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Background. In Portugal the awareness of the potential of the delivery of parenting programmes as a promotion, prevention and intervention strategy to improve children well-being is growing, both at governmental and local services levels. The use of paren

abstract

Background. Intrafamilial problems, child abuse and neglect are complex processes and place professionals for a difficult task. They need to 'know' which characteristics are associated with an increased risk, 'see' these often subtle or masked signals, 'interpret' what they observe to assess the amount of risk, and take 'action' after noticing risks.
Research shows that errors in decision-making can be situated on the level of know¬ledge, observation, interpretation and preparing interventions. Most errors seem to be caused by leaning too exclusively on intuition, by using fragmentary information to interpret (the severity of) a situation, and by making suspicion an end point instead of the start for further actions. When different professionals are involved with a family, errors are often caused by not sharing information, by declining responsibility on other services and by a lack of coordination. Nevertheless, vulnerable children and families need early intervention to avoid escalation of problems and harmful effects on the development and well-being of the child.
This paper draws on the development of an instrument to improve early intervention in families at risk for severe parenting problems -in particular child abuse and neglect- by professionals involved in child and family welfare services in Flanders (Belgium).

Purpose. Instead of offering professionals merely a list of risk signals, we wanted to construct an instrument to support intuition and vigilance, enhance reflection and systematic decision-making, and stimulate professionals to take further action when suspicions arise. To construct the instrument, we used different sources of information.
Firstly, we did an extensive literature search for publications about risk factors for child abuse and neglect, existing screening instruments and risk scales, errors in decision-making, and characteristics of cases of fatal child abuse.
Secondly, we organized focus groups with professionals working in various areas of child and family welfare services (e.g. preventive care, ambulatory/residential services, services for people with disabilities/youth care) to incorporate their clinical experience in the instrument.
In a first session they were asked to describe characteristics of children and families that lead to concern or to intervention. In a second session a preliminary version of the instrument was discussed. During both sessions we also asked professionals about their ideas, wishes and needs for an instrument. A third session was organized after completion of the instrument, to discuss its content and form, and prior conditions that should be fulfilled to enhance successful implementation.
Thirdly, we analyzed 11 cases reported to the Committees for Special Youth Care because of suspicion of child abuse/neglect or because of another serious concern (e.g. severely problematic child behavior), with suspicion of (underlying) parenting problems only arising during the process of assessment and care. We tried to develop more insight in why some parenting problems weren't noticed earlier or didn't lead to interventions.

Key findings. The instrument consists of 25 risk signals, concerning characteristics of the relation between the professional and the parents (2 items), the parents (6 items), the family (4 items), the child (1 item) and the parent-child interaction (12 items). Each item consists of a description (what is the item about?) and a reflection to support interpretation and evaluation (which thoughts must be considered?). After reflecting, a choice must be made between 'signal is present', 'doubt' and 'signal is absent'. For each choice, information is given on what to do next.
The professional can be stimulated to further explore the situation through contacts with the family and other professionals. Important aspects or other items from the list to be explored are suggested. He can also be stimulated to provide support and to reflect on the need for support in the family and the provision of care (e.g. which service(s), waiting lists, coordination of care).
The instrument also provides some background information (e.g. some reflections on the safety of the child, suggestions for a good collaboration between services). Its web-application permits a flexible use, so that each professional can 'click' on these aspects of the instrument that answer to his needs in each specific case.
The instrument is not intended to be a checklist or a screening instrument which allows calculating a risk score. It was in the first place constructed to be an aid for an individual professional or for a team, to support the process of thinking about families at risk for parenting problems and to strengthen the use of a similar frame of reference.
The application of the instrument will be embedded in the process of realizing a policy towards a more integrative care system for children and families.

Recommendations. The instrument will be implemented in February/March 2008. First of all it will be important to inform professionals about the aims and potential of the instrument and to stimulate them to get to know and use it. Secondly the use of the instrument must be embedded in the existing practices concerning at risk families, both on individual and team level. Thirdly professionals must be able to report experiences and bottlenecks (practical, technical and with regard to content), so that improvements can be made.
Further research will be necessary to evaluate the usefulness and value of the instrument, and the satisfaction of professionals using it. It will be most important to evaluate to what extent the instrument improves the detection of and intervention in at risk families.

