Metselaar, Janneke

English

Gezin Centraal is een programma dat zich richt op kinderen (6-14 jaar) met ernstige psychosociale problemen en hun gezinnen. Het programma bestaat uit intensieve gezinsbegeleiding, daghulp en residentiële hulp. Vraaggericht en gezinsgericht werken bepalen de methodiek. De dissertatie betreft een praktijkgestuurd effectonderzoek. De algemene vraagstelling is: Hoe verloopt de hulpverlening aan 6-14 jarigen bij het programma Gezin Centraal en welke resultaten worden gehaald in vergelijking met gebruikelijke hulpverlening? Gezin Centraal verleent hulp aan een doelgroep die bij aanvang vergelijkbaar is met de doelgroep van gebruikelijke hulpverlening. Er lijkt bij een deel van de doelgroep onvoldoende inzicht te bestaan in de probleemsituatie en de noodzaak van behandeling. Gezin Centraal onderscheidt zich in het vraaggericht werken en gezinsgericht werken minder van gebruikelijke hulpverlening dan verwacht. Op basis van een pilotstudie blijkt dat cliënten van Gezin Centraal na afloop minder problemen ervaren in het functioneren van het kind. Intern vergeleken is er sprake van minder opvoedingsstress. Meer zicht is verkregen op het proces van het programma. Het onderzoek zet aan tot het expliciteren van normen voor (proces)uitkomsten en het selecteren van de doelgroep

