
COPES:
Relationship
Dimensions.
Relationshipsarecrucialwhenitcomestoresidentialcare.Itcanbeareasonforchil
drentoenterspecialcarefacilitiesduetoadysfunctionalrelationshipwiththeirpar
ents,orbecausetheycannotmakeadequatecontactwithpeers.Therefore,itisim
portantthatchildreninresidentialcarecanbuildsolidandhonestrelationshipswith
theirstaff.
As
the
COPES
measures
childrens
and
staffs
perspectives,
it
is
important
Relationship Dimensions
Involvement (I) How active and energetic young people are in the program.
Support (S) How much young people help and support each other and how sup-
portive the staff are towards young people.
Spontaneity
(Sp)
How much the program encourages the open expression of feelings by
young people and staff.
8/10/2019 The Community Oriented Programs Environment Scale
19/51
12
tofocuson literaturethatreviewschildrenandstaffsviews.AsthestudyofDavies
andWright (2008) confirmed, children in care are able to commenton their own
therapyandexperienceofmentalhealthservices.Itisoftenforgottenthatevenvul
nerablechildrenwithsupportarecompetenttodothis.
3.1 Involvement
Perspectivesofmembers and staff concerning involvement in treatmentprograms
vary across different literature sources.Mostly, it is found that clients value non
verbal interactions more than group activities. However, they do think relational
componentsareofgreat importance intreatmentprograms. Inwhat follows,some
differentviews
of
clients
are
described.
It isquiteremarkablethatBiancosino,Barbui,Pera,Osti,Rocchi,MarmaiandGrassi
(2004),whoadministeredtheOpinionsonCurativeFactorsQuestionnaire(OCFQ)to
asampleof157severelyillpsychiatricpatientsinthenorthofItaly,foundthatclients
in residential psychiatric care considered verbal group activities as being not that
helpful.Thepatientsinthisstudywereaged21to77yearsold.Inthisinvestigation,
the lowestranked interventioncomponentsweredailymeetingsontheward,com
munitymeetings,
treatment
team
meetings
and
group
therapy.
From
this
study,
it
seems likepatientsdonotappreciatejointcommunityactivities.Theauthors think
thismightbebecausetheseaspectsdonotallowcohesivegroupstodevelopanddo
notallow individualproblems tobeaddressed.Patientsdescribed,however,other
specificmodalitiesof treatment as veryhelpful. Thesewere talkingwithadoctor,
medication,visitors,nonhospitalsettingandfreepass.Theauthorsdefinetheseas
pectsas theones thatoffer theclientsahomelikeenvironment. In this study it is
concluded thatpsychiatricpatients rate factorsbasedon individual approaches as
veryhelpful,
as
well
as
aspects
of
the
therapeutic
milieu
that
assure
few
restrictions,
no stigmaand interactionswith theoutsideworld.Thoughmostof thepatients in
thisstudywereolderthentheyoungpeopleinourstudy(1223years),thereissome
overlap inageandtherefore it ischosento includethisstudy inthisreport.Similar
findingsaredescribedinthestudybyDaviesandWright(2008;seefurther),inwhich
childrenacknowledgethevalueofnonverbalinteractions(e.g.drawing,playing).
Only fewstudieswere foundwhichexaminedtheviewpointofchildrenthemselves
specifically
on
the
involvement
in
treatment
programs.
Aubrey
and
Dahl
(2006)
re
vealthatthosemakingdecisionsabouttheirlivesdonotalwaysaskchildrenfortheir
8/10/2019 The Community Oriented Programs Environment Scale
20/51
13
views.However,Mason (2008)statesthatchildren from8to18years inAustralian
outofhome care emphasise the importance of being able to influence and have
somecontroloverconnectionswithothersandthewaytheylivetheirlives.Mullan,
McAlister,RollockandFitzsimons (2007) reportthat lookedafterchildren inNorth
ernIreland
(12
to
25
years
old)
sometimes
see
talking
with
staff
as
apositive
mean
of
copingwithdifficult feelingsandsituations. Inthisstudy,theyoungpeoplealsore
portedseveral factors thatare important foragoodcareexperience.Forexample,
theadolescents saw supporting family relationshipsandhavinganumberofother
social relationshipswhile in care as being very important. In the following section
aboutsupport,itwillbecomeclearthatthisisarecurringfindinginliterature.
Concerningtheinvolvementinprograms,youngpeoplewereverycriticalofmanyof
thepolicies,
procedures
and
the
rules
in
the
residential
care
facility.
They
all
experi
encedLACreviews1asverynegativetothemselves.Manyyoungpeoplequestioned
thenecessityofalltheexistingproceduresandpolicies,becauseitoftentakesaway
theirsenseofnormality.Nexttothisdoubtaboutpolicyandprocedures,theyoung
people state that leisure space; time and activity are valuable for good emotional
health.Italsoprovidesasenseofachievement,whichisimportantforchildrenwith
low selfesteem.Obviously, stabilityofplacementwasalso an important aspect in
thechildrenslife.
DaviesandWright (2008) found that lookedafter childrendovaluemeaningful in
volvement in their therapy, and that they want a voice in decisions about their
treatment.Theyreviewed14articlesaboutchildrensexperiencesofmentalhealth
servicesintheUK.Thestudywasbaseduponthevoicesof200childrenofdifferent
ages. Itbecameclearthatchildrencouldmeaningfullycommentonthetherapeutic
process, identifyingaspectsthattheyfeltwerehelpfulandunhelpful, includingpar
ticulartechniques.Aconsistentfindingacrossmodalitiesandagegroupswastheval
ueof
non
verbal
interactions
to
be
engaged
in
therapy.
For
many
children,
the
au
thors say, talking is a sourceof challenge anddiscomforteven though it could be
helpfulandvaluable.Inpractice,nonverbalcommunicationsaremostlyseenasob
vious and neglected, instead of being a central therapeutic activity. As it is now
shown thatyoungpeople (Biancosino,Barbui,Pera,Osti,Rocchi,Marmai&Grassi,
2004) as well as children value this type of intervention, it is important to
acknowledgethisthemeinthetrainingofmentalhealthprofessionals.
