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Paper

The efficacy evaluation and cost-benefit analysis of the intervention towards troubled youth and its families: OIKOS Service

abstract

Background. Nowadays the care of troubled youth is still an open issue, as many fields of social/health services are involved. Furthermore, the number of users cared is not diminishing (Regione Veneto, 2006), as what is produced in terms of "result" is not an actual "solution" to what is considered "problematic". The biographical career of "social/health services user" (Turchi, Della Torre, 2007) goes on even after the users' removal from residential care, as the expectations of family members, educatio n officers, teachers, peers etc. (the system-community) become more and more based on the label "social/health services user". At the same time, users tend to identify themselves more and more with the label, thus generating a "vicious circle" which keeps the biographical career. The overall result is a high economic and organizational cost for the caring of troubled youth and their families.

For these reasons it becomes necessary also to project alternative forms of care, which could represent an efficient and efficacious answer to these critical aspects. OIKOS Service- from Greek home - is marked out from the usual care framework pattern as it which is alternative to that, addressing all the address to the whole relational context lived by the youth, that's to say all social 'actors' who contribute to maintain the definition of the situation as "troubled", then promoting the biographical career of "user" (Mussoni, Zamboni, Lamanna, 2007).

Method. OIKOS Service is structured according to the dialogical model (Turchi, Mussoni, Di Maso, Salvini, 2000) used as a framework for the theory and praxis of interventions. Based on that, the aim is to modify the modalities used to describe minors (discursive configurations), which usually imply the "crystallization" of the biography in term of "biographical career" of "health/social services user". In other words, OIKOS aims at maintaining/restoring the social role of "person" instead of "user", as well as at restoring the development of the biography, representing in this way a health promotion intervention.

Our main strategy is to build a strong synergy with and between public social/health care and third sector, based on the sharing of the same intervention aim. The strategies specifically defined by each of these actors become then strictly coordinated, building a high-embedded team, which can move as a flexible network for the fostering of personal and community development. Health promotion becomes then a responsibility shared by everyone; the whole community-system shifts from a "passive service user" position to become a sort of "non-formal service", reducing the length and cost of care itself.

The method used to carry on the efficacy evaluation is M.A.D.I.T., Method of Computerized Textual Data Analysis (Turchi, 2007). Through this, the discursive configuration of people involved in the caring service is compared before (T0) and after (T1) interventions. This method allows to determine the configuration point, a decimal number included between 0 and 1, where the value 0 represents to the great extent the configuration of biography (thus the social status of "person"), while 1 represents to the great extent the biographical career of "user". Basing on that it becomes possible to put in relation actual costs and the surveyed spread of the configuration point between T0 and T1.

The case-study used to show an application of what above mentioned concerns the application of OIKOS toward two minors. The situation was critical to the extent that the main clinical perspective was to moving minors in a therapeutic residential care service. Differently, the intervention has been provided on the community through a mixed team composed by professionals of the social care district Ulss 17 - Unit for Mothers, Children, Family and Development (Mieef) and altreStrade no-profit organization.

After 7 months of intervention, the surveyed modification of the average discursive configuration switched from .696 to .416 (Delta=.280 toward the configuration "biography"). The adopted operative model empowered the intervention, allowing the managing of the situation within the community. The moving of the two minors in a residential care service would have implied cost proportionally higher to the extent of the 150,5%, as well as further costs for the reintegration of the users on their territory: it's also recommended to go on with further investigation which can compare OIKOS and residential care service on a cost-benefit balance basis.

In conclusion, results showed how the adoption of a scientifically founded operative model allowed to plan an efficacious intervention, as well as the rigorous definition of what can be considered as "benefit". This allows the introduction of a research field which can be grounded on the overcoming of the dichotomy between clinical and economic indicators, leading to the finding of strategies of improvement which can combine clinical efficacy and organizational efficiency.

Key References

Mussoni, A., Zamboni, F., & Lamanna, M. R. (2007). L'intervento clinico come promozione della salute: il progetto OIKOS. In G. P. Turchi & C. Della Torre (Eds.), Psicologia della salute. Dal modello bio-psico sociale al modello dialogico: generare e gestire processi trasformativi nell'ambito della 'salute'. Roma: Armando Editore.

Regione Veneto, Comunicato stampa n. 2093 del 12/12/2006, consultabile su web: http://www.regione.veneto.it/Notizie/Comunicati+Stampa/Dicembre+2006/2093.htm

Turchi, G. P., Mussoni, A., Di Maso, A., & Salvini, A. (2000). Identity as social and self narration: an approach to clinical psychology. International Journal of Psychology, 35.

Turchi, G. P., & Della Torre, C. (Eds.). (2007). Psicologia della salute. Dal modello bio-psico sociale al modello dialogico: generare e gestire processi trasformativi nell'ambito della 'salute'. Roma: Armando Editore.

Turchi, G. P. (2007). M.A.D.I.T. - Manuale per la metodologia di analisi dei dati informatizzati testuali. Roma: Aracne.

Contacts: Prof. Gian Piero Turchi, Università di Padova - Dipartimento di Psicologia Generale, via Venezia n.8 - 35131 Padova - Italy, E-mail: gianpiero.turchi@unipd.it, Phone +39 0498276633, Fax +39 0498276600.

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