Home-visiting interventions for families with complex and multiple problems:A systematic review and meta-analysis of out-of-home placement and child outcomes

Children growing up in families experiencing complex and multiple problems (FECMP) are at an increased risk of developing problems in multiple areas of life. A wide array of home-visiting interventions has been developed to address the complex care needs of these families. The aim of this study is to investigate out-of-home placement rates and child outcomes of these home-visiting interventions. A systematic review and meta-analysis was conducted using five scientific databases (PsycInfo, ERIC, SocIndex, MedLine, & Picarta). The systematic search of these databases yielded 8,377 hits. Forty-two publications reporting on 50 studies were included in the review. A random-effects survival curve meta-analysis model was estimated for out-of-home placement and random-effects meta-analysis models were estimated for children's behavioral problems and stressful experiences. Out-of-home placement increased from 7.5% at case closure to 24.3% one year after case closure. On average there was a moderate decrease in emotional and behavioral problems (d = 0.50) and stressful experiences (d = 0.50) during intervention, but considerable problems remained after case closure. More research is needed to investigate family and service characteristics that may explain heterogeneity in outcomes. Furthermore, there is a need to adopt a broader perspective in evaluations of home-visiting services by including outcomes related to the skills, development, and wellbeing of children

Elucidating care for families with multiple problems in routine practice: Self-registered practice and program elements of practitioners

Contains fulltext : 217617.pdf (publisher's version ) (Open Access)Families with multiple problems (FMP), also defined as multiproblem families or multistressed families, face multiple, severe, chronic and intertwined problems in different areas of life. Content and provision of interventions targeting FMP in routine practice may largely deviate from guidelines in intervention manuals. The aim of this study was to identify practice and program elements provided to FMP in routine practice, including the intensity, manner of provision, and recipients, per intervention phase (starting-, care- and end phase). We selected interventions with at least moderate (d >= 0.5) effect sizes in the Dutch context, yielding eight interventions. Practitioners of 26 Dutch organizations systematically registered information on practice and program elements, intensity, manner of provision, and recipients, using the taxonomy of interventions for FMP. Within 474 trajectories we found that elements regarding activation of the social network of FMP were provided least often (in less than 48-77% of the families). Elements were provided mainly through psycho-education (25-33%) and instruction (21-24%). Interventions focused more on parents (53-62%) than on children (26-32%). Program elements hardly changed between phases of interventions, although the number of visits decreased (from an average of six visits a month during the starting phase to four visits during the end phase). An inventory of elements that make part of interventions for FMP allows studying the effectiveness of these interventions in a more detailed way. This yields information that may help to identify the optimal sequence, intensity and duration of elements and enables to better understand outcomes of interventions for FMP.10 p

The team around families with multiple and complex problems: Findings from English studies

Deze bijdrage gaat over onderzoek naar het Westminster Family Recovery Project(FRP). Dit is één van de 15 Engelse Think Family-projecten, die recent zijn ontwikkeld als antwoord op de constatering dat hulp vaak niet de gezinnen met de meest ernstige problemen bereikt. Bij FRP gaat het om een intensieve outreachende (IO-)benadering van gezinnen met meervoudige en complexe problemen. Er wordt een multidisciplinair team (Team Around the Family, TAF) samengesteld met de IO-werker als spil. De volgende basisprincipes staan centraal: a) er is sprake van een empathische en ondersteunende houding naar ouders en kinderen; b) er moet snel duidelijkheid ontstaan over wat er zou moeten veranderen, met respect voor de visie van de ouders op wat het beste kan worden gedaan; c) veiligheid en welzijn van kinderen staan voorop, werkerszijn eerlijk wanneer dwingende maatregelen nodig zijn; d) er is individuele aandacht voor de ouders en oog voor hun praktische, relationele en gezondheidsproblemen; e) de benadering behelst een flexibele combinatie van praktische hulp, ondersteuning, educatie, en behandeling. Onderzoek laat zien dat – gemiddeld genomen – gezinnen (N = 33) zeven contacten in de 14 dagen hebben met (vooral) de IO-werker of een ander TAF-lid. Hulptrajecten duren gemiddeld 28 weken (minimaal 6; maximaal 69). Bij afsluiting van de hulp is het welzijn van meerdere gezinsleden in bijna tweederde van de gezinnen (63%), naar verwachting duurzaam, verbeterd.Deze bijdrage gaat over onderzoek naar het Westminster Family Recovery Project (FRP). Dit is een van de 15 Engelse Think Family-projecten, die recent zijn ontwikkeld als antwoord op de constatering dat hulp vaak niet de gezinnen met de meest ernstige problemen bereikt. Bij FRP gaat het om een intensieve outreachende (IO-)benadering van gezinnen met meervoudige en complexe problemen. Er wordt een multidisciplinair team (Team Around the Family, TAF) samengesteld met de IO-werker als spil. De volgende basisprincipes staan centraal: a) er is sprake van een empathische en ondersteunende houding naar ouders en kinderen; b) er moet snel duidelijkheid ontstaan over wat er zou moeten veranderen, met respect voor de visie van de ouders op wat het beste kan worden gedaan; c) veiligheid en welzijn van kinderen staan voorop, werkers zijn eerlijk wanneer dwingende maatregelen nodig zijn; d) er is individuele aandacht voor de ouders en oog voor hun praktische, relationele en gezondheidsproblemen; e) de benadering behelst een flexibele combinatie van praktische hulp, ondersteuning, educatie, en behandeling. Onderzoek laat zien dat – gemiddeld genomen – gezinnen (N=33) zeven contacten in de 14 dagen hebben met (vooral) de IO-werker of een ander TAF-lid. Hulptrajecten duren gemiddeld 28 weken (min. 6; max. 69). Bij afsluiting van de hulp is het welzijn van meerdere gezinsleden in bijna tweederde van de gezinnen (63%), naar verwachting duurzaam, verbeterd