Dissertations of the University of Groningen

   University of GroningenVraaggerichte en gezinsgerichte jeugdzorgMetselaar, JannekeIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2011Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Metselaar, J. (2011). Vraaggerichte en gezinsgerichte jeugdzorg: processen en uitkomsten. s.n.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 04-06-2022SummaryNeeds-led and family-centred child care and treatment:Process and outcomesGezin CentraalGezin Centraal is an experimental child and youth care programme intended forchildren aged – with severe psychosocial problems and their families. e pro-gramme has three components: intensive family coaching, out-patient treatmentand care at a residential home. Needs-led care and a family-focused approach arethe core features of the programme; other elements that determine the nature ofthe care provided are the theory and application of the solution-focused approach,systemic theory and a contextual approach, learning theory, competencymodellingand communication theory. e main goal of Gezin Centraal is the empowermentof families and increased resilience in families facing various kinds of (behavioural)problems (Knorth et al., ). | SummaryNeeds-led careNeeds-led care implies that the main focus is on the care needs expressed by theclient, that clients participate to a high degree and that child and youth care workersadopt a needs-led attitude. e evidence base for needs-led care consists of studiesof goal attainment, client-centredness and client participation, and research on theimpact of care professionals’ behaviour on the outcome of the care provided.Programme evaluationGezin Centraal’s programme evaluation can be described as practice-based out-comes research, a kind of research which focuses on incorporating the evaluationinto everyday care activities, utilizing the research data, and linking the research tothe interventions. e evaluation was set up along the lines of a pre-test – interven-tion – post-test design with comparison groups (internal and external ‘care as usualtrajectories’). e general question of this study was: how does the care provided tochildren aged – in the Gezin Centraal programme unfold and what results areobtained in comparison with standard care programmes?e ‘outcomes ladder’ created byVeerman andVanYperen () provided a frameof reference for answering this question. Before gathering data to support the effec-tiveness of the intervention, two other steps were very important. e rst was tocheck whether the intended target group was in fact reached. e second was tomake clear what distinguished this intervention – as it was carried out in practice –from other interventions.Target groupAs a child and youth care intervention Gezin Centraal aims to reach a group ofclients similar to the group of care as usual. On the basis of demographic features,the group of clients receiving care throughGezinCentraal is representative of clientswho apply for child and youth care interventions in theNetherlands.e care needsexpressed by clients pertain in equal measure to the child (in particular a child’sbehaviour) and to the family (in particular parenting).emajority of the problemsinvolved are characterized by the child and youth care workers as ‘moderate’. eclients report severe to very severe problems in the child’s functioning and/or highlevels of parenting stress. However, in some cases within the group reached byGezinCentraal the child’s functioning could be designated as ‘normal’, and some clientsin the group experienced low to average parenting stress. In over half of the cases,Summary | at the beginning of the care programme the child and youth care workers reportfamily functioning for which a milder form of treatment would have sufficed.Gezin Centraal provides care for a target group which at the beginning of thecare programme is comparable with the target group receiving care as usual. Interms of demographic characteristics, areas inwhich assistance is needed, the child’sfunctioning, parenting stress, family functioning, motivation and coping with par-enting problems, the group reached by Gezin Centraal is similar to the groupreached by care as usual. e only difference is that in the external comparisongroup a larger number of care needs were expressed and a larger number of majorstressful events were reported.As far as the nature of the problems is concerned, Gezin Centraal provides careto the intended target group. However, in terms of the severity of the problemsinvolved, the group reached by Gezin Centraal only partly corresponds with theintended target group. It appears that at the beginning of the care programme thereis not always enough insight into the problem situation and its severity, and theextent towhich treatment is needed. Admission to the programme is not sufficientlyselective. In the internal and external comparison groups the situation is similar. Itcan be concluded that Gezin Centraal indeed reaches a group of clients similar tothe group of clients of care as usual. Although it should be noted that this groupshould be composed more selectively.ProcessGezin Centraal aims to deliver child and youth care which distinguishes itself in itsprocess from care as usual. In each care pathwayGezin Centraal usesmore than twomodules on average. In over half of the cases outpatient care is combined withmoreintensive care. In comparison with the internal comparison group Gezin Centraalis not different in this respect, but in comparison with the external comparisongroupGezin Centraal usesmoremodules of intensive care than are used on average.is means that the care provided is more intense than in the external comparisongroup. e outpatient care Gezin Centraal provides for a family lasts approximately months; the duration of the whole programme, including other modules, is months. is is comparable with both comparison groups. Gezin Centraal’s familyguidance entails more than two contacts eachmonth. In this respectGezin Centraalis also similar to the internal and external comparison groups.Valuable information was gained by looking at the areas to which the care goalswere related. e data showed that Gezin Centraal does not focus speci cally onfamily goals more oen than the two comparison groups. | SummaryFocusing on clients’ needsOne context in which the focus on clients’ expressed needs comes to the fore is inprogress interviews. In Gezin Centraal’s outpatient care for the family (intensivefamily coaching) more attention is paid to progress interviews than in the careprogramme of the internal comparison group. Although the experimental researchgroup does not pay a signi cantly larger amount of attention to setting goals, thechild and youth care workers do set goals at the right time more oen than theexternal comparison group – namely, at the beginning of the care programme.Withrespect to the other four caremeasures which are relevant to focusing on the client’sexpressed needs, there is no marked difference between the experimental researchgroup and either of the two comparison groups.In approximately  of Gezin Centraal’s contacts, counsellors report on con-tact with the whole family. In this respect the programme does not differ from theinternal and external comparison groups.Clients and care workers are positive about the care process. eir experience isthat the care provided does in fact focus on the needs expressed by the clients. eclients and child and youth care workers of Gezin Centraal give the same rating tothis aspect of the programme as the clients and child and youth care workers of thetwo comparison groups.Client participationChild and youth care workers at Gezin Centraal do not pay a signi cantly largeramount of attention to measures