Multiproblem Families Research Articles

Family assistant – a modern form of support for multiproblem families

People frequently perceive family as, to quote Anthony Giddens, “the refreshing source of joy, warmth, love andaffection” (Giddens, 2005, s. 196). However, a family can be also the scene of loneliness, violence, and mental insecurity; it may not be able to cope with fulfilling its basic social roles. Such family should be cared for by institutional aid and support, as well as by professional family assistants. Since 2012 families may count on a family assistant in the course of overcoming their life struggles. Even though this profession has been present on our market already for 10 years, its organizational context still needs to be clarified. In particular, there are significant issues referring to the family assistant qualifications, competence, methods, tools, and workroom. The article aims mainly at pointing out to the specific role of the family assistant and to the preferred competence and skills required for this profession.

Changes in Adolescents' COVID-19-Health-Related Stress, Parent-Adolescent Relationships, and Mental Health During the COVID-19 Pandemic: The Effect of Personality Traits.

Previous studies investigated short-term effects of COVID-19 on families. However, much is unknown about how families with adolescents fared throughout the pandemic, as well as factors that might explain interindividual differences in adjustment. The current study used latent change score models to investigate associations between changes in adolescents' mental health, parent-adolescent relationship quality, and COVID-19-health-related stress from Fall 2019 to Spring 2021, and whether personality predicted changes in adolescents' mental health, relationship quality, and stress. Participants were 242 adolescents (Mage = 11.56, SD = 0.44, 50% girls). Parent-adolescent negative interactions decreased from before the pandemic to the first lockdown, and stronger decreases (both in this period and between Fall 2020 and Spring 2021) were associated with simultaneous stronger increases in mental health. From Spring to Fall 2020, decreases in stress were stronger for less extraverted adolescents and were associated with better mental health. More agreeable adolescents reported a stronger decrease in stress between Fall 2020 and Spring 2021. The findings suggest that it is important to consider heterogeneity in designing future intervention and prevention programs. Especially adolescents with existing problems and from multi-problem families might be at risk for adverse consequences during pandemic-like situations.

Effectiveness of a multidisciplinary treatment with youth-initiated mentoring for youths with mental health needs from multi-problem families: a quasi-experimental study

BackgroundChildren from multi-problem families have an increased risk for experiencing mental health problems. These families face problems in several domains that are often found to be chronic and intergenerational. Yet, the effects of mental health care for youths from multi-problem families are small at best, urging research on new treatment programs. The InConnection approach is an integrated care program to improve resilience of youths with mental health needs from multi-problem families by connecting professional expertise from multiple disciplines with the informal social network of the youth. Youths are asked to nominate a youth-initiated mentor (YIM) from the supportive adults in their network.MethodsThis quasi-experimental study compared the effectiveness of the InConnection approach to treatment as usual in a sample of 107 families (n = 66 intervention group, n = 41 control group) with n = 115 youths receiving treatment (cases). Youths (n = 102 reports, Mage = 15.59 years), parents (n = 85 reports) and case managers (n = 107 reports) responded to questionnaires four times over 15 months. Using these data, we measured youth resilience as the primary outcome, seven secondary outcomes, and three intermediate outcomes.ResultsLatent growth models showed only one significant change in outcomes over time across conditions, namely a decrease in case manager-reported child unsafety, and only two condition effects, which were both parent-reported. Parents in the InConnection group reported improvements over time in youth’s emotional and behavioral problems and their own positive parenting, whereas control parents reported no changes (ps ≤ 0.013).DiscussionThe treatment conditions were not effective in improving most of the youth and parental outcomes over time, except for child safety reported by the case manager. The InConnection approach only outperformed care as usual on two parent-reported outcomes. Future research should examine for whom and under what circumstances the InConnection approach works more convincingly.Trial registrationNetherlands Trial Register NL7565. Retrospectively registered on 05/03/2019.