1LAC
reviews:
A
Looked
After
Child
(LAC)
Review
is
ameeting
to
discuss
the
care
of
ayoungster
in
an
institu
tion.Themeetinglooksatthepracticalarrangementsforthechildandmakesplansforitsfuture.
8/10/2019 The Community Oriented Programs Environment Scale
21/51
14
Thatchildrenandyoungpeoplearemoreinterestedin informalprocessesbasedon
personalrelationshipswithcarerstheyknowandtrustratherthaninformalprocess
es isalsodescribedbyCashmore (2002).Herarticleaboutpromotingtheparticipa
tionofchildrenandyoungpeople in care reviews research literature from theUK,
NorthAmerica,
Australia
and
New
Zealand.
She
says
that
children
are
not
seeking
selfdeterminationortocontrolthedecisionmaking;theydo,however,wanttobe
informedandinvolvedintheprocess.
From literature, it isquiteclear thatpatientsvalue relationalcomponentsof treat
mentprograms.Supportfromstaffseemstobeasignificantcomponentforsuccess
intreatmentprograms(cfr.nextsection).Specificallyconcerningtheinvolvementof
clientsinaprogram,thereviewedliteraturesuggeststhatchildrenandyoungpeople
incare
generally
wish
to
be
more
involved
than
they
usually
are
in
the
way
decisions
are made about them. Cashmore (2002) adds that they especially like to decide
where they live and how often they can see familymembers.Weve also shown
abovethatclientsprefera lessrestrictivesetting, forexample freewalking,visitors
andhavingfreeholidays.
3.2 Support
Itisquitecommontoreadinliteraturethatchildreninresidentialcarecitetheposi
tive relationships with staff as central to their care experience (Mason, 2008;
Kendrick,Steckley&Lerpinier,2008).Somestudiessuggeststhattherapeuticorienta
tion might be secondary to other factors in identifying effective therapies (Stiles,
Shapiro & Elliot, 1986). Being heard and understood by staff might be more im
portant to children than therapeutic responsiveness (Davies&Wright,2008).With
this inmind,the investigationofthe relationshipbetweenstaffandusersbecomes
moreimportant,
because
negative
relationships
in
mental
health
institutions
can
have negative consequences for both staff and children. Rose, Madurai, Thomas,
DuffyandOyebode(2010)foundoutthatthereexistsasignificantrelationbetween
someburnoutand reciprocitymeasures.Negative relationships canbeharmful for
children too, since there is evidence that some children and adolescents aremal
treatedbytheircaregiverswhileinstatecare(AttarSwartz,2011).
In this section, the perspectivesof children are discussed first, followed by staffs
views.
Gallagher
and
Green
(2012)
interviewed
16
young
adults
who
had
been
placed
inatherapeuticchildrenshomeinEngland.Mostofthechildrenweremaltreatedin
8/10/2019 The Community Oriented Programs Environment Scale
22/51
15
earlychildhood,sotheysometimesdisplayedattachmentissuestooneorbothpar
ents. In general, theadolescentswerepositive about their relationshipswith staff
andthecontacttheyhadwithstaffafterleavingtheinstitution.Acrucialfindingwas
thatallofthe16participantsstatedthattheyhadbeenabletoformapositiverela
tionshipwith
at
least
one
member
of
staff.
The
authors
note
that
it
is
possible
for
these children to establish positive relationships with staff. The interviewees de
scribeda lotofbenefits from the relationships, including feeling safeor cared for,
havingapersonwhomtheycouldtalktoorplaywith,trustand friendship.Several
adolescentsindicatedthattherelationshipwiththestaffhelpedthemdealwiththe
emotionalandbehaviouralchallengestheyhadfaced.AnotheraspectGallagherand
Greenstudied,wastheremainingcontactwiththestaff,aftertheyoungadultshad
lefttheinstitutions.Theydiscoveredthat14ofthe16participantswerestillintouch
withatleastonememberofstaff,afteronaverage5,9yearssinceleavingthehome.
Theauthorsconcludethatisitveryclearthatrelationshipscanhaveaprofoundrole
inthelivesofchildreninresidentialcare.
Asalreadystated inthesectionabout involvement,Mullanetal. (2007)foundthat
supportfromfamilyandcareworkersisthemost importantforagoodcareexperi
ence,accordingtoyoungadultsinresidentialcareinIreland.Therewas,however,a
discrepancyinwhomtheadolescentssawasmostimportantandwhomtheysawas
mostsupportive.
Mostly
the
foster
carers,
key
workers,
co
workers,
aftercare
work
ers,teachers,siblingsorfriendswereidentifiedasmostsupportive.Theyoungpeo
pledescribeddifferentaspectsofasupportiverelationship,suchastheworkerknow
ingtheyoungpeoplewell,beingopenandfriendlyandbeingableandwillingtolis
ten.
Inadditiontotheexperiencesofchildren,itisalsoimportanttolookattheviewsof
leadersandstaffaboutsupportiverelations in institutions.Hicks(2008)studiedthe
roleof
leaders
in
childrens
homes
in
the
UK.
It
was
revealed
that
it
is
crucial
in
chil
drenshomesthatthemanagerisacceptedasembodyinggoodpracticefromwithin
a clear ethos and had positive strategies forworking both with the behaviour of
youngpeopleandinrelationtotheireducation.Thestudyalsofoundthatthewayin
whichtheroleofmanageriscarriedoutisvitallyimportantintermsoftheoutcomes
experiencedbyyoungpeople.
