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Personalized plans considering both the needs of the person and the family. Results from a research with 15 families with children, and with multiple-problems

abstract

Background. The research was promoted by the Abruzzo Region in order to put into practice the content of the art. 2, Dpcm 14/2/2001. Article 2 prescribes that Regions define their guidelines on "modalities and criteria for the definition of personalised care plan", by means of multidimensional evaluations, in order to guarantee integrated social and health care.

Intervention-research experimented modalities for an integrated taking care of families with children, living in situations of disadvantage and social exclusion, defined as a multiple-problem situation, in order to guarantee a better services and local community taking care. In this sense, this research explores innovative methods in population and service-based research with severely troubled families with children.

Purpose A multiple-problem family is defined as a family where at least half of its members had had social and/or socio-health or legal problems within the last 5 years, with "one or more members with a given sickness, or people with behavioural problems and social exclusion, so that to disrupt family" (Malagoli, Togliatti, Rocchietta Tofani, 1987).

Multiple-problem families absorb large amount of resources, interventions, and activities of the social and health services. Notwithstanding, they do not get out of their situation of need. Moreover, social services interventions often overlap and are fragmented. Generally, professionals find it difficult to find places, times and instruments for a real integration, pushed by emergencies and influenced by the pressure, sometimes even contrasting, of their own organizations.

Altogether, the research took in care 15 family groups with multiple problems, with 27 children, from December 2005 and January 2007 (14 months) in the Chieti District in Italy, according to the methodology of the work for personalised care plan (Pompei e altri, 2000).

The research protocol defined inclusion criteria, integration methods, instruments for the evaluations of families and children conditions and instruments for plans documentation and evaluation. The Multiprofessional Project Unit (Ump), described by the protocol, aims at arranging and monitoring the process of global taking care of the family group, avoiding the division and overlapping of interventions on different members of the family group.

The documents supporting this research involve a personalised care plan sheet, some check sheets, and some instruments for the need evaluation, as follows:

  • Informed consent for the family;
  • Collection of the request;
  • Analysis of the request;
  • Evaluation of the child and the family;
  • Synthesis of the decisions;
  • Care plan check, check of the involved responsibilities, output check, outcome evaluation.

Key findings. All families showed at least one problem in the sociorelational area: parenting inadequacy (10 families out of 15), deficient economic situation (10 families), strong social exclusion (8 families). Moreover, 11 families (73,5%) showed at least one problem in the cognitive-behavioural area and 9 families (60%) in the functional-body one. No family index was adequate in the answering scale. In 8 families, children showed behavioural and/or psychological difficulties.

For all 15 families involved it was possibile to analyse the differences between their condition at the moment of the defining of the personalised plan (T0) and at the moment of its first evaluation (T1).

 

Tab. 1 - Average of family indexes[1] for 15 families (T0 and T1)

 

Mother

Father

Couple relations

Family relations

Social relations

Relations with the educative and spare time organizations

Economic condition

Mean

T0

0,40

0,28

0,28

0,23

0,24

0,31

0,21

0,29

T1

0,47

0,33

0,33

0,26

0,28

0,41

0,21

0,34

Difference (%)

18,7%

16,8%

18,9%

13,5%

16,0%

31,9%

2,8%

17,3%

The table shows improvements in every given area, with the exception of the economic situation, which seems stable (+2,8%, being still very low - index 0,21). The greatest improvements can be observed in the "relations with the educative and spare time organizations" area (+31,9%), and in the "couple relations" (+18,9%), the situation of the mother (18,7%) and of the father (+16,8%).

The analysis of the situation of the 7 families with 3 evaluations (T0, T1 and T2) was more meaningful, given the fact that those families had been taken in care for a longer period (8-15 months).

Tab. 2 - Average of family indexes for 7 families (T0, T1 and T2)

 

Mother

Father

Couple relations

Family relations

Social relations

Relations with the educative and spare time organizations

Economic condition

Mean

T0

0,32

0,25

0,16

0,21

0,22

0,21

0,22

0,24

T1

0,51

0,34

0,44

0,31

0,24

0,37

0,21

0,34

T2

0,49

0,38

0,46

0,34

0,31

0,37

0,30

0,37

Difference %

51,0%

51,2%

185,9%

60,7%

42,2%

73,7%

35,3%

57,8%

Overall, in the period of time between the access (T0) and the final evaluation (T2), al the 7 families showed an improvement in every given area. At the time T2, the highest index was the mother one (0,49), approaching 0,50 and showing the difficult situation experienced by mothers. The difference in percentage between T0 and T2 is relevant, in particolar for the couple relations showing double indexes as compared to T0 (+185,9%), relations with educative and spare time organizations (+73,7%), family relations (+60,7%), mother and father (+51% and +51,2% respectively). The economic situation of the involved families improved more in the long-term than in the short one.

Results show the possibility to evaluate the outcome of personalised care plans, facilitating the comparison between different services and professionals and giving professionals the satisfaction of being able to measure the reached outcomes. In particular, an improvement in family and children situations can be seen in the learning, functional and social-relational areas. Moreover, no child involved in the research for a longer period (from 9 to 15 months) got worse during the research and improvements are more evident for these children than for those in care for a shorter period of time.

Professionals appreciated the instruments of the personalised care plan, the role played by the Multiprofessional project Unit and the care manager for the integration of different services in the personalised care plan.

Implications. The method of taking in care experimented in Chieti introduces many innovations in service practice as compared to traditional approaches, trying to concretize the indications of relevant literature. In particular, the most important innovations are:

  • The Multiprofessional Project Unit, as a project group following the taking care of the family, and not only the multidimensional evaluation of its needs;
  • Evaluation sheets on falily and children's needs, forcing different professionals to discuss over the same measurement;
  • The global plan for the taking care, in order to avoid fragmented plans;
  • The documentation system, forcing professionals to define together the problem, the aims, the interventions, the time-schedules and the system of responsibility;
  • The periodic check and re-planning sheet, helping to measure the possible chages;
  • The conntract with the family, who has to play a fundamental role.

Key references

Bortolotti G., Galli D., Garavini C. (1994) Storie di servizi e di minori. Milano: Franco Angeli.

Canali, C., Maluccio A. N., Vecchiato T., a cura di (2005), La valutazione di outcome nei servizi per l'età evolutiva e la famiglia, Padova: Fondazione Zancan.

Malagoli Togliatti M., Rocchietta Tofani L. (1987), Famiglie multiproblematiche, Roma: La Nuova Italia Scientifica.

Pompei A., Costanzi C., Risso A., a cura di (2000), Il lavoro per progetti individualizzati, Padova: Fondazione Zancan.

Contacts: Gianmaria Gioga, Fondazione E. Zancan (Padova), Via Vescovado 66 - 35141 Padova Itala, Phone 049 663800 - 329-2107137, gianmaria.gioga@sanita.padova.it.

 


[1]. L'analisi è effettuata sulle medie degli indici della somma delle diverse aree.

 

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