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Paper

Working with the family-context of young people in residential care

abstract

Background. Organisations for child and youth care experience an increasing need to involve the context of the child (especially the family-context) in their systems of care.
In 2003 we conducted a pilot study on how care workers and parents thought about the possibilities to make a better balance between an individual, child-focused approach and a contextual, family-focused approach in residential care. At the same time we examined the actual balance between individual and contextual elements of care (Geurts, Knorth, & Noom, 2004, 2007). The pilot study has provided suggestions about how to work with the context of the admitted child, resulting in the JIC-method (Jeugdzorg In Context, i.e. Child and Youth Care in Context). The JIC-method refers to all activities that enhance the involvement of the (family) context of the child in residential care.
The primary aim of the present study was to evaluate the JIC-method. Research questions relate to (1) characteristics of the target group, (2) components of the intervention applied, and (3) clinical outcomes obtained. Some preliminary results will be presented here.

Method. Data were collected on 167 children (age 8-18 years, mean 15,9 years; nearly half of them male) in two organisations for residential child and youth care, in a design where the JIC-method - applied in one organisation - was compared with care as usual (CAU) in another similar organisation. The following concepts were measured.
Problem behaviour was measured using the Child Behavior Checklist (CBCL), a measure of emotional and behavioural problems (Achenbach, 1991; Verhulst et al., 1996). This questionnaire was completed by parents and care workers, and administered at the beginning and at the end of the residential care and treatment process.
Realisation of treatment goals was measured by the Treatment Goals List (TGL) (Geurts, 2005). At the end of the care process residential workers assessed whether and to what extent goals had been realised; goals that refer to the behaviour and well-being of the child and his/her family-context.
Family focus in care and treatment was measured by the Family-Context Interview (FCI), a standardised interview with parents and care workers. It was developed by Jansen and Oud (1990) and designed to measure the extent of family involvement ('family-centredness') during a residential stay. Parents and care workers were asked about the families' presence during admission, their thoughts and feelings about the placement, the contacts with the child during placement, the contacts between the care worker and the family, and the family's satisfaction about the (involvement in) treatment.

Results. At the start of the care process in both conditions (JIC and CAU) the mean scores of children on the CBCL-scales 'total problems', 'internalising problems' and 'externalising problems' were falling within the clinical range, indicating the presence of serious behavioural and emotional problems. At the end of the care process resp. 7%, 18% and 21% of the children who completed treatment were evaluated as having moved from the clinical to the normal range on these scales; corresponding numbers in CAU were 0%, 10% and 14% (Fisher's exact test: p=.50).
In the JIC condition 74% of the youngsters completed their residential stay according to the arrangements in the treatment plan, the other 26% dropped out prematurely (but later than two months after admission). The corresponding numbers in CAU were 62% resp. 38% (χ2 =2.95; df=1; p=0.086).
In the JIC-programme the most frequently treatment goals refer to independent living, personality and social development, and contact with the family; this in contrast with care as usual where the most prominent goals refer to social, emotional and personality development of the child.
Concerning the 'family-centredness' of the residential programmes statistically significant differences (Λ=4.86; p=.00; η= .20) were found between JIC and CAU. The FCI -scores of workers and parents both indicated that the latter were more involved during the admission phase and received more counselling by residential workers in the JIC programme as compared to CAU. Besides JIC-parents reported a higher level of counselling overall. Workers added to this that, in comparison with parents in the care as usual condition, JIC-parents had more opportunities to have a say in care arrangements, had more parental responsibilities during the residential stay of their son or daughter, and had overall been approached more often in a family-centred way.
Parents of those children whose behaviour on the internalising problems domain substantially improved during treatment (indicated by Reliable Change Index) had been approached with a higher level of family-centredness overall and they also received more counselling compared with parents of children who did not improve (F(6.38)=89.60; p<0.015). A similar pattern was discovered related to the externalising problems dimension (F(6.81)=95.54;p<0.012).
Statistically significant differences were found between those children who regularly completed their stay and those who dropped out (Λ=3.69; p=.00; η= .17). Family-centredness overall was the highest for those who completed treatment in the JIC condition and was the lowest in the CAU condition. Parents of treatment completers in JIC experienced most frequently opportunities to have a say in care arrangements; the scores of parents of CAU-children were the lowest at this point. Parents of dropout children in JIC had the most counselling contacts with residential workers, parents of children in CAU had the fewest.
We found an interesting difference in the realisation of the treatment goals: in the JIC condition more children (and their families) had realised their family goals (t=2.46; df=105.36; p=0.016).

Conclusions. Our preliminary analysis of the data reveals interesting associations between level of family-centredness and outcomes of two residential programmes that participated in this research project. As might be expected on several indices the JIC-programme showed higher levels of family-centredness than CAU. These higher levels were associated with some favourable outcomes in terms of behavioural changes, treatment completion and goals attained. However, these findings should be interpreted with caution; the design that was applied does not allow us to make causal inferences. Further analyses will be necessary to clarify the complex interrelatedness of client characteristics, (family-focused) intervention components, and outcomes related to behaviour and perceptions of children and parents concerned.

Key references
Geurts, E. M. W., Knorth, E. J., & Noom, M. J. (2004). Child and Youth Care in Context: Results of a Pilot Study. Leiden: Leiden University, Department of Special Education and Child Care (in Dutch).
Geurts, E. M. W., Knorth, E. J., & Noom, M. J. (2007). Contextual, family-focused residential child and youth care: Preliminary findings from a program evaluation study. Relational Child and Youth Care Practice, 20 (4), 46-58.
Jansen, M. G., & Oud, J. H. L. (1990). Residential child and youth care evaluated. A study on the development and treatment course of admitted young people in the Dutch province of North-Brabant. Nijmegen: Nijmegen University, Dept. Special Education and Child Care (in Dutch).

Contacts: Esther M.W. Geurts, MSc, University of Groningen/STEK Child and Youth Care, Jacob van Lennepkade 6, 2802 LH Gouda, the Netherlands, E-mail: e.geurts@stekjeugdzorg.nl, Phone 00 31 18 25 22 855.

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