Key references
Hellinckx, W., Lacluyse, K. & Grietens, H. (2007). Signaallijst ernstige opvoedingsproblemen: Ontwikkeling van een werkinstrument voor het onderkennen van ernstige opvoedingsproblemen, ter ondersteuning van hulpverleners werkzaam binnen de Integrale Jeugdhulp. [Development of an instrument to detect severe parenting problems, supporting professionals involved in child and family welfare services]. KU Leuven, Research report.

Contacts: Kristien Lacluyse, Centre for Parenting, Child Welfare and Disabilities, Katholieke Universiteit Leuven Vesaliusstraat 2, 3000 Leuven Belgium, E-mail: Kristien.Lacluyse@med.kuleuven.be.

Example: Part 3 'Characteristics of the family', item 9
9. The family has a low socio-economic status (poverty, unemployment, housing), which negatively affects the parenting situation.

Description
A low socio-economic status can affect the parenting situation. Financial problems, debts, unemployment, housing difficulties may occupy the parent to such an extent, that little time and energy are left over to spend on interactions with the child and to take up a parenting role. As a consequence the child may receive less developmental challenges or has to take up responsibilities that interfere with its own developmental process.

Reflection
A low socio-economic status doesn't always negatively affect the parenting situation; neither do excellent material conditions guarantee high quality parenting.
A parent with financial difficulties can receive help from social services or support from others, which may allow him to be a good parent and to diminish possible negative consequences for the child.
It becomes problematic when circumstances negatively affect the quality of the parent-child interaction:
-    Does the parent have left enough energy and time to be a parent and to spend time with the child?
-    Do problems exist in different domains of life? How long do they already exist? How serious are they?
-    What are the consequences of these problems for the child? For the parent-child relation?

Signal is absent
Write down observations and important information

I doubt
Further exploration
You can do further exploration yourself
-    What does the parent undertake to deal with the socio-economic problems?
-    What does the parent expect the child to do?
-    How does the parent feel about the parenting situation?
-    How does the parent think about the future?
-    Does the parent mention he needs professional help for himself or his family? Does he show willingness to participate in professional care?
You can not do further exploration yourself
1. Report your concern and doubts to a collegue or to your team
2. Contact other professionals who are involved with the child or the family
-    Do they have the same feelings about the family?
-    If necessary make arrangements: who will look after/take care for this family?
-    Pass on important information and own impressions
3. If concerns remain or increase over time: contact a Committee for Special Youth Care or a 'Trust Centre'
Write down observations, important information, actions you've taken and decisions

Signal is present
Further exploration
You can do further exploration yourself
Suggestions for further exploration are done. This concerns risk signals in the different parts of the instrument ( relation parent-professional, the parent, the family, the child and the parent-child interaction).
You can not do further exploration yourself
1. Report your concern and doubts to a colleague or to your team
2. Contact other professionals who are involved with the child or the family
Do they have the same feelings about the family?
If necessary make arrangements:
-    Who will explore which domains? (parent, family, child, parent-child interaction)
-    When and how will information be exchanged?
-    Who will look after/take care for the family?    
Pass on important information and own impressions
3) If concerns remain or increase over time: contact a Committee for Special Youth Care or a 'Trust Centre'

Provision of care and follow-up
You will provide care for the family yourself
1. Check out if you are able to provide sufficient care for this family? (in terms of intensity and frequency)
2. Make arrangements with other professionals
-    Who is responsible for which aspect in the process of care?
-    When and how will information be exchanged?
-    Who will coordinate the process of care?
3. Don't let go of the family until you have certainty about the safety of the child
4. If necessary: work together with or under supervision of a Committee for Special Youth Care or a 'Trust Centre'
Care will be provided by other professionals or services
1. Check out who is already involved with this family?
-    Can anyone of these professionals provide care for this family?
2. Check out with service can provide appropriate care for this family?
-    Which service can offer help to deal with the socio-economic problems?
-    Does the parent need counseling?
-    Does the family need parenting support?
-    Can care be provided immediately?
-    How long is the waiting list?
-    Can you refer the family to another service?
3. Pass through important information
4. Make arrangements about follow-up
5. Don't let go of the family until you have certainty about the safety of the child
Write down observations, important information, actions you've taken and decisions

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