The lived experiences of complex care of families with complex problems: A realist evaluation of Integrated Social Care

Introduction/Background: An ongoing realist evaluation of the implementation of the program [Amsterdam Customization method] in social welfare in Amsterdam (NL), focussing on multi-problem families, revealed among others, that participating organisations within the program tend to focus on their own tasks, without shared decision making. This becomes extremely clear in the context of safety for the children: parents are not seen as partners to guarantee this safety but as causer of the problem. And this view from the perspective of one organisation seems to diminish all efforts to offer the parents help in finding ways to create a safe environment for their children. Instead parents are more or less threatened by the risk that the children will be taken away from them. The mechanism is a lack of interdisciplinary adjustment of observations and a lack of shared decision making, the outcome for the parents is fear and withdrawal from involved professionals. This is in contrast with the principles of the implemented program.
 Why a workshop? A 90 minutes workshop is a good way to share experiences with the delegates and find ways to handle a well-known problem within the implementation of integrated care programs.
 Who is it for? Participants from the area of social work as well as participants in implemented integrated care programs as such are a welcome audience to share ideas and experiences.
 What we are going to do?
 •A 15 minute 
 ointroduction on the context of the implemented program and the findings of one part of the research: client interviews [first researcher]
 oFocus on one finding: the missing collaboration between all stakeholders in the context of safety for the children in multi-problem families [first researcher]
 •Depending on the number of participants: 60 minutes discussion in one or more groups around two questions (1. do you recognise the situation [examples]; 2. What did you do / are you planning to do/ could be done to stimulate shared decision making that involves all stakeholders)
 •15 minutes report and (an attempt to) conclusions
 •10 minutes wrap up and eventually exchange of contact addresses
 
 How are you going to engage with the audience? Fitting to the concept of a workshop the meeting will be interactive, participants in the subgroups are asked to appoint a speaker to present the core of the group discussion, results of the plenary will be written down and per email shared with interested participants.
 How are you going to summarize the take home messages? We end up with lessons learned and sum these up in take home messages. Attendees are invited to write these down and take these with them.
 
 

The role of parents in the care for adolescents suffering from emotional and behavioral problems.

Parents play an important role in the psychosocial care of their children. Previous research has primarily examined their role in care entry, whereas evidence on their role in other stages of the care process is scarce and lacking particularly in regard to the perspective of care providers. Our aim was therefore to examine how psychosocial care providers perceive the role of parents in the process of psychosocial care for adolescents. We used data from 25 semi-structured interviews with psychosocial care providers on the roles of parents in the care process. We analyzed data using consensual qualitative research and thematic analysis. Four main themes were identified: (1) parents as a source of adolescents' problems; (2) parents trying to escape from responsibility for adolescents with problems; (3) parents as an active part of the care for adolescents; and (4) parents as a barrier to effective care. Psychosocial care providers should specifically address the role of the parents in psychosocial care to improve outcomes. Specific interventions are needed to support the involvement of parents in care, as their role is important. Moreover, professionals can be better trained in working with multi-problem families also to resolve some of the negative perceptions of these parents.

Resilience, well-being and informal and formal support in multi-problem families during the Covid-19 pandemic

BackgroundThe Covid-19 pandemic may have had negative effects on youth and parental mental health, especially in high-risk populations such as multi-problem families (i.e., families that experience problems in multiple domains, such as mental health and social network problems). Using one to four assessments during all phases of the Covid-19 pandemic up until January 2022, we examined the associations between pandemic-related stress and mental health (resilience and well-being) of youth and parents from multi-problem families. We also investigated whether experienced informal (i.e., youth informal mentoring) and formal support (i.e., therapist support) served as protective factors in this association.MethodsA total of 92 youth aged 10–19 years (46.7% girls; mean age 16.00 years) and 78 parents (79.5% female; mean age 47.17 years) filled in one to four questionnaires between March 2020 and January 2022. Multi-level analyses were conducted to account for the nested structure of the data.ResultsFor youth, pandemic-related stress was associated with lower well-being, but not with resilience. Perceived support from both mentors and therapists was positively associated with youth mental health. Furthermore, high perceived therapist support protected youth from the negative effect of pandemic-related stress on resilience. For parents, pandemic-related stress was not related to mental health, irrespective of therapist support. Yet, therapist support was directly and positively associated with parental mental health.ConclusionsYouth from multi-problem families who experience pandemic-related stress are at risk of (elevated) mental health problems during the pandemic, specifically if they have no or weak therapist support. The mental health of parents, however, was minimally affected by pandemic-related stress, indicating strength and flexibility. Youth and parents who experienced support during the pandemic reported higher levels of resilience and well-being, demonstrating the importance of support for individuals’ mental health during stressful times such as a pandemic.

