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Process and outcomes of needs-led and family-focused child and youth care: preliminary findings in a programme evaluation


Background. The organisation for child and youth care Cardea in Leiden, the Netherlands, has developed a needs-led and family-focused child and youth care programme, called Gezin Centraal (GC, which means: Family Central). In order to test and to improve this experimental youth care programme, Cardea asked the Department of Clinical and Adolescent Studies of Leiden University, co-operating with the Child and Youth Care Research Group of the University of Groningen, to carry out an evaluation study.

The programme focuses explicitly on the needs of both the child and the family-members. It consists of modules like intensive family coaching, out-patient treatment and care at a residential home. The target group of the programme comprises troubled and troublesome children in the age of 6 until 14 years and their parents. Aim of this programme evaluation is therefore to contribute to the evidence-base of interventions for these vulnerable children and their families.


Purpose and method. The main questions to be answered are: 1. How is the needs-led approach being executed at the various units within the GC-programme, and 2. what consequences (in terms of learning, behavioural outcomes, client satisfaction, et cetera) has this approach for both the families and the organisation.

In this programme evaluation we use a quasi-experimental research design. Care trajectories of GC are being followed and compared to trajectories of children in the same age who have been referred to another CYC organisation serving clients with comparable problems. The sample consists of 164 cases. We collect information on several subjects, divided into two broad subjects: processes and outcomes.

Processes within the care trajectories are being followed with the use of a Form for Recording Worker Activities and Techniques (VerrichtingenLijst - VL). The form, inspired by research on the Families First intervention programme by Ten Brink et al. (2004), includes five main categories (for sub-categories, see Metselaar & Van Beek, 2004): keeping up a working alliance, gathering information, working on behavioural changes, enlarging environmental support, and realising practical help.

Next to this form, which departs from the idea of self-observation, a careful investigation of Case Files (CF) takes place. Files are composed in accordance with a protocol that covers items like problems and assets of the child and family, treatment goals, treatment activities, evaluation meetings, et cetera.

In addition to the VL and the CF-method the care process will be evaluated at the end of the treatment period when families and workers are being asked to fill in the Vraag-study Evaluation Questionnaire (VEQ). Themes in the VEQ are: level of participation of clients; needs-led attitude of the professionals; dialogue between clients and child care workers; satisfaction with the results; and effectiveness, i.e. whether treatment goals are reached.

Outcomes will be measured by using several standardised questionnaires: two questionnaires on the behavioural development of the child (Child Behavior Checklist - CBCL; Strengths and Difficulties Questionnaire - SDQ); a questionnaire on parenting (Parenting Stress Index - PSI); a questionnaire on coping behaviour of parents (Utrecht Coping List - UCL); a questionnaire to obtain an indication of the severity of the child's situation (Standaard Taxatie Ernst Problematiek - STEP); and a questionnaire on family functioning (Vragenlijst Gezinsfunctioneren - VGF).

Findings and implications. The evaluation is still in progress. Therefore, only some preliminary results of the above mentioned questionnaires will be presented. The paper will focus on qualitative results, and includes first implications for research and practice. Response rates indicate that we have been able to include 67% (164 cases) of the intended sample. This percentage might seem quite acceptable, but a closer look - for instance at the rates of received evaluation forms in the experimental group (35% for the outpatient treatment workers, and 47% for the family coaches) - reveals a lower response rate.

Connected to these response rates, we will discuss qualitative findings considering the process of evaluation in daily CYC-practice. One of the qualitative findings refers to the 'research mindedness' of Dutch child and youth care practice. Encouraging participation of workers in the evaluation took up more time of the evaluators than foreseen, due to a fear of too much bureaucracy of the workers and to time pressures in daily practice. It proved to be necessary to stimulate professionals to welcome renewed attention to their practice and service design by evaluators. By making the information gathered for the evaluation accessible for the care process, child and youth care workers felt encouraged to participate and stimulate clients to fill in questionnaires. Another lesson is that in the organisation no misconceptions should exist on the responsibilities of all those involved in the evaluation.

Key references

Metselaar, J., Knorth, E. J., & Van den Bergh, P. M. (2007). Needs-Led and Family-Centered Child and Youth Care: Theoretical considerations and evaluation in practice. Relational Child and Youth Care Practice, 20 (2), 38-46.

Metselaar, J., & Van Beek, S. (2004). Manual for the VraaG-study. Leiden, the Netherlands: Cardea/Leiden University (in Dutch).

Ten Brink, L. T., Veerman, J. W., De Kemp, R. A. T., & Berger, M. A. (2004). Implemented as intended? Recording family worker activities in a Families First program. Child Welfare, 83, 197-214.

Contacts: Janneke Metselaar, MSc, Leiden University, P.O.box 9555, 2300 RB Leiden, The Netherlands, Tel. 00-31-71-527-4089, j.m@fsw.leidenuniv.nl.


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