Functional Coupling of Ryanodine Receptors to KCa Channels in Smooth Muscle Cells from Rat Cerebral Arteries

The relationship between Ca2+ release (“Ca2+ sparks”) through ryanodine-sensitive Ca2+ release channels in the sarcoplasmic reticulum and KCa channels was examined in smooth muscle cells from rat cerebral arteries. Whole cell potassium currents at physiological membrane potentials (−40 mV) and intracellular Ca2+ were measured simultaneously, using the perforated patch clamp technique and a laser two-dimensional (x–y) scanning confocal microscope and the fluorescent Ca2+ indicator, fluo-3. Virtually all (96%) detectable Ca2+ sparks were associated with the activation of a spontaneous transient outward current (STOC) through KCa channels. A small number of sparks (5 of 128) were associated with currents smaller than 6 pA (mean amplitude, 4.7 pA, at −40 mV). Approximately 41% of STOCs occurred without a detectable Ca2+ spark. The amplitudes of the Ca2+ sparks correlated with the amplitudes of the STOCs (regression coefficient 0.8; P < 0.05). The half time of decay of Ca2+ sparks (56 ms) was longer than the associated STOCs (9 ms). The mean amplitude of the STOCs, which were associated with Ca2+ sparks, was 33 pA at −40 mV. The mean amplitude of the “sparkless” STOCs was smaller, 16 pA. The very significant increase in KCa channel open probability (>104-fold) during a Ca2+ spark is consistent with local Ca2+ during a spark being in the order of 1–100 μM. Therefore, the increase in fractional fluorescence (F/Fo) measured during a Ca2+ spark (mean 2.04 F/Fo or ∼310 nM Ca2+) appears to significantly underestimate the local Ca2+ that activates KCa channels. These results indicate that the majority of ryanodine receptors that cause Ca2+ sparks are functionally coupled to KCa channels in the surface membrane, providing direct support for the idea that Ca2+ sparks cause STOCs

Toward tailored care for families with multiple problems:A quasi-experimental study on effective elements of care

Several effective interventions have been developed for families with multiple problems (FMP), but knowledge is lacking as to which specific practice and program elements of these interventions deliver positive outcomes. The aim of this study is to assess the degree to which practice and program elements (contents of and structure in which care is provided) contribute to the effectiveness of interventions for FMP in general and for subgroups with child and/or parental psychiatric problems, intellectual disabilities, or substance use. We performed a quasi-experimental study on the effectiveness of practice and program elements provided in attested FMP interventions. Using self-report questionnaires, we measured primary (child's internalizing and externalizing problems) and secondary (parental stress and social contacts) outcomes at the beginning, end, and three months thereafter. By means of Latent Profile Analysis, we identified groups of families receiving similar combinations of practice elements ("profiles"), and we calculated propensity scores. Next, we assessed how practice element profiles and program elements affected improvement in outcomes, and whether these effects were moderated by subgroup characteristics. We found three practice element profiles (explorative/supportive, action-oriented, and their combination), which were equally effective. Regarding program elements, effects were enhanced by more frequent telephone contact between visits and more frequent intervision. Effectiveness of practice and program elements varied for specific FMP subgroups. Variations in the content of care for FMP do not affect its effectiveness, but variations in the structure of the care do. This finding can help to further improve effective interventions