Paper
The psycho-social treatment of the maltreated children: a follow-up study
- issue: Issue 2 / 2009
- authors: Antonio Maria Corato, Paola Baglioni
- keywords: Italy, long term outcome, abuse, maltreatment
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- downloaded: 0
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abstract
Background. We want to introduce the results of follow-up study on children treated by the Centro Regionale "L'Arca" of Vicenza. The purpose of the research is to gather information on the long term effectiveness of the psycho-social interventions on the minors and their families.
Objective. The study wants to investigate whether child welfare services care has moderated the risk of psychopathological evolution or social deviance, after at least 2 years from the closing of the case. More in detail we wanted to estimate which could be the factors implied in a relatively favorable outcome of the evolution, trying to differentiate the contribution of the variables tied to the quality of the treatment from the variables relative to the characteristics of the minor and its family.
It has been set up a quantitative study, with calculation of the frequencies and crossing between variable through the statistical test of the Chi-square.
The experimental design requires the comparison between two groups: a "target group", composed of maltreated minors which have experienced at least six months of psycho-social treatment by the Center, and have been discharged from at least two years from the date of the study; a "control group", constituted of maltreated minors, with homologous social and clinical characteristics, valuated before the treatment.
The target group is constituted of 31 minors (age 8-18, feminine sex 61%), the control group of 25 minors (age 6-18, feminine sex 68%); the two groups have been constructed to present the same frequency of kind and duration of maltreatment (sexual abuse 35%, neglect 26%, assisted violence 12%, moderate forms of maltreatment 26%; duration of abuse superior to a year in 60% of the cases).
Measures. For both samples has been used the Achenbach questionnaire, in the three versions (child, caregiver, teacher). The instrument measures the competences/resources of the minor (in the three areas, activity, sociality and school), and the problems of clinical interest (total scales for externalization problems and internalization problems, symptoms scales for problems of withdrawal, somatic complaints, anxiety/depression, social problems, thought problems, attention problems, delinquent behavior, aggressive behavior, sexual problems).
The target group has been analyzed through a social-clinical inventory called "scheda psicosociale". The variables are: characteristics of the minors and their family before treatment (the duration of the maltreatment; category of maltreatment; psycho-pathological disturb diagnosed in the minor; presence in the minor of organic or hereditary pathologies; personal resources of the minor; author of the maltreatment; psychopathological disturbs diagnosed in the parents; classification of the familiar pattern according to the problem-solving ability; prognostic factors); characteristics of the psycho-social treatment (placement of the minor; objects of the treatment project; kind of social resources; kind of psychological support resources; reason of the closing; time for the realization of the treatment plan); evaluation on the quality of treatment at the moment of the closing (subjective level of satisfaction of the operator regarding the attainment of the treatment targets; subjective level of satisfaction on the quality of the therapeutic relationship at the end of the treatment; definition of the expectations, formulated in the moment of the closing, regarding the future evolution of the situation).
Key findings
Comparison between target and control groups:
The treated minors shows greater incidence of scores in the norm in the competence scales: activity (80% vs/ 60%, p.>.09), sociality (97% vs/ 64%, p.>.001), school (76% vs/ 38%, p.>.009). We evidence therefore a better adaptation and inclusion in the social context of the target group, more marked in the area of the school.
The treated minors shows smaller incidence of the score of clinical attention in the total scales of the problems: Total scale (32% vs/ 48%, p.>.23), Internalization scale (29% vs/ 56%, p.>.04), Externalization scale (26% vs/ 52%, p.>.04). The data indicate therefore a better level of emotional well-being and behavioral adaptation in the target group.
Some single scales of the problems evidence the prevalence of scores of clinical interest in the control group: social problems (20% vs/ 6%, p.>.12), attention problems (56% vs/ 29%, p.>.04), aggressive behavior (40% vs/ 13%, p.>.02). The other scales of the problems do not discriminate the two groups. The data confirm the smaller incidence of behavioral problems and social adaptation in the group of the discharged minors.
Analysis of the variables inside the target group.
The clinical-therapeutic variables have been crossed with the scores to the Achenbach test (clinical - not clinical). The data, for the limited number of cases, is not statistically significative, but may suggest useful qualitative indications.
The clinical variables (kind of maltreatment, author of the maltreatment, psychopathology of the parents, sex, psychopathology and hereditary problems of the minor) do not discriminate the scores of the Achenbach test; the unique discriminating factor appears the "duration of maltreatment (if the duration has been superior to a year there is greater incidence of clinical scores, 82% vs/ 60%, p.>.21).
The variables relative to the quality of the treatment demonstrate a greater discriminating power. A positive outcome (not clinical score to the test) turns out more frequent at least two years from the closing, when: the familiar system answers positively (aware acceptance and online with the own needs) to the project of treatment (60% vs/ 36%, p.>.20); the family receives the aid and assets its own independent resources for change (60% vs/ 36%, p.>.20); the operators have expressed, to the termination of the treatment, a positive evaluation on the quality of therapeutic relationship (75% vs/ 45%, p.>.10); the operators have expressed satisfaction for the attainment of the project targets, at the moment of closing (50% vs/ 27%, p.>.22). On the contrary, in specular way, an outcome results more frequently negative (clinical score to the test), when: there is an adhesion only of facade from part of the familiar system to the treatment project (64% vs/ 40%, p.>.20); the family demands "chronic" support and is unable to activate the inner resources for change (64% vs/ 40%, p.>.20); the operators expresses, at the term of the treatment, dissatisfaction for the quality of therapeutic relationship (55% vs/ 25%, p.>.10) and for the attainment of the targets (73% vs/ 50%, p.>.22).
Moreover, intensive treatments with wide use of social resources appears mainly associate to a negative outcome (clinical score to the test): at a distance of time, the minors appears more disturbed, when have experienced a long term treatment (superior to three years, 55% vs/ 25%, p.>.10) and when have been activated one or more economic and educative supports (64% vs/ 25%, p.>.03).
Conclusions. The research demonstrates that, in general terms, the psycho-social treatment has had a function of moderation of the damage from Adverse Childhood Experiences (Ace). The data, confronted with the international research on the outcomes in the long term from ACE, appears independent from the factor "time" (distance from the traumatic events).
The quality of the improvements mostly evidences on the external behaviors (social adaptation, control of deviant behavior).
The clinical factors (diagnosis, kind of maltreatment, etc), excluded the duration of the maltreatment, do not appear associate to the outcome. It appears instead significant the quality of treatment, intended as the possibility to construct a successful relation of cooperation between familiar system and operators, which appears linked to a favorable evolution. In addition, "intensive", long term treatments, with weighty use of social-educational resources, result mainly associate to negative outcomes: we assumes that the failure in activating the independent resources of the familiar system, leads to a progressive regression of the situation due to the lack of the supports activated from the service.
Key references
Achenbach, T. M. (2001). Child Behavior Checklist/4-18. Ghedini.
Di Blasio, P. (2000). Psicologia del bambino maltrattato. Bologna: Il Mulino.
Malacrea, M. (2006). Caratteristiche, dinamiche ed effetti della violenza su bambini e bambine. In Vite in bilico, indagine retrospettiva su maltrattamenti e abusi in età infantile. Centro Nazionale Documentazione e Analisi per Infanzia e Adolescenza, Questioni e Documenti, 40.
Contacts: Antonio Maria Corato, Centro Regionale "L'Arca", Contrà Mure San Rocco 34, 36100 Vicenza - Italy, E-mail: arca@comune.vicenza.it, antoniocorato@ctcc.it, Phone 0444 222537 - 222566.