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Paper

Implementation and development processes of a new service for long-term institutionalized youth

abstract

Background. In Portugal, a series of issues have been raised regarding the definition and organization of residential care, and the types of services needed to respond to the needs of adolescents who have a history of long-term institutionalization (e.g., Bullock et al., 1993; Casa, 1993; Valle, 1998). Indeed, the most prevalent residential care model in Portugal fosters experiences within "the institution walls", which strongly impacts interpersonal development, self identity and social integration after these adolescents reach adulthood. Moreover, it hinders the development of facilitative connexions for their social integration, as a source of social support at the time institutional care terminates. For these reasons, it was important to create a flexible mentoring structure during the period of transition from institutionalization to autonomous adult life.

Growing interest has developed in evidence-based mental health treatments and evidence-based medicine. However, the foundations of evidence-based practices have been largely based in randomized controlled trials, with little evidence about how to implement interventions in real-world care. This study captures the process of development of evidence-based practices in actual community settings, in line with the work developed by Janzen et al. (2005) in evidence-based practices with families at risk.

 

Purpose. The present paper describes the implementation of a new service (described in this symposium) and its development methodological processes.

A project team was created, composed by 1 coordinator, 1 psychologist, 2 youth educators, and 1 external supervisor. Four residential autonomization units were planned, and opened in a time-phased manner. A personal and social developmental program was tailored to the needs of each group of adolescents in each unit, based on Smith (1999).

The study followed an experimental design. According to inclusion criteria, female and male adolescents were randomly selected to be admitted in the units. The control group was composed by non-selected youth who received "treatment-as-usual" (case management for a few months after leaving the institution). Both quantitative and qualitative methods were utilized to gather data at program entry, during the intervention, and at the end of the program. Qualitative data was also retrieved from the team members, specially the youth educators, who maintained a diary of the interpersonal process issues raised in the work with the youth. Challenges and opportunities were experienced by the team throughout the process of developing a flexible structure to match the needs of the specific adolescents in each unit.

After one year of implementation, three residential autonomization units have been created. A total of 42 adolescents were assessed (17 in the experimental group and 25 in the control group) at time of admission, including an assessment of their autonomy (Iowa Development Autonomy Inventory; Hood & Lorraine, 1983), social support (Social Support Questionnaire; Sarason et al, 1983), psychological well-being (Scales of Psychological Well-Being; Ryff, 1989), and overall adjustment (antisocial behaviour; anger management problems; emotional disorders; and positive self-concept; Reynolds Adolescent Adjustment Screening Inventory; Reynolds, 2001). Qualitative measures were also taken, including focus groups with each unit's adolescents, youth written life narratives at the end of the program, and diaries from the educators on interpersonal processes during the intervention.

 

Key findings. The results of the study are aimed to contribute to the empirical support of a new evidence-based program that addresses the specific needs of long-term institutionalized adolescents, providing a tailored response to their particular issues (namely, promote emancipation skills and develop competence for an autonomous life).

Implementation and development processes regarding the team are considered essential in the program design. Recent supervision theory (Bernard & Goodyear, 1998) presents three interdependent supervisory roles: (1) consultant, (2) teacher and (3) counsellor. These roles are illustrated in the case of the supervision of the team responsible for implementing this project, and whose task demanded both research and clinical skills. Different needs reported by the team were used as indicators for supervision to switch roles and to accompany the team's development, making use of a developmental theory of supervision. Finally, "parallel process" in supervision was evidenced, that is, the working through of issues in the supervision meeting which parallel the processes occurring in the residential units between the youth and the team members.

The importance of external supervision for teams working in the field of child/youth abuse and neglect are emphasized, highlighting some of its principal goals, including the promotion of reflectivity (Neufeldt, Karno & Nelson, 1996; Neufeldt & Nelson, 1999) and of burn-out prevention/self-care strategies (Skovholt, 2001).

 

Key references

Janzen, C., Harris, O., Jordan, C. & Franklin, C. (2005). Family Treatment: Evidence-Based Practice with Populations at Risk (4 ed). Wadsworth Publishing.

Smith, J. (1999). Life Panning: Antecipating Future Life Goals and Managing Personal Development. In J. Brandtstädter & R. Lerver (Eds.). Action & Self-Development.

Valle, J. (1998). Manual de Programación y Evaluación para los Centros de Protección a la Infancia. Salamanca: Junta de Castilla y León Consejeria de Sanidad y Bienestar Social.

 

Contacts: Carla Moleiro, ISCTE - Lisbon University Institute, Portugal; CIS - Research Centre for Social Research and Intervention, Address: Avenida das Forças Armadas, 1649-026 Lisbon, Portugal, Email: carla.moleiro@iscte.pt, Phone: +351-21-790-30-22.

 

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