Early Maternal Caregiving Capacities in Highly Vulnerable, Multi-Problem Families

Caregiving capacities may be an important link between multi-problem circumstances and adverse child development. This study aims to assess caregiving capacities and their correlations in highly vulnerable, multi-problem families in Rotterdam, the Netherlands. Caregiving capacity (overall, emotional and instrumental) was prospectively assessed in 83 highly vulnerable women using video-observations of daily caregiving tasks, six week postpartum. Supporting data were collected at three time points: at inclusion, six weeks after inclusion and six weeks postpartum, and these included psychological symptoms, self-sufficiency, problematic life domains, home environment, income, depression, anxiety and stress. Pregnancy- and delivery-related information was collected from obstetric care professionals. Maternal caregiving scores averaged below adequate quality. Mothers living in an unsafe home environment (B = 0.62) and mothers with more problematic life domains (≤3 domains, B = 0.32) showed significantly higher instrumental caregiving capacities. Other variables were not related to caregiving capacities. Caregiving capacity in this highly vulnerable population was below adequate quality. However, in most cases there was no significant association between caregiving and the variables related to vulnerability. This means that a potential association between vulnerability and caregiving capacities might be driven by the interaction between several problems, rather than the type or number of problems.

Home-Based Treatment of Multi-Problem Families (MPF): State of Research and New Results

This article summarizes four studies of process and outcome research on family outreach therapy (ATF) with multi-problem families (MPF). We examined the relationship between different "patterns of of collaboration" and outcome variables in the treatment of MPF. Furthermore, we examined the relationship between childhood adversity factors and protective factors for the development of child psychiatric symptoms, and evaluated catamnesis data (follow-up 3 years). The paper summarizes four naturalistic studies of pre and post values and follow-up data in children aged 4-18 years, participating in an integrative, structural family therapy with (X = 115 sessions in 28.8 months, SD = 19.2). The data n = 1,031 show large effect sizes (ES) (d) (thirteen parameters, mean = 1.04, range 0.34 - 2.18). The outcome values correlate most strongly with the pattern "Improving Alliance", i. e. the improvement of the working alliance in the pre-post comparison (d = 0.64). Empirical studies on childhood adversity and protective factors showed significantly higher stress factors and significantly fewer protective factors in children from MPF compared to the non-clinical sample (95.7 % of children from MPF had a psychopathological diagnosis). The follow-up data showed stable treatment effects (three years of follow-up).The empirical research on the treatment of MPF requires further empirical studies in the sense of the treatment aptitude research on the question "what works for whom?".

Needs of Youth and Parents From Multi-Problem Families in the Search for Youth-Initiated Mentors

Youth-initiated mentoring is an innovative youth care approach in which youth recruit supportive adults from their social networks as a mentor for youth and a partner for parents and professionals. This qualitative interview study documents what youth ( n = 15) and parents ( n = 13) from multi-problem families look for in a mentor, what mentors ( n = 8) believe they have to offer, and whether what mentors believe to offer matches youth’s and parents’ needs. Youth and parents indicated that a strong connection and trust were most important, or even prerequisites, as youth who were unable to find mentors did not have strong relationships of trust. Youth and parents also voiced preferences for an understanding, sensitive mentor who offered youth perspective by providing support and advice and (according to some) setting rules. What mentors believed to offer matched youth’s and parents’ needs, suggesting that most youth successfully recruited suitable mentors.

Video Intervention Therapy for primary caregivers in a child psychiatry unit: a randomized feasibility trial

BackgroundDuring child psychiatry hospitalization, working with the families or attachment figures is a challenge, most of the children who are admitted to these units come from multi-problem families, with limited research in this area. Video feedback (VF) interventions have proved to be a powerful resource to promote parental and child well-being in small children and has been used with parents with a psychiatric condition. Parental Reflective Functioning (PRF) is one of the parental abilities that can be improved with VF and could be especially important in coping with conflict and negative emotions in older children. The aim of this study is to implement Video Intervention Therapy (VIT) to enhance PRF in primary caregivers of inpatient psychiatric children. As there is no published research using VF with parents of children with severe psychopathology in a hospitalized context. This report, then, becomes a much needed pilot study providing evidence for a larger randomized control trial (RCT).MethodsThe study is a single-center, two-arm feasibility randomized control trial with a qualitative component. Block randomization was done to generate a 2:1 allocation, leaving more participants in the intervention group. The intervention comprises four modules; every module has both one video-recorded play session and one VIT session (in a group setting) per week. Evaluation of the caregivers included assessments of PRF and well-being, and child assessment included parent-ratings and clinician-ratings of symptomatology and general functioning.ResultsThirty participants were randomized; eligibility and recruitment rate were 70.6% and 83.3%, respectively. The compliance-to-intervention rate was 85% in the VIT group and 90% in the control group. All participants completed entry evaluation and 90% at the 3-month follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. Outcome data must be treated with caution due to the small numbers involved, yet indicate that the VIT may have a positive effect in improving parental and child mental health outcomes.ConclusionsVIT for primary caregivers of child inpatient children was feasible to deliver and acceptable for participants, therapist, and the staff unit involved; there is sufficient evidence to undertake a full-scale effectiveness RCT.Trial registrationClinicalTrials.govNCT03374904. Registered on 14 December 2017