Rose,etal.(2010)askedstaffmembersintheUKtoreporttheirperceivedreciprocity
in
the
relationship
they
had
with
service
users,
other
staff
and
the
organisation
they
workedfor.Theresultsshowedthatmostoftheresidentialcareworkersperceived
8/10/2019 The Community Oriented Programs Environment Scale
23/51
16
themselvesasinvestingmoreintherelationshipwiththeserviceusersthantheyre
ceivedinreturn.Thestaffreportedthattheyexperiencemostreciprocitywithother
staffworkers,morethenwiththeserviceusers.Theorganisationalrelationshipwas
theoneinwhichtheyreportedthattheyexperiencedtheleastreciprocity.
3.3 Spontaneity
IntheCOPES,thelastsubscaleoftherelationshipdimensionmeasureshowmuchthe
programencouragestheopenexpressionoffeelingbymembersandstaff.Theques
tionsinvestigateforexamplehowopenlychildrendaretotalkabouttheirfeelingsto
stafforhowoftenchildrencandowhattheyfeellike.Wefoundlittleliteratureabout
feelingsand
emotions
in
child
welfare
institutions.
Most
articles
concern
organisa
tionalandpracticalissues,ratherthantalkingaboutchildrensandstaffsfeelingsand
emotions.Itisprobablyadifficultissuetoassessinthefield.Also,whilereadingarti
clesaboutrelationshipsbetweenstaffandusers,itwasnoticeablethatpeopledont
mind talkingabout the relationship itself,but theaspectof the feelings theyhave
aboutcertain relationships ismostly leftunspoken.However,a fewarticlesdo talk
brieflyaboutthissubject.
Inthe
study
of
Mullan,
et
al.
(2007),
which
was
referred
to
before,
issues
of
confiden
tialitybetweenmembersandstaffarealsodiscussed.Theyoungpeopleinthestudy
werebetween12and17yearsoldandLookedAfteroraged18 to25yearsand
entitledtoLeavingCareServices.TherewerefourcareservicesinvolvedinNorthern
Ireland, resulting inaparticipantgroupof51youngsters.Theyoungpeople in the
studydemonstratedakeenunderstandingof the importanceofconfidentiality, the
authors say.Some felt thatproblemshadarisendue theprocessof confidentiality
notbeingadheredtoandthustrustbeingbreached.Youngpeoplefeltthattheshar
ingof
information
needed
to
be
more
explicit
regarding
what
the
person
was
passing
on, towhomandwhy.They stated that trust thathasbeenbreachedhadadetri
mentaleffectonthelikelihoodofsomeyoungpeopleopeningupagain.Theauthors
alsoaddthatsomeprofessionals,inordertoprotectthemselves,mayfeelthatthey
have topassall informationon.But therehas tobeanopportunity for theyoung
peopletotalkaboutconfidentialinformationinprivate.Theauthorsthussaythata
greatertrustandresponsibilityneedstobegiventoprofessionalstousetheirprofes
sionaljudgementmorefreelyinkeepinginformationprivateandconfidential.Mullan,
etal.
(2007)
conclude
that
the
most
clear
message
of
their
research
is
the
need
to
8/10/2019 The Community Oriented Programs Environment Scale
24/51
17
understand attitudes, experiences and behaviours of the young peoplewithin the
contextof their lives.Theyoungpeople in carehaveemotionalneeds,yet the re
searchhas shown that theirexperiencesbefore care,duringcareand indeedafter
careintensifythoseneeds.
Inaliteraturereviewaboutpromotingtheparticipationofchildrenandyoungpeople
incare,Cashmore (2002)quotes some remarkable statements fromchildrenabout
supportandtrustincare.HerreviewconsistsofliteraturefromtheUK,NorthAmeri
ca,AustraliaandNewZealandandexplores theperceptionsof childrenandyoung
people incareconcerningtheextenttowhichtheyhavebeenabletoparticipate in
decisionsthataffectthem,thereasonstheywanttodoso,andwhat isrequiredto
make iteffective.Cashmore(2002)statesthat inanumberofstudies,childrenand
youngpeople
have
said
they
want
agenuine
and
personal
relationship
with
a
workerwhocaresaboutyou, listensandactuallyknowswhoyouare,someone
whodoesntthinktheyknowwhatsbest,justbyreadingthefile.
IntheliteraturesynthesisofDaviesandWright(2008)itbecomesalsoclearthatstaff
sometimes does not take the feelings of children seriously. When children were
askedforsuggestionsandimprovementsintheirtherapeuticprogram,theyempha
sisedthattheywanttheirsuggestionstobereceivedwithduerespectandconsidera
tion.The
children
also
considered
trust
and
adegree
of
control
in
choosing
what
to
talkaboutashelpfulforfacilitatingcommunicationwithcaregivers.
Ifwewanttoevaluatehowstaffthinkaboutspontaneityincaringrelationships,itis
importanttomentionthatstaffwillalways lookattherelationshipfromadifferent
perspective.Bickmanetal.(2004)saythatthis isalwaysthecase,regardlessofthe
duration of the relationship or the frequency of contact between both parties.
Vanderstraeten and Standaert (2008) investigated the experience of the relations
betweenyoungpeopleandstaffinguidancehomesinBelgium.Theyfoundthatstaff
mostly say that theyexperiencea good relationshiporeven a therapeutichelping
relationshipwiththeadolescent,whiletheadolescents incontrastsaythattheyex
periencenofeelingofarelationship.
Another important feature of spontaneity in a relationship is the degree of self
disclosure both the parties of the relationship allow. More indepth information
aboutthissubjectcanbefoundinthestudyofBurkard,Knox,Groen,PerezandHess
(2006). In the lightof staffperspectives, it is interesting to read in this study that
therapistsreported
self
disclosure
as
improving
the
therapeutic
relationship.
Thera
8/10/2019 The Community Oriented Programs Environment Scale
25/51
18
pistsalsotypicallyreportedthattheselfdisclosurehelpedclientstofeelunderstood
andallowedclientstoadvancetootherissuesinpsychotherapyorintheirlives.
