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: questionnairesInformant Start End Follow up

Parent SDQOKIV-RNVOSNOSI

SDQOKIV-RNVOSNOSI

SDQOKIV-RNVOSNOSIFeedback Quest

Minor SDQOKIV-R motherOKIV-R father

SDQOKIV-R motherOKIV-R father

SDQOKIV-R motherOKIV-R fatherFeedback 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)

-4-3,5-3-2,5-2-1,5-1-0,500,511,522,533,54

Confl icts Acceptation T otal

OK I V - R s c hal en

CaH

CNM

CNF

OKIV-Reducational relationship

(parent)

-4-3,5-3-2,5-2-1,5-1-0,500,511,522,533,54

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 AcceptatieTotaal

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 cul ties 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

Emotionalsymptoms

Conduct problems

Hyperactivity

Peer problems

P rosocial 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

12

3

4

56

7

8

T1 T2 T3

Emotionalsymptoms

Conductproblems

Hyperactivity

Peer problems

Prosocialbehaviour

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)

00,5

11,5

22,5

33,5

Acc Aan Pro And Bel All Ple Goe

residential groupIFPS

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

510

1520

2530

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

hubert.vanpuyenbroeck@vub.ac.be

Thank you.

Please contact me for further discussion