that facilitate participation, such as discussing theclient’s perception of possible solutions or discussing forces within and around thefamily, than those in the comparison groups. In the out-patient component op theprogramme, discussing the daily routine is regarded as themost importantmeasurethat increases client participation. Gezin Centraal’s child and youth care workerspay a signi cantly larger amount of attention to this than the child and youth careworkers of the internal comparison group.In spite of its family-focused approach, Gezin Centraal does not work towards asigni cantly larger proportion of family goals in its family coaching. In addition, itappears that contacts with the whole family are notmore frequent inGezin Centraalthan in the internal and external comparison groups. However, in Gezin Centraalin-patient treatment, the internal comparison shows that contacts with the wholefamily are more frequent. Moreover, the initiative for contact is more frequentlytaken by parents. In the in-patient treatment, Gezin Centraal’s family-led approachcomes into its own as an important component of the programme.Gezin Centraal’s clients have plenty of opportunity to participate, but the clientsof the two comparison groups have had similar experiences. Gezin Centraal’sSummary | clients, as well as the clients of the comparison groups, indicate to a lesser extentthat they have had opportunities to determine the care provided to a high degree orfully (the top rung of the participation ladder devised by oburn et al. ()).According to the clients, Gezin Centraal has succeeded in offering a family-ledprogramme, but the clients have not experienced the programme as being family-focused care (Dunst et al., ). Unlike the clients, Gezin Centraal’s child andyouth care workers report that participation at the highest level of the participationladder has been attained. In this respect the Gezin Centraal child and youth careworkers differ signi cantly from the child and youth care workers of the externalcomparison group.ismeans that their intention is to carry out theGezin Centraalprogramme in accordance with the principles of family-focused care. However, wesuspect that the execution of the programme needs improvement if the clients arealso to report having experienced family-focused care.Needs-led attitude of carersOver  of the care provided by Gezin Centraal and in both comparions groups, isrelated to working on changing behaviour. Maintaining a working relationship andgathering information take up equal percentages ( each). e speci c purposeof maintaining the working relationship is to enable child and youth care workersto put their needs-led attitude into practice. In the Gezin Centraal programme asigni cantly greater amount of attention was paid to maintaining the working rela-tionship than in the external comparison group.e child and youth careworkers inthe in-patient treatment also gave substance to their needs-led attitude by investingmore in collaboration with the client.e clients of Gezin Centraal had a positive opinion of the child and youth careworkers’ needs-led attitude. However, in this respect there is no difference betweenGezin Centraal and the two comparison groups. In the course of their work, theGezin Centraal child and youth care workers deliberately set out to focus on theneeds expressed by the clients; they have a rm grasp of the treatment strategy.However, in the clients’ opinion their attitude is not more needs-led than that of thechild and youth care workers of the care programmes with which Gezin Centraalwas compared.Gezin Centraal differs less from the comparison groups than had been expected.Signi cant differences between Gezin Centraal and one or both of the comparisongroups with respect to the methods used are in the minority. On the other hand,there are very few signi cant differences in which Gezin Centraal comes off worse.Possible explanations for the low level of difference have been put forward. It couldbe that the Gezin Centraal methods have not been applied to a sufficient degree; or | Summarythat over time the basic elements of needs-led and family-focused working proce-dures have been applied more and more broadly; or that the features of needs-ledcare are related to generally effective factors which play a signi cant role in everyform of psychosocial care.OutcomesA pilot study of the outcomes of this care service showed that in comparison withthe internal and external comparison groups, aer the interventionGezin Centraal’sclients have fewer problems with the child’s functioning. e internal comparisonshowed that Gezin Centraal clients had less parenting stress. However, because ofthe limited scope of the study these outcomes cannot be attributed to the methodsused.e pilot study did not show that a greater focus on needs expressed by theclients necessarily led to better outcomes. e importance of devoting enough at-tention to working on behavioural change in care programmes was highlighted bythe outcomes of the pilot study.Re ections on the studye study con rms the importance of checking whether the intended target groupis in fact reached by the intervention in question, before more demanding studiesare being caried out. It also con rms the importance of examining whether theworking procedure is carried out in accordance with its de nition and whether theintervention or programme – in this case Gezin Centraal – can be distinguishedfrom care as usual.To a limited extent the study of Gezin Centraal was incorporated into care prac-tice. e research data were also utilized – to a limited extent – in the primaryprocess. e fact that the information gathered for the study was not utilized forthe primary process means that an opportunity was missed to give clients who didnot need intensive treatment more appropriate care. Another missed chance wasthe opportunity to carefully examine the problem areas of clients who do belong tothe target group and to ensure that they were given the most appropriate care.With the instruments chosen, we attempted to coordinate our research with thecare service. is was particularly successful in the case of a self report form torecord care worker activities and techniques, called ‘Verrichtingen Lijst’.Summary | RecommendationsIn our opinion better analysis of the complaints and better selection of the targetgroup for the Gezin Centraal programme is advisable. e recommendation is forthe methods of family-focused care to be put into practice more explicitly. Workingwith the ‘Verrichtingen Lijst’ could be integrated into the working procedures to ahigher degree. e added value of this could be enhanced by drawing up concreteguidelines or standards based on the treatment strategy.e possibilities of focusing on clients’ expressed needs could be used moreeffectively in the Gezin Centraal care programme. e Gezin Centraal child andyouth care workers’ way of applying some measures which focus speci cally onclients’ needs could do with some improvement. In any follow-up study the threatsto practice-based outcomes research should be reduced to a minimum.e evaluation of Gezin Centraal has been an important step towards gaining abetter idea of the programme’s process.e study stimulates those involved to drawup explicit standards for outcomes and to reach the target group through betterselection. Further development of the intervention and further outcomes researchcan build on the foundation that has been laid by the present study.

Vraaggerichte en gezinsgerichte jeugdzorg:processen en uitkomsten

https://pure.rug.nl/ws/files/144754208/10_summary.pdf

Vraaggerichte en gezinsgerichte jeugdzorg:processen en uitkomsten

Abstract

Similar works

Full text

Available Versions

Dissertations of the University of Groningen