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Preventing child placement through the help between families. The experience of family helpers in the program P.I.P.P.I.

abstract

P.I.P.P.I. (Program of Intervention for Prevention of Institutionalization) is a research-training-intervention program developed as an intensive care program for vulnerable families, funded by the Italian Ministry of Welfare. It aims at preventing child placement out-of-home by balancing risk and protective factors, and focuses on supporting parenting through multi-professional and resilient based intervention. P.I.P.P.I. is inspired by the well known resilient girl Pippi Longstocking and aims at working on parental problems related to child neglect, that is intended as a significant deficiency or a failure to meet the child's needs recognized as fundamental on the basis of current scientific knowledge (Lacharité et al. 2006).

Since the best predictor of success is the engagement of families (Berry 2010), in P.I.P.P.I. the involvement of parents and children in care planning and intervention is key. In order to support child wellbeing and parenting within a bio-ecological perspective, four main interventions are used by Child Protection Services according to the needs and situation of each family and involving different people belonging to the child's world (home care intervention, parents' group, participation of school, family helpers).

This paper focuses particularly on the role of «Family Helpers» (F.H.), a family belonging to the network of the family who is involved to give emotional, concrete and parental support to the family as a «resilience tutor» (Milani, Ius 2010) and that can foster in vulnerable families the possibility to be involved, step by step, in mutual help with others and not being a only receiver.

Subjects. P.I.P.P.I. is the result of a collaboration between the Ministry of Welfare, the Laboratory of Research and Intervention in Family Education (LabRIEF, University of Padova), and of 10 Italian cities (Bari, Bologna, Florence, Genoa, Milan, Naples, Palermo, Reggio Calabria, Turin, Venice) that joined the program thanks to a specific fund by the Law 285/1997, in 2010-2012 for the first implementation and in 2013-2014 for the second one.

The target group of the first implementation consists of 122 children 0-11 years old belonging to 89 families, equally distributed among the cities. This paper focuses only on the 106 children and 77 families that were supported by F.H. Among these, 5 children were helped only by F.H., the others also by home care intervention (66), parent's group (73), and by participation of school (91).

The control group is composed by 37 children, same age, for 35 families, that received the mainstream social work interventions of Child Protection Services.

Methods. P.I.P.P.I. is based on the principles of participatory research, where tools are useful to negotiate practice, rules, routines (Guba, Lincoln 1999).

In order to experiment and test P.I.P.P.I., participants are full subjects of the research path within a learning by doing method, where evaluation tools of PIPPI are used for a dual purpose:

- to verify what happens, in order to determine the accordance with the program;

- to allow and promote new learning contexts, for professionals and also for families, in order to experiment new practice (Serbati, Milani 2013).

Mixed-methods are used, with both quantitative and qualitative tools that in 2010-2012 were used in three data collections. The first gathering of data was done between May and September 2011 (T0), in both groups. Afterwards practitioners run interventions and the second collection occurred between April and June 2012 (T1) in the experimental group. The last gathering was in October-November 2012 (T2), both in the experimental and the control group.

The main tool is RPMonline, that stands in Italian for «Assessment, Planning and Monitoring», and it is a web tool, used by practitioners, families and support families to build the care plan for each child. RPMonline is based on Multidimensional Model of the Child's World that consists in the Italian translation and adaptation of the triangle of the Assessment Framework (Department of Health 2000). It aims at representing all the systems that compose the child's life and its ecology: each side of the Triangle (Child's Needs, Parenting Capacity and Environmental Factors) has its section divided in a different number of dimensions (respectively 13, 6, 3). For each dimension, RPMonline provides with a space for the assessment, for the care plan (goals to achieve and actions to take) and for outlining changes of families through a quantitative synthesis scale with 6 levels, from serious problem to evident strength.

Other measures are used such as the Strengths and Difficulties Questionnaire - SDQ, filled in by mother, father, home care worker and teacher; the Multidimensional Scale of Perceived Social Support - MsPSS, filled in by mother and father.

Findings. Care plans created using RPMonline were content analyzed and show that the 70% of the goals planned were totally or partially achieved both in the first verification (T1) and in the second (T2).

The quantitative scale of RPMonline, shows an improvement (T0-T2) in all the evaluated areas (Child's needs: 18,4%; Parenting Capacity: 23,4%; Environmental Factors: 18,6%). Also control group improved, but less than experimental one (7,8%; 14,3%; 17,7%) and the Wilcoxon test shows significant improvements in all dimensions only for the experimental group.

Considering the whole experimental group (122 children), RPMonline scale, regarding the sides of triangle, shows families from T0 to T2 improve more when 3-4 interventions are provided (19,3%, 21,4%, 22,7%) than only 1-2 intervention (11,6%, 19,3%, 14,3%).

The SDQ regarding the Experimental Group reports a decrease of problematic situation in children's behaviour for each person that filled in the tool (father: -14,8%; home care worker: -18,1%; teacher: -20,1%); this is significant by Wilcoxon test, except for mothers (-1,5%) who recognized less problematic situations at intake level, probably due to the «ghost of institutionalization» they were afraid of and consequently to the need to show the situation of their children better that the real one.

Same improvements in SDQ aren't visible in control group (father: -3,3%; home care worker: -8,9%) except for the mother (-14,8%), that registered more problematic situations at intake levels than the mothers of experimental group (significant change of 22% between mothers of target group and control group).

MsPSS shows high level also at the first filling out for both experimental and control groups, however mothers of experimental group showed a significant variation in the factor «other adult» (9,4%, shown significant by Wilcoxon test), probably related to the introduction of F.H.

Conclusions. Data available do not allow measuring the impact of each of the four main interventions, due to the fact that interventions are strongly integrated within the program. In conclusion, data show that F.H. can be an effective intervention when intentionally integrated and coordinated with other intervention. Moreover, data underline that vulnerable families need multidimensional help within an ecological framework able to promote and empower the integration between professional and no-professional intervention. The challenge for the future (2013-2014) is to improve the participation of F.H. within the care process through even more coordinated planning together with vulnerable families and professionals.

Key references

Berry, M., (2010). Inside the intervention: evidence-based building blocks of effective services. In E.J. Knorth et al. (eds), InsideOut. How interventions in child and family care work. Garant: Antwerpen-Apeldoorn, 44-47.

Department of Health (2000). Framework for the assessment of children in need and their families. The family pack questionnaires and scales. London: The Stationery Office.

Guba, E. and Lincoln, Y. (1989). Fourth Generation Evaluation. Newbury Park, CA: Sage.

Lacharité, C., Ethier, L. and Nolin, P. (2006). Vers une théorie écosystémique de la négligence envers les enfants. Bulletin de psychologie, 59, 4, 381-394.

Milani, P. and Ius, M. (2010). Sotto un cielo di stelle. Educazione, bambini e resilienza. Milano: Raffaello Cortina.

Serbati, S. and Milani, P. (2013). La tutela dei bambini. Teorie e strumenti di intervento con le famiglie vulnerabili. Roma: Carocci.

 

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