8/10/2019 The Community Oriented Programs Environment Scale
26/51
19
4 THE USE OF THE COPES WITH CHILDREN AND YOUNG
PEOPLE
4.1 StudiesusingtheCOPESwithadolescents
Asdiscussed in the firstchapter,Moosoriginal targetgroup for theCOPESwason
substanceabusingadolescents.However,MooswritesinthemanualthattheCOPES
canbeused inabroad rangeof community treatmentprograms.Wedidnot find
many studies inwhich theCOPES isusedwith children.Mostof the literaturewe
foundontheCOPESandyoungpeople, isaboutadolescents inadrugabusetreat
mentprogram. In thisproject,however, the interest isonchildren inchildwelfare
institutions.Some
studies
on
the
COPES
in
this
setting
(residential
care)
were
found
(table4),although this cannotbeanexhaustive list.Theoverview isbasedon the
bibliographybyMoos(2006)andourownlimitedresearch.Theonlyinclusioncriteria
were that the studyhas tobeaboutchildrenoradolescents,and that thestudy is
about residential care services.However,mostof the settings in these studiesare
large group home settings, not only consisting of young people. Brunt and Rask
(2012)mentionthatthereareonlythreestudies,reported in internationaljournals,
thathavebeenperformedwiththeCOPES insupportedhousing/smallgrouphome
settings.Inthetablebelow,thosearemarkedwithanasterisk(*).
8/10/2019 The Community Oriented Programs Environment Scale
27/51
Table4.StudiesabouttheuseoftheCOPESwithyoungpeopleinresidentialcare
Study Sample Institution type Use of the COPES
Brunt & Hansson
(2002a) *
33 persons
aged 18 to 55
Group homes As part of research
by local authorities
illness the characte
ment was investiga
sions of the Commu
ronment Scale (CO
residents and staff
county in southern S
Brunt & Hansson
(2002b) *
51 persons
aged 18 to 55
Group homes The study showed
ronment differs betw
Residents and staf
dences rated higher
er levels of Practica
gression and Orde
tients and staff in inp
8/10/2019 The Community Oriented Programs Environment Scale
28/51
21
Cavicchia (1983) Adolescent group
homes
Disagreements betw
administrators helpe
levels of intrastaff an
Friedman, Glickman &
Kovach (1968a)
482 adoles-
cents
Residential drug abuse
programs
Compared to clients
grams, clients and
rated them as m
structured and as hi
al problem orientatio
anger. Staff in both
appraise the treatm
tively than clients drated the program e
than women staff.
reports of woman
similar to the reports
Friedman & Glickman
(1987)
2500 adoles-
cents
Residential drug abuse
programs
More successful pro
lors as more sponta
open expression ofphasis on client inde
8/10/2019 The Community Oriented Programs Environment Scale
29/51
22
Gilmour-Barrett (1974) Residential centres for
disturbed youth
There were strong c
COPES relationship
workers reports of
with the youth.
Golden (1974) Psychiatric halfway
house for adolescents
The real and ideal
used to help improv
way house for adole
Johnson (1981) 3 groups of 15
staff
Residential cottages for
emotionally disturbed
adolescents
Staff group cohesion
degree of support,
personal problem ortreatment environme
hesion was negativ
staff control. High s
sary to foster ther
milieus.
Kohn, Jeger & Koretzky
(1979)
320 adoles-
cents
Treatment centre for
emotionally disturbedand delinquent adoles-
cents
Principal componen
sets identified two versus disinterest a
ganisation.
8/10/2019 The Community Oriented Programs Environment Scale
30/51
23
Lemke & Moos (2002) 432 young or
middle-aged
patients
Residential alcoholism
treatment programs
Older patients repo
port and organizatio
gression, than thei
Overall, patients wh
the program had b
This was as true for
younger patients. Th
patients with alcoho
ed in age-integrat
treatment milieu so
middle-aged and y
spond similarly to th
McKinney (1987) Group home The adolescent clie
programs emphasiz
staff control. Compa
institutional facility h
anger and less pers
olescents and their
agreed closely on therage, they saw it a
ward achievement,
and a moral religious
8/10/2019 The Community Oriented Programs Environment Scale
31/51
24
Middelboe (1996) * Group home Descriptive study in
Morehouse & Tobler(2000)
232 adoles-cents
Residential program According to the Clow to moderate em
mensions, on auton
and on order and
emphasis on the e
control. Overall, the
tive social climate th
specifically, staff r
support, order, and cdifferences in social
those that were m
youngsters alcohol
rienced and stable
have a more positive
Phillips, Coughlin, Fix-
sen, & Maloney (1979)
Boys home The COPES showed
itive changes (that
came closer to the "
group home environ
8/10/2019 The Community Oriented Programs Environment Scale
32/51
25
Rivard, Bloom,
Abramovitz, Pasquale,
Duncan, McCorkle &
Gelman (2003)
61 adolescents Residential program The programs wer
Model, which posits
to occur within the
stable, and socially
munity. Consistent
pared to standard re
tuary Model progra
ment, support, spon
entation, and a safe
tuary specific ideals.
Rivard, J. C., Bloom, S.L., McCorkle, D., &
Abramovitz, R. (2005).
87 adolescents Residential program The two groups of rrable at baseline; ho
the Sanctuary Mode
port, spontaneity, a
orientation, and a s
Models specific goa
ings, youth treated
developed a strong
and less antagonisti
8/10/2019 The Community Oriented Programs Environment Scale
33/51
26
Schneide, Kinlow, Gal-
loway & Ferro (1982)
10 adolescents Group home Both youths and sta
in their homes as m
ideal teaching famil
gram change. In ess
a more open, yet mo
Shinn (1982) Group home The process was su
tions of program cli
showed reliable imp
to their own baselin
homes. However, thto individual outcom
not affected. The pro
stable homes where
trol over important d
tive evaluation effor
responsive to the c
bers and instill prob
in participants.
