Abstract

Families with multiple problems (FMP), also defined as multiproblem families or multistressed families, face multiple, severe, chronic and intertwined problems in different areas of life. Content and provision of interventions targeting FMP in routine practice may largely deviate from guidelines in intervention manuals. The aim of this study was to identify practice and program elements provided to FMP in routine practice, including the intensity, manner of provision, and recipients, per intervention phase (starting-, care- and end phase). We selected interventions with at least moderate (d ≥ 0.5) effect sizes in the Dutch context, yielding eight interventions. Practitioners of 26 Dutch organizations systematically registered information on practice and program elements, intensity, manner of provision, and recipients, using the taxonomy of interventions for FMP. Within 474 trajectories we found that elements regarding activation of the social network of FMP were provided least often (in less than 48–77% of the families). Elements were provided mainly through psycho-education (25–33%) and instruction (21–24%). Interventions focused more on parents (53–62%) than on children (26–32%). Program elements hardly changed between phases of interventions, although the number of visits decreased (from an average of six visits a month during the starting phase to four visits during the end phase). An inventory of elements that make part of interventions for FMP allows studying the effectiveness of these interventions in a more detailed way. This yields information that may help to identify the optimal sequence, intensity and duration of elements and enables to better understand outcomes of interventions for FMP.

Highlights

  • Families with multiple problems (FMP), defined as multiproblem families or multistressed families, face multiple, severe, chronic and intertwined problems in different areas of life (Morris, 2013; Spratt & Devaney, 2009; Tausendfreund, Knot-Dickscheit, Schulze, Knorth, & Grietens, 2016)

  • Our study further showed that parents were the main care recipients of practice elements in interventions for FMP, confirming studies reporting that within FMP more attention is generally paid to parents than to children (Knorth, Knot-Dickscheit, & Thoburn, 2015; Tausendfreund, Knot-Dickscheit, Post, Knorth, & Grietens, 2014; Tausendfreund et al, 2015)

  • We found that duration of visits, intervision, supervision, consultation and 24-hour reachability hardly changed between phases, the intensity of the interventions decreased towards the end phase

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Summary

Introduction

Families with multiple problems (FMP), defined as multiproblem families or multistressed families, face multiple, severe, chronic and intertwined problems in different areas of life (Morris, 2013; Spratt & Devaney, 2009; Tausendfreund, Knot-Dickscheit, Schulze, Knorth, & Grietens, 2016) These problems could regard combinations of behavioural problems of the child, parenting problems, family conflicts and health and financial problems (Bodden & Deković, 2016). Multisystemic Therapy (MST) and Multidimensional Family Therapy (MDFT) (Ogden & Hagen, 2006; van der Pol et al, 2017) These interventions focus in particular on improving parenting skills, reducing problem behaviour of the child, and preventing out of home placement of the child. Effectiveness studies have shown beneficial effects for some of these interventions on domains such as problem behaviour of the child and/or parenting stress (Asscher, Deković, Manders, van der Laan, & Prins, 2013; van der Pol et al, 2017; van der Stouwe, Asscher, Stams, Deković, & van der Laan, 2014)

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