Long-Term Effects of Home-Based Family Therapy for Non-responding Adolescents With Psychiatric Disorders. A 3-Year Follow-Up.

ObjectiveHome-based treatment of families with low socio-economic status and multiple psychosocial problems (multi-problem families, MPFs) is gaining importance in clinical social epidemiology and health services research. The sustainability of the treatment is of special importance in order to breach transgenerational effects.MethodsWe examined outcome, effect size, and clinical significance of home-based treatment for 84 multi-problem families in a naturalistic setting. 48 of the families were available for a follow-up after 3 years. The baseline characteristics of these family systems included low collaboration, an increased family adversity index, minors with high rates of child psychiatric disorders, a high prevalence of comorbidity, low relational family functioning, and adolescents who refused any form of treatment or had unilaterally terminated different forms of treatment before. The home-based family therapy consisted of one or two face-to-face counseling sessions per week over an average of 28.8 months (SD = 19.2). The symptoms and competence of the adolescents, the caregivers, and the family structure were assessed with 13 variables.ResultsAll variables showed significant improvement rates (pre- vs. post- treatment) with medium to high effect sizes (mean of Cohen’s d = 1.04, range = 0.34 – 2.18). All variables showed a sustained or even further improvement at follow-up.ConclusionThis study provides evidence of statistically (p), practically (d), and clinically (RCI) significant changes in symptom and competence-related variables among adolescents and caregivers in MPFs with sustainable long-term effects in the 3-year follow-up period.

Effectiveness and working mechanisms of the InConnection approach in multi-problem families: study protocol of a mixed-methods study

BackgroundMulti-problem families face problems in several domains that are often found to be chronic and intergenerational. Effective mental health care for youth from these families is currently lacking, urging research on new methods. The InConnection approach is an integrated care program to improve resilience in multi-problem families by connecting the professional expertise from multiple disciplines with the informal social network of the youth. Specifically, youth are asked to nominate a youth initiated mentor (YIM) from among the supportive adults in their network. The aim of this protocol is to describe the design of a mixed-methods study to examine the effectiveness and working mechanisms of the InConnection approach.Method/designThe effectiveness of the InConnection approach is studied in a quasi-experimental questionnaire study using propensity score matching, with N = 300 families with youth aged 10–23 years receiving treatment in either the intervention group (InConnection approach) or the control group (care as usual). The main outcome variables include youth resilience (primary), youth mental health, parental functioning, and the number, duration and types of out-of-home placements. Mediators, moderators, and predictors of effectiveness are examined. Assessments take place at the start of the care program and after three, nine and 15 months. Additionally, semi-structured interviews are conducted with families who have and have not nominated a YIM to understand why some families successfully nominate a YIM, whereas others do not.DiscussionEffective care for youth in multi-problem families is urgently needed. Given its flexibility and accessibility to suit all youth aged 10–23 years from multi-problem families, and its low costs compared to out-of-home placements, the InConnection approach seems an appealing approach to support these families. The current study will provide information on the effectiveness of the InConnection approach. Strengths of this study include its robust design, the ecological validity, and the inclusion of possible mediators, predictors, and moderators of treatment effects.Trial registrationNetherlands Trial Register NL7565. Retrospectively registered on March 5, 2019.