8/10/2019 The Community Oriented Programs Environment Scale
34/51
27
Shinn, Perkins & Cher-
niss (1980)
Group home Staff perceptions o
mental homes show
time relative to the
one successful hom
were greater on d
during the developm
sions not so targeted
8/10/2019 The Community Oriented Programs Environment Scale
35/51
4.2 CriticalreflectionofusingtheCOPESwithchildren
Basedupon thepreliminary findingsof thestudy, it isclear that theCOPES isa
veryuseful instrument formeasuring the social climate in childwelfare institu
tions.There
are
only
few
instruments
that
focus
on
the
views
of
both
clients
and
staffon thisbroad rangeofvariables.As theCOPES ismostlyusedwithadults,
therearehoweverafewproblemsthatarisewhenconductingthetestwithchil
drenandyoungadolescents inacareprogram. In thissection,some reflections
onthisaregiven.ThesereflectionscameupwhendoingresearchontheCOPES
anditsuseinthisproject,andareworthwhilecommunicating,inthelightoffur
therresearchwiththeCOPESonchildren2.
InthemanualoftheCOPES,therearenoagerequirementsforthosetakingthe
test.Itsaysthatreadingskillsmustbeonasufficientleveltobeabletoreadand
comprehendthestatements.This isabsolutelyarequirementwhencarryingout
theCOPESquestionnairewithchildren. In this researchproject,notallchildren
hadareadinglevelthatwassatisfactoryforunderstandingthestatements.Inthat
case,theassistantsreadthequestionstothem,whichtakesalotmoretimethan
isusuallyprovided.Also,thechildrencaninterpretthequestionsdifferentlywhen
theyareread tothem.Tobesurethat thetest isobjectivelytaken,allchildren
shouldbe
provided
with
the
same
help
and
conditions.
In
this
project
it
was
de
cidedthatthequestionsshouldbereadtothechildreniftheyarenotabletodo
thatthemselves.Also,whiletakingthetest,childrencanask forsomemoreex
planationaboutthequestionstheydontreallyunderstand.
Inadditiontohavinganadequatereadinglevel,childrenalsohavetobeableto
comprehendthespecificcontentofthequestions. Inthisproject,theassistants
noticed thatsomeof thequestionscontaindifficult language thatmightbe too
complicatedforchildrentounderstand.Thiscanbearesultofthetranslationof
2Apilotstudyhasalsobeencarriedouttofindoutaboutthestrainontheyoungpeoplefromparticipat
ingintheresearchstudy(includingfillingouttheCOPESform),andwhetheranythingcouldbeimproved.
Tenyoungpeople,theirmaincontactpersons,andtheleadersoftwoinstitutionswereinterviewedabout
theirexperiences.Themainfindingwasthatthestudyshouldbereduced insize(fewerquestionstoan
swer), the researchassistantsmustbepresent in theroomwhere thequestionnaires (includingCOPES)
arebeing filledoutby theyoungpeople, so that they can receivehelp/advice, regularbreaksmustbe
included,anditshouldbeconsideredwhetherparticipationinthestudyistoodifficultfortwelveyearolds
(Ulset 2011). After the pilot study several changesweremade in the research procedure including a
changein
the
order
of
filling
out
the
survey
instruments,
in
order
to
ensure
that
COPES
is
filled
out
in
the
beginning,andincludedintheminimumsetofresponsesfromtheyoungpeople.
8/10/2019 The Community Oriented Programs Environment Scale
36/51
29
thequestions intoNorwegian.However, this isprobablynot the case,because
the translationwasdone very accurately,without changing the contentof the
questions.Theassistantsalsoreportthat it ismostlythesamequestions,which
arenotunderstoodbythechildren. Intheoverview(table5)given,thedifficult
statementscanbeidentified,aswellasthereasonwhythechildrendontunder
standthesequestions.
Table
5.
Difficult
statements
in
the
COPES
Allthetopicsmentionedabove,areespecially importantwhenthetargetgroup
containschildrenwithspecialneeds. Inthiscase,youhavetotake intoaccount
thatthosechildrenmightfunctionataloweragelevel.Adaptationsintheproce
durecanbemade,likereadingthequestionstothechildren.Likewise,thedegree
of difficulty of the statements has to be considered for these children. Some
wordsintheoriginalquestionsaredifficulttounderstandfornormallydeveloped
adolescents,sothiscanbecertainlyaproblemforchildrenwith,forexample,in
tellectual disabilities.When using the COPES, it is of great importance that all
childreninresidentialprogramscangivetheirviewsonthesocialclimate.Toen
sure that, someadaptations to theCOPES shouldbemade.However,wemust
addthatmostofthestatementsoftheCOPESareveryrelevantforapopulation
ofchildrenandyoungpeople.Revisionsforchildrenshouldfocusonthephrasing
ofthestatements,aswellasthemethodforanswering.
Anotherissuetheassistantsinthisprojectnoticedisthattheconcentrationofthe
childrencan
sometimes
be
disturbed
during
the
completion
of
the
questionnaire.
Statement Difficulty
11. This is a lively program Language: understanding
of the word lively
20. The staff very rarely punish young people by taking
away privileges
Language: understanding
of the word privileges
75. Young people are taught specific new skills in this
program
Content: understanding the
meaning of the statement
83. Members tend to hide their feelings from staff Content: it cannot be gen-
eralised.
87. Staff here think it is a healthy thing to argue Content: understanding the
meaning of the statement
8/10/2019 The Community Oriented Programs Environment Scale
37/51
30
Itcanbehard forchildrentoconcentratewhilereadingandthinkingabout100
statements.Specifically in thisproject, therewerealsoother tests tobe taken.
