What do we learn from procesoutcome research?
Paris, september 23th, 2005
Bert Van Puyenbroeck - Programme leader IFPS Flanders
Gerrit Loots, phd, Vrije Universiteit Brussel
Hans 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-R
educational relationship (parent)
4
3, 5
3
2, 5
2
1, 5
1
0, 5
0
-0, 5
-1
-1, 5
-2
-2, 5
-3
-3, 5
-4
CaH
CNM
CNF
Conf l i ct s
A ccept at i on
OK I V - R schal en
T ot al
OKIV-R
educational relationship (parent)
4
3,5
3
2,5
2
1,5
1
0,5
0
-0,5
-1
-1,5
-2
-2,5
-3
-3,5
-4
Conf l i cts
Acceptati on
T otal
T1
T2
T3
Conclusion OKIV-R parent
• Parents experience their relationship with minor as very
problematic
• This does not change/ improve during or after the
crisintervention
OKIV-R
educational relationship (minor)
OK I V - R schal en
3
CaH
1
K NM
-1
K NV
-3
Conf l i ct hant er i ng
A ccept at i e
T ot aal
OKIV-R
educational relationship (minor)
2, 5
1, 5
0, 5
Conf l i ct hant er i ng
A ccept at i e
-0, 5
T ot aal
-1, 5
-2, 5
-3, 5
T1
T2
T3
Conclusion OKIV-R minor
• Minors experience their relationship with their parents
as very problematic
• This doesn’t change/ improve during or after the
crisisintervention
SDQ
Strengths & Difficulties Minor (parent)
T ot al di f f i cul t i es scor e
20
15
10
5
0
T1
T2
T3
SDQ
Strengths & Difficulties Minor (parent)
8
E mot ion al
7
sympt oms
6
Con duct pr oblems
5
Hyper act ivti y
4
3
P eer pr oblems
2
P r osocial behaviour
1
0
T1
T2
T3
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
SDQ
Strengths & Difficulties Minor (minor)
T ot aldif f icult ies scor e
25
20
15
10
5
0
T1
T2
T3
SDQ
Strengths & Difficulties Minor (minor)
8
Emot ion al
7
sympt oms
6
Con duct
5
pr oblems
4
Hyper act ivti y
3
2
Peer pr oblems
1
0
Pr osocial
T1
T2
T3
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)
3, 5
3
2, 5
2
r esi dent i al gr oup
1, 5
I FP S
1
0, 5
0
A cc
A an
Pr o
A nd
B el
Al l
Pl e
Goe
NVOS, part 1
Stress, Opvoedingsbelasting (parent)
A ccept at i e
4
A ankunnen
3
P r obl emen
A nder s wi l l en
2
B el ast i ng
1
A l l een
0
P l ezi er
T1
T2
T3
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 2
ID of situation (parent)
7
6
5
4
3
2
1
0
T1
T2
T3
NVOS, part 2
ID of situation (parent)
35
30
25
20
T1
15
T2
10
T3
5
0
B0 8
B0 7
B0 6
B0 5
B0 4
B0 3
B0 2
B0 1
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