Soins précoces : devenir psychosocial des familles et développement des enfants

Abstract

In the past decades, an extensive body on early intervention research programs has grown with numerous scientific publications in the English language litterature, while such studies remain rare in France. This study reports the outcome of families whose children were followed in an out-patient treatment centre, the Unité de Soins Spécialisés à Domicile (USSD) in Paris. This institution, created in 1975, was designed to promote healthy parent-infant relationships and prevent difficulties for families exhibiting psycho-emotional and or psychiatric risks. The objectives are to enhance infant and early child development, to support parenting competences and to fight against intergenerational process of maltreatment and child placement. The theoretical references of the multidisciplinary team are the psychoanalysis, the attachment theory and the clinic of interactions. Thirty-height families were selected from the files of the USSD: They all had a child aged before the age of 18 months, born between 1985 and 1990 and were cared for more than one year ; the other children received intervention after this age. Assessment of parents and children was made when the families had been out of treatment for at least five years. As it is a preliminary study without a control group, we have choose a psychosocial and comprehensive approach more focused on family issues than individual ones. For each child and family, institutional data were collected and argued with the all the professionals still present in the institution: admission in the institution, parental problems and infant symptoms (with reference to the DSM IV and the Zero-to-Three classification), therapeutic interventions (psychodynamic or interpersonal, parents-children groups, parental or children groups, home visiting…), child's re-educations, relationship with other social or psychiatric teams, orientation after the intervention.Thirty-one situations were re-evaluated. Standardized materials (WISC-R subtests, Rutter A scale for children, Nottingham Health Profile for parents) and semi-structured interviews were used for the assessments. Parental consent and administrative authorizations (for children in foster families or institutions) were obtained and interviews were registered. Two groups of families were studied. Group I included families without specific pathology, they received therapeutic intervention for a mean of 2 1/2 years, most of the mothers were depressed. It was composed of 2 sub-groups : in 8 families, the child's birth with severe perinatal problems had brought about the parental trauma, for 7 families, psycho-emotional problems were blew up again after the child's birth, signs of maltreatment could be detected. Group II included families at high risk for child abuse and neglect with numerous psychosocial stress, most of them were followed by social workers ; interventions had lasted for a mean of 6 years. It was composed of two sub-groups: seven disorganized family situations with alcohol abuse and depressed mothers, and nine families with psychotic mothers, most of the babies were placed in foster care. We met 16 parental couples and 13 monoparental families twice and seven foster families. Twenty-five young people were interviewed and complementary information was obtained for seven others from the Child Protection services and foster agencies. Results focus on: 1) the families' present situation, healh representations and their social/relational and parental competences ; 2) for the young people: the intellectual and scholastic competences, behaviour, social relationships with their peers. They are presented in each of the sub-groups for parents and for children ; differences and common points are noted in the two groups of families I and II. Mean ages at assessment were 12,3 years for children in group I and 13,3 in group II. Except in one case (children became Wards of the State), parents are able to carry out their responsibilities, totally in group I or partially in group II where it was shared with the Child Protection services for most children and adolescents were still placed. No serious child abuse or neglect was detected and there was a positive evolution for the parents' social and family relationships especially in group I. The family support is more precarious in group II, counterbalanced by social and medical support. Concerning children and adolescents, two third are in the normal school system, the others are in classes for slow learners, one is in a day care hospital. A third have behaviour problems. For all of these young people, verbal subtests (Vocabulary and Similarities, were more succeeded than the performance subtest (Block Design), this result is associated with facilities in verbal expression showed during the interviews. The impact of early therapeutic intervention is notable among children of the families at high risk who had received such care before the age of one: the all have better social competences with peers, less behaviour problems and school failure than the others. Given these results, we can assume that early therapeutic intervention mediates psycho-social risk in these families. As this study is mostly descriptive, it should be followed by complementary research on larger populations.