Theassistantsmentioned that theyalwaysadminister theCOPESas the second
instrument,because it isa test thatrequiresa lotofeffort fromthechildren in
termsofconcentrationandattention.Becauseofthis,ashortformoftheCOPES
hasbeendevelopedtoenableprogramevaluatorstoobtainamorerapidassess
mentofaprogramstreatmentenvironment.Maybethiscanbeconsideredtobe
amore suitable form for children, so that biases of nonconcentration can be
avoided.However, thismightnotgivea complete representationof the childs
viewanddoesnotsolvetheproblemofthedegreeofdifficultyoftheformulation
ofthequestions.AmethodologicalreviewofthisshortformwasdonebyBrunt
andRask(2012),wherebytheysuggestarevisionforitsuseinsupportedhousing
facilities.
Whenevaluating childrensand youngpeoplesperspectives froman individual
study,itcanbeusefultocomparetheirviewswitharelevantnormgroup.Inthe
researchprojectdescribed inthis report, the initialanalysiswasdoneusingthe
children'srawscores,ratherthanthestandardscoresdevelopedbyMoosandhis
associatesintheUnitedStates.Thenormativesample,asdescribedinthemanual
(Moos,2009), isbasedonover200 communityprograms,mostly from theUS,
andmostly
aimed
at
users
in
psychiatry,
substance
abuse,
homeless
services,
halfway houses and similar programs. The standardized scores based on this
normalpopulationwerenotconsideredtoberelevantforusewithapopulation
ofchildrenandyoungpeopleinresidentialcareinstitutionsinNorway.TheCOPES
manualdoesnotstatespecificallywhichagegroupisusedinthenormativesam
ple,butmanyoftheprogramsappeartobeaimedmainlyatadults.Itisquiteevi
dentthatageisnotthemostimportantfeaturetakenintoaccount,whenmeas
uring the socialclimateofaprogram.Since theCOPESwasused in thecurrent
studytofindoutaboutchildrensviews,itisimportanttocomparethiswiththe
opinionsofchildrenofasimilarage.
Despite thecommentsabove, theCOPEShasa lotofbenefitswhichcannotbe
foundinotherevaluationinstruments.Forexample,theCOPEScanmeasurethe
viewpointsoftheusers,aswellasthoseofthestaff,withthesamequestionnaire.
It isorganised indifferentdimensions,whichprovides theopportunity to com
parethethreemaincomponentsofthesocialclimateofaninstitution.Itisatthe
sametime
possible
to
split
those
dimensions
into
different
subscales
to
look
clos
8/10/2019 The Community Oriented Programs Environment Scale
38/51
31
eratdifferent aspects.Another advantage is that theCOPES includespersonal
factors,aswellasorganisationalfactorsofaprogram.Thequestionnaireincludes
statementsaboutindividualusers,abouttheinteractionbetweenindividualsand
aboutpracticalfeaturesintheinstitution.ThequestionsareansweredonCOPES
with repliesofeither trueor false.This canbe seenasadisadvantage, since it
doesnotallowformoredifferentiatedreplies,butitisalsohelpfulinreducingthe
timerequiredtocompletethesurvey.Theseareonlyafewofthebenefitsofthe
COPES,whichinthisprojectwasfoundtobeveryuseful,whilebearingtheabove
reflectionsinmind.
8/10/2019 The Community Oriented Programs Environment Scale
39/51
32
8/10/2019 The Community Oriented Programs Environment Scale
40/51
33
5 DISCUSSIONANDSUMMARY
Inthisreport,anattemptwasmade todescribetheuseoftheCommunityOri
entedPrograms
Environment
Scale
(COPES;
Moos,
1974,
1988,
1996,
2003)
in
childandadolescentresidentialcareservices.Atfirst,somegeneral information
abouttheCOPESwasprovided.Atheoreticalframework,concerningtherelation
shipbetweenprogramandpersonalfactorsandresidentstability,wasdiscussed
toprovidemoreinsightinmeasuringsocialclimateusingtheCOPES.Afterwards,
theuseoftheCOPESinthecurrentproject:MentalHealthinChildrenandAdo
lescentsinChildWelfareInstitutionswaspresented.
Inthe
second
part
of
the
theoretical
background,
literature
about
relationships
betweenstaffandadolescentsininstitutionswasdiscussed.Thisliteratureisrel
evantasitrelatestothefirstdimensionoftheCOPESwhichfocusesonthreepar
ticularconceptsregardingrelationships Involvement,SupportandSpontaneity.
Findingsaboutthesethreeconceptswerealsodiscussedinthischapter.
In the next section, more information was given about the use of the COPES with
children and young people. First, an overview of studies concerning the COPES
and its use in residential care with children was provided. Second, some reflec-tions on the use of the COPES with children were discussed, based on an inter-
view with the research assistants working on the research project.
Fromliterature,itwasshownthatchildreninwelfareinstitutionsvaluerelational
componentsof treatmentprograms (Mason,2008;Davies&Wright,2008).Alt
houghsomestudiessaythatusersprefernonverbal interactions (Biancosinoet
al.,2004;Davies&Wright,2008),theyalsothinkmeaningfulinvolvementinther
apyis
of
great
importance.
A
recurring
finding
is
that
children
and
adolescents
see
talkingwithstaffandtherelationwiththemasthemostimportantfeatureofres
identialcare(Mason,2008;Mullan,McAlister,Rollock&Fitzsimons,2007;Cash
more,2002).Theyvaluetheserelationshipsmorethanthetherapeuticaspectsof
theinstitution.However,DaviesandWright(2008),pointoutthatthoserelation
shipscannotbeforced.Formanychildren,talking isachallengeandasourceof
discomfort.Nexttothis,anoftenheardcommentoninvolvementisthatchildren
wish tohavemoreparticipation in the, sometimes lifechanging,decisions that
aremade
about
them
(Mason,
2008;
Cashmore,
2002).
8/10/2019 The Community Oriented Programs Environment Scale
41/51
34
Childrenseesupportfromthestaffasbeingveryhelpfultotheircareexperience.
