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Paper

Evaluation of child parent treatment centres in Israel

abstract

Background. In Israel, until the last decade, the predominant response to child maltreatment and disturbed parent-child relationships was out-of home-care. In recent years, the child welfare system is shifting toward community-based services for vulnerable children and families. This paper presents an evaluation of an innovative service for children at risk, the Child-Parent Centre.

The goal of the service is to improve children's emotional wellbeing, parent-child relations and parental care. The centres are operated by multidisciplinary teams and are affiliated with local welfare service departments. The professional approach emphasizes seeing the child in the context of the family; utilizing a variety of expressive therapies; focusing on family strengths; creating a warm and accepting atmosphere; involving clients in designing their own treatment plan and collaborating with the welfare department and the educational system in meeting the children's needs. The treatment is limited to one and a half years, after which a follow up plan is designed for each family with the welfare department.

Research questions. The evaluation examined implementation and outcomes and served as a formative evaluation for the service during its first years (2000-2004). Questions regarding implementation included: which families are served and do they belong to the target population? Which interventions are provided? How does the centre cooperate with other services? How are families involved in the treatment plan? What follow up plans are prepared for the families and are they carried out? Questions regarding outcomes include: how did the centre affect the childrens' emotional wellbeing, their behaviour and their school performance? How did it affect parent child-relations, parental authority, and daily care? Finally, the evaluation asked, how did the families experience the centre? What did they find helpful?

Method. The sample consisted of 140 families, treated in nine child-parent centres, as well as a comparison group of 150 families treated by welfare departments without access to a child-parent centre. Questionnaires were administered to welfare department social workers, centre therapists and parents regarding each child at referral, upon ending treatment, and one year later. The instruments included scales relating to child and parents' behaviours, as observed by the social worker. Social workers and parents of the comparison group, completed questionnaires at two points of time, with a one-year interval.

Outcomes were measured by comparing the scores on the various scales before and after treatment at the centre, and scores from the two measurements for the comparison group. The study also included semi-structured interviews and focus groups with policy makers, staff, parents and children.

 

Key findings. The evaluation showed several aspects of the treatment model that are widely implemented: treatment is provided in various settings, such as parent-child dyad, or family therapy, a wide range of expressive therapies is used, such as art therapy, play therapy, and animal-assisted therapy. Virtually all of the clients (98%) were satisfied with the treatment. Analysis of qualitative materials showed that clients particularly appreciated the warm and non-judgmental approach of the staff, the variety of treatments, and the attention to parents and children's problems.

Several principles were not fully implemented: one third of the treatments lasted longer than the designated period and therapists are not oriented towards short term methods; the collaboration with welfare and educational services was partial, and about one quarter of the families did not have a follow up plan.

As far as outcomes, children treated at the child-parent centres showed statistically significant improvement in two areas: the percent of children with at least one problem in school behaviour declined from 61% to 43%, and the percent of children with at least one anti-social behaviour declined from 46% to 34% (N=118, p<0.05). The percentage of children with symptoms of anxiety or depression did not decline significantly (76% pre-treatment, 70% post-treatment); however, among the children in the comparison group there was a significant increase in symptoms of anxiety and depression, from 38% at the initial measurement, to 53% one year later.

Data relating to parental care and parent-child relationships also revealed some statistically significant findings. There was a marked decline in the number of children with poor relationships with their fathers, from 91% to 70% (N=53, p<0.01); the percent of children exposed to emotional, physical or sexual abuse (proven or suspected) declined from 29% to 20% (N=109, p<0.05). In addition, mothers' scores on the Parenting Stress and Competence Scale (Mash and Johnson, 1989) improved significantly. Outcomes were relatively stable; there were no significant changes between the post-treatment and the follow-up data collected approximately one year later.

Implications. In the context of developing community-based services, the evaluation shows that vulnerable children and parents can be helped by appropriate services, specifically geared towards families that would not normally engage in intensive counselling. The strengths of the services seem to be the friendly and non-judgemental approach, the use of expressive therapies and attention to children and parents' issues. These principles can be applied in additional services as well. The study also shows the challenges: the service is meant as a short-term "boost" for families with recurring crisis and long-term needs, yet it has not developed a time limited practice. Involving long-term services and providing a follow up plan are essential for this purpose.

Key references

Mash, E. J. & Johnston, C. (1989). A measure of parenting satisfaction and efficacy. Journal of Clinical Child Psychology, 18(2), 167-175.

Contact: Dori Rivkin, Myers-JDC-Brookdale Institute, Jerusalem, P.O.B. 3886, Jerusalem, 91037, Israel, E-mail: dorir@jdc.org.il, Phone +972-2-6557382.

 

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