Paper
Crisis intervention for families: The search for effective elements
- issue: Issue 2 / 2009
- authors: Channa Al, Geert Jan Stams, Peter van der Laan
- keywords: The Netherlands, effectiveness, crisis intervention
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abstract
Background. This study focuses on the effectiveness of crisis intervention for families. Through the evaluation of 'Spoedhulp', with Families First the main intervention program for families in crisis in Holland, we try to enlarge the knowledge about crisis intervention. When Spoedhulp is indicated there isn't necessarily a direct threat of out-of-home placement of children (contrary to Families First), although (temporarily) out-of home placement is a possibility; Spoedhulp focuses on a broader range of crisis situations and desired intervention outcomes.
Purpose and method. Spoedhulp is an intensive, short - four weeks - in-home crisis intervention program. The goals are to restore safety and balance in family functioning, to analyze the problematic situation, to set short-term goals in cooperation with the family, to formulate an advice and if necessary to organize specific professional care for the family. The approach is network focused with attention for the family system, competence, solutions and cooperation. Moreover, Spoedhulp has a quick start - within 24 hours - and it is a structured, goal-directed and flexible intervention program.
The program is built on evidence-based 'what works principles' for effective (crisis) intervention (e.g. Hermanns, 2004; Van der Laan & Slotboom, 2002, Van Yperen, 2003).
Furthermore, Spoedhulp meets conclusions of internationally published research on crisis (intervention): positive experiences with short-term and intensive crisis intervention (Kutash & Rivera, 1995), a focus on the whole family (Günter et al., 1999; Henggeler et al.,1998) and working with knowledgeable, special trained social workers (Simington et al., 1996).
Several crisis intervention studies have found support for the effectiveness of crisis intervention, including intensive family preservation services (Kinney et al., 1977), Crisis Child Care (Cowen, 1998) and Families First - in Holland - (De Kemp et al., 1998; Kemper, 2004). Recently Van Puyenbroeck, Loots, Grietens and Jacquet (2007) and Veerman, De Meyer and Roosma (2007) reported positive results of crisis intervention programs resembling Spoedhulp. Many studies, however, suffer from methodological shortcomings (e.g. Lindsey, Martin & Doh, 2002). There's also discussion about the research focus regarding to chosen measures of successful intervention outcomes (e.g. Bagdasaryan, 2004).
We are interested to know more about the factors that define effectiveness of crisis intervention. Therefore we are working on a meta-analysis of crisis intervention studies, and an evaluation study of Spoedhulp employing a design that overcomes the methodological and research focus shortcomings encountered in previous crisis intervention studies. Because the data collection started in November 2007, this text describes the methodological choices, construction and content of our research rather than the results.
Our main purpose is to detect effective elements in Spoedhulp; what contributes to effectiveness of the intervention and in what way do various elements of the intervention and client characteristics? We will explore and analyze these relations using a mixed methods design.
The current study will be directed at the following six elements in particular: the crisis aspect, perception (differences) of people who are involved, family functioning, goals which are set during the intervention and goal attainment, the relationship between the clients (family members) and the social workers and program integrity/ fidelity.
Clients fill in questionnaires about these topics, using primarily validated questionnaires with complementary self-formulated items. There are three measurement waves: the base-level-test during the first week of the intervention, the post-test, when families have finished the program, and the 6 months follow-up assessment. The social workers, managers and supervising psychologists involved fill in questionnaires as well, which we will relate to the clients measures.
The main constructs to be measured are: child behavioral problems, parent-child interaction, parental stress, stress coping, self-efficacy, marital satisfaction, quality of the therapeutic relationship, and social support. In addition, the study includes interviews, observation and an experiment with randomized control group on goal setting.
Both quantitative (questionnaires and goal setting experiment) and qualitative measures (open interviews) will be used in order to cross-validate our research findings.
The use of multilevel analysis offers an important statistical tool to examine the associations between process variables and intervention outcomes.
Driven and with joy we commit to the great and important challenge to find suitable research methods to do scientific research in this field with the intention to enlarge understanding of effective ways to intervene when confronted with families in crisis; an important issue in Society.
Key references
Cowen, P. S. (1998). Crisis Child Care: an intervention for at-risk families. Issues in comprehensive pediatric nursing, 21, no. 3, 147-158.
Günter, M., Karle, M. Kleefeld, H., Werning, A. & Klosinski, G. (1999). Psychiatric-psychotherapeutic crisis intervention for inpatient adolescents. Crisis, vol. 20, no. 2, pp. 71-77.
Henggeler, S.W., Schoenwald, S.K., Borduin, C.M., Rowland, M.D. & Cunningham, P.B. (1998). Multisystemic Treatment of Antisocial Behavior in Children and Adolescents. New York / London: The Guilford Press.
Kinney, J.M., Madsen, B., Fleming, T., & Haapala, D. (1977). Homebuilders: Keeping families together. Journal of Clinical and Counseling Psychology, 43, 667-673.
Lindsey, D., Martin, S. & Doh, J. (2002). The Failure of Intensive Casework Services to Reduce Foster Care Placements: An Examination of Family Preservation Studies. Children and Youth Services Review, vol. 24, nos. 9/10, pp.743-775.
Simington, J. A., Cargill, L. & Hill, W. (1996). Crisisintervention. Program Evaluation. Clinical Nursing Research. Vol. 5, no. 4. p. 376-390.
Contacts: Channa Al, PhD student, Faculty of social and behavioral sciences, Department of education, University of Amsterdam, E-mail: c.m.w.al@uva.nl.