In a lot of studies (Mullan,McAlister, Rollock& Fitzsimons, 2007;Gallagher&
Green,2012),childrenindicatethattheirrelationshipwiththestaffhelpedthem
dealwithemotionalandbehaviouralchallenges.Theyseetalkingwithstaffasa
positivemeansofcopingwithdifficultfeelingsandsituations.Mullanetal.(2007)
gaveadescriptionofwhatyoungpeople seeasa supportive relationship.They
wantthecaregivertoknowthemwell,tobeopenandfriendlyandtobeableand
willingtolisten.Fromthestaffsview,itisfoundthatmostcareworkersperceive
themselvesasinvestingmoreintherelationshipwiththeserviceusersthanthey
receivedinreturn(Rose,etal.,2010).
An important issue in childwelfare institutions is howmuch the social climate
allowsthe
open
expression
of
feelings
by
members
and
staff.
In
this
light,
confi
dentialityand trustplayan important role.Mullan,etal. (2007)concludes that
thereisaneedtounderstandattitudes,experiencesandbehavioursoftheyoung
peoplewithin the context of their lives. Young people in care have emotional
needs, yet research has shown that their experiences before, during and after
careintensifythoseneeds.Mullan,etal.(2007)alsosaysthatstaffmustbegiven
agreaterresponsibilityandtrusttousetheirprofessionaljudgementmorefreely
inkeepinginformationprivateandconfidential.Thisisimportant,becauseyoung
peoplein
care
feel
that
trust
that
has
been
breached
had
adetrimental
effect
on
thelikelihoodofopeningupagain.Fromstaffviews,itisshownthattheyseeself
disclosureasimprovingthetherapeuticrelationship.Theyreportthatithelpsad
olescentstofeelunderstoodandallowsclientstoadvancetootherissuesintheir
lives(Burkhard,Knox,Groen,Perez&Hess,2006).
Theabovementionedfindingsindicatethattheconceptofrelationshipcannotbe
left unnoticed in childwelfare institutions. Young people in care should be in
volvedin
decisions
about
their
lives,
and
more
emphasis
should
be
placed
upon
thedevelopmentofpositive relationswith staff.As this seemsmore important
thantherapeuticaspects,therehastobemorefocusoncreatingcomprehensive
relationshipsbetween childrenand staff, regardlessof the fact that these rela
tional interactionshave to be verbal,orhave a therapeutic content. Trust and
confidentialityhastobecharacteristicfortherelationshipinordertopermitself
disclosurefromthechild,whichcanbetherapeuticallyhelpful.
As
can
be
concluded
from
the
above,
relationships
in
child
welfare
institutions
cover many different areas. Experience with, and research about the COPES
8/10/2019 The Community Oriented Programs Environment Scale
42/51
35
shows that this instrument is valuable in addressing these different aspects of
relationshipsincare.However,afewcommentscanbemadeconcerningtheuse
oftheCOPESwithchildrenandadolescents.Someofthestatementsincludedtoo
difficult languageorcontent foryoungpeople tounderstand,andalso thecon
centrationspanoftheadolescentsmostlywasnotsufficienttostayfocused.No
normativesampleforyoungpeopleisavailable,whichmakesitnecessarytouse
therawscoresforfurtheranalysis.
Still,thisinstrumentcanbesaidtohavealotofadvantagesthatcannotbefound
in other evaluation instruments. First, there are not many instruments to be
found thatassessdifferentaspectsof the social climate in community settings.
Also,thisinstrumentdoesnotonlyincludequestionstoadministerorganisational
factorsbut
it
also
examines
personal
factors
regarding
the
individual,
the
interac
tionbetweenindividualsandpracticalfeatures.Nexttothis,viewsfromchildren
themselvesaswellas fromstaffcanbecollected.Keeping inmindsomeof the
limitationstheCOPEShasforitsusewithchildren;itcanstillbeseenasavaluable
and important instrument forexamining thedeterminantsofprogram climates
andforidentifyingstrengthsandweaknessesinthesocialclimateofaninstitution.
8/10/2019 The Community Oriented Programs Environment Scale
43/51
36
8/10/2019 The Community Oriented Programs Environment Scale
44/51
37
REFERENCES
Anonymous(2008),Journalinterview:ConversationwithRudolfMoos.Addiction,
103,13
23.
AttarSchwartz, S. (2011). Maltreatment by staff in residential care facilities:
theadolescentsperspectives.SocialServiceReview,85,635664.
Aubrey,C.andDahl,S.(2006).Childrensvoices:Theviewsofvulnerable
children on their service providers and the relevance of services they
receive.BritishJournalofSocialWork,36,2139.
Biancosino,B.,
Barbui,
C.,
Pera,
V.,
Osti,
M.,
Rocchi,
D.,
Marmai,
L.
and
Grassi,L.(2004).Patientopinionsonthebenefitsoftreatmentprogramsin
residentialpsychiatriccare.CanadianJournalofPsychiatry,49,613620.
Bickman,L.,deAndrade,A.R.V.,Lambert,E.W.,Doucette,A.,Sapyta,J.,Boyd,A.S.,
Rumberger, D.T., MooreKurnot, J., McDonough, L.C., and Rauktis, L.B.
(2004).Youththerapeuticalliance in intensivetreatmentsettings.Journal
ofbehavioralhealthservices&research,31,134148.
Brunt,D.&Hansson,L.(2002a).Characteristicsofthesocialenvironmentofsmall
grouphomes for individualswith severemental illness.NordicJournalof
Psychiatry,56,3946.
Brunt,D.&Hansson,L.(2002b).Acomparisonofthepsychosocialenvironmentof
two types of residences for personswith severemental illness. Interna
tionalJournalofSocialPsychiatry,48,243252.
Brunt,D.
&
Rask,
M.
(2012).
A
suggested
revision
of
the
Community
Oriented
Program Environment Scale (COPES) for measuring the psychosocial
environment of supported housing facilities for personswith psychiatric
disabilities.IssuesinMentalHealthNursing,33,2431.
Burkard,A.W.,Knox,S.,Groen,M.,Perez,M.,Hess,S.A.(2006).European
Americantherapistselfdisclosureincrossculturalcounseling.Journalof
CounselingPsychology,43,1525.
8/10/2019 The Community Oriented Programs Environment Scale
45/51
38
Cashmore,C.(2002).Promotingtheparticipationofchildrenandyoungpeoplein
care.ChildAbuse&Neglect,26,837847.
Colton,M. (1989). Foster and residential Childrens perceptions of their social
environments.British
Journal
of
Social
Work,
19,
217
233.
Davies,J.&Wright,J.(2008).Childrensvoices:Areviewoftheliterature
pertinent to lookedafter childrens views of mental health services.
ChildandAdolescentMentalHealth,13,2631.
Gallagher,B.andGreen,A.(2012).In,outandaftercare:Youngadultsviewson
theirlives,aschildren,inatherapeuticresidentialestablishment.Children
andYouthServicesReview,34,437450.
Heal,K.,Sinclair,I.&Troop,J.(1973).Developmentofasocialclimate
questionnaireforuse inapproved schoolsand communityhomes.British
JournalofSociology,24,222231.
Hicks,L.(2008).Theroleofmanagerinchildrenshomes:theprocessofmanaging
andleadingawellfunctioningstaffteam.ChildandFamilySocialWork,13,
241251.
Kendrick,A.,
Steckley,
L.,
Lerpiniere,
J.
(2008).
Ethical
issues,
research
and
vulnerability:gainingtheviewsofchildrenandyoungpeopleinresidential
care.ChildrensGeographies,6,7993.
Mason,J.(2008).Achildrensstandpoint:Needsinoutofhomecare.Children&
SocietyVolume,22,358369.
Middelboe,T. (1996).Bofaellesskaberforpsykisk syge [InDanish,Grouphomes
forthelongtermmentallyill].Unpublisheddoctoraldissertation,Universi
tyof
Copenhagen.
Moos,R.(1972).Assessmentofthepsychosocialenvironmentsofcommunity
orientedpsychiatrictreatmentprograms.JournalofAbnormalPsychology,
79,918.
Moos, R. (1974). Community oriented Programs Environment Scale manual:
FirstEdition.PaloAlto,CA:ConsultingPsychologistsPress.
8/10/2019 The Community Oriented Programs Environment Scale
46/51
39
Moos, R. (1988). Community oriented Programs Environment Scale manual:
SecondEdition.PaloAlto,CA:ConsultingPsychologistsPress.
Moos, R. (1996). Community oriented Programs Environment Scale manual:
ThirdEdition.
Menlo
Park,
CA:
Mind
Garden.
Moos, R. (2003). Community oriented Programs Environment Scale manual:
FourthEdition.MenloPark,CA:MindGarden.
Moos,R.(2006).CommunityorientedProgramsEnvironmentScale:Anannotated
BibliographySecondedition.MenloPark,CA:Mind Garden.
Moos, R. & Lemke, S. (1996). Evaluating residentialfacilities. The Multiphasic
Environmental
Assessment
Procedure.
Thousand
Oaks,
CA:
Sage
Publications.
Moos,R.&Swartz,J.(1972) J.Treatmentenvironmentandtreatmentoutcome.
JournalofNervousandMentalDisease,154(4),264275.
Moos, R.,& Petty, C. (1971). Treatment environment and treatment outcome:
Areplication.PaloAlto,Calif.:StanfordUniversity,Departmentof
Psychiatry,SocialEcologyLaboratory.
Mullan,C.,McAlister,S.,Rollock,F.&Fitzsimons,L.(2007).Carejustchangesyour
live:factorsimpactinguponthementalhealthofchildrenandyoungpeo
plewithexperiencesofcareinnorthernIreland.ChildCare inPractice,13,
417434.
Rose,J.,Madurai,T.,Thomas,K.,Duffy,B.andOyebode,J.(2010),Reciprocityand
burnoutindirectcarestaff.ClinicalPsychology&Psychotherapy,17,455
462.
Stiles, W., Shapiro, D. & Elliot, R. (1986). Are all psychotherapies equivalent?
AmericanPsychologist,41,165180.
Ulset,G.(2011)Psykiskhelsehosbarnibarneverninstitusjoner.Etterunderskelse
frapilot.Internrapport2011fraBarnevernetsutviklingssenteriMidtNorge,
NTNUSamfunnsforskningAS.
8/10/2019 The Community Oriented Programs Environment Scale
47/51
40
Vanderstraeten,A.andStandaert,V.(2008).Eenbelevingsonderzoeknaardere
latietussenjongerenenhunbegeleidersbinnenbegeleidingstehuizen .Niet
gepubliceerdelicenciaatsverhandeling.UniversiteitGent,FPPW.
8/10/2019 The Community Oriented Programs Environment Scale
48/51
41
Listoftables
Table1.TheCOPES:DimensionsandSubscales.
Table2.Overviewoftoolsusedintheresearchproject.
Table3.TheCOPES:RelationshipDimensions.
Table4.StudiesabouttheuseoftheCOPESwithyoungpeopleinresidentialcare.
Table5.DifficultstatementsintheCOPES.
8/10/2019 The Community Oriented Programs Environment Scale
49/51
42
8/10/2019 The Community Oriented Programs Environment Scale
50/51
43
Listoffigures
Figure1.TheSocialClimateScales.
Figure2.Amodeloftherelationshipbetweenprogramandpersonalfactorsand
residentstabilityandchange.
8/10/2019 The Community Oriented Programs Environment Scale
51/51
Dragvoll All 38 B7491 TrondheimNorway
Tel: 73 59 63 00
ISBN 978-82-91927-20-6 (trykk)ISBN 978-82-91927-21-3 (web)
Barnevernets utviklingssenteri Midt-Norge