Feasibility and potential effectiveness of an intensive trauma-focused treatment programme for families with PTSD and mild intellectual disability

ABSTRACT Background Persons with mild intellectual disabilities or borderline intellectual functioning (MID-BIF; IQ 50–85) have a higher risk of being exposed to traumatic events and developing posttraumatic stress disorder (PTSD). EMDR therapy has shown to be applicable, safe and potentially effective for the treatment of PTSD in individuals with MID-BIF. However, in traumatized multi-problem families with MID-BIF and (impending) out of home placement of children, standard PTSD treatment in an outpatient setting may not be appropriate. Objective To evaluate the feasibility and potential effectiveness of KINGS-ID, a six-week clinical trauma-focused treatment programme consisting of intensive EMDR therapy with parents and children, and parental skills training followed by two weeks of parent support at home. Method Six families (nine parents of whom six had MID-BIF) and 10 children (all having MID-BIF) participated in the KINGS-ID programme. Seven parents and seven children had PTSD. Data were collected within a single case study design. For each family member data were collected during baseline (three measurements), treatment (seven weekly measurements), posttreatment (three measurements) and at follow-up (three measurements). Results None of the family members dropped out. Within the first two treatment weeks all but one child and one parent no longer met PTSD symptom criteria. In both children and parents, trauma-related symptoms and daily life impairment significantly decreased following treatment and in parents a significant decrease in symptoms of general psychopathology and parental stress was found. Results were maintained at six-month follow-up. Conclusions The findings of the current study are promising given that the treatment programme seems to offer new perspectives for traumatized multi-problem families with MID-BIF.

Elucidating care for families with multiple problems in routine practice: Self-registered practice and program elements of practitioners

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.

The Effect of Childhood Adversities and Protective Factors on the Development of Child-Psychiatric Disorders and Their Treatment.

Context: Families with high rates of childhood adversities (CAs) (multi problem families, MPF) have an increasing importance in public health-policy.Objective: The present study addresses the relationship between risk- and protective factors and the severity and treatment-outcome of mental disorders.Setting: Family-therapeutic home-based treatment for MPF. We examined a clinical sample (N = 1031) of children between the age of 4 to 17, and a non-clinical sample of 148 children. We hypothesized that of all children of the clinical group have a predominance of risk factors and a higher number of psychopathological symptoms. Furthermore, we hypothesized that children with a predominance of protective factors benefit stronger from psychotherapy.Main Results: In the clinical sample, most children met the criteria of a psychopathological diagnosis (95.7%, as compared to 21.6% in the non-clinical sample) and showed significant higher rates of CAs and significant less protective factors as compared to the non-clinical sample. The clinical group showed a significant reduction of psychopathological symptoms and benefited equally well from treatment. The number of risk factors was a significant predictor for a child from the non-clinical sample to meet the criteria of a psychopathological diagnosis, while the number of protective factors significantly predicted the absence thereof.Conclusion: Children and adolescents with high scores of CAs show significant associations with child psychiatric symptoms (d = 0.35; including all ICD-diagnosis such as, e.g., Asperger Syndrome, ADHD etc. with a higher rate of genetic etiology). Early life stressors, however, do not trigger an irreversible fate, as psychotherapy with young people with high numbers of risk factors does help to reduce psychopathological symptoms significantly (range of five outcome parameters: d = 0.31–0.72).

Kijk naar jezelf! Reflectie op beeldmateriaal in onderzoek en praktijk

Look at yourself! A reflection on images in research and in practice Social workers play an important role in helping multiproblem families to deal with multiple, interrelated and often intergenerational problems. Social workers indicate that effective collaboration – with clients, their family members and other professionals – is crucial. Defective collaboration can have major consequences for effective support. In this study, six social workers were followed intensively in their collaborative relationships with families, families’ social network and other professionals providing services to these families. Video recordings and stimulated recall interviews were used to explore the behavioral indicators of this collaboration. The value of the method for research and practice is described.

Improving care for multiproblem families: Context-specific effectiveness of interventions?

An overview of the effectiveness of interventions for multiproblem families (MPF) is lacking, and evidence seems to be context-specific. The aim of this study is to summarize the evidence on this topic in one country, the Netherlands, to better understand the reasons for the heterogeneity of findings. We searched literature published between January 2005 and April 2017. We found 26 Dutch studies of 11 interventions aimed at MPF. Most studies used a pretest-posttest design. The effect sizes of the studies ranged from small to large and varied between interventions, but also between studies of the same intervention. This large variation in effect sizes implies a need for more insight into the components of interventions. A better fit between problems of MPF and intervention components could improve the effectiveness of interventions targeting this population.

Services use by children and parents in multiproblem families

BackgroundMultiproblem families are multi-users of psychosocial and health care services, but little is known about factors associated with their care utilization in the general population. The aim of this study was to assess which factors were associated with the overall and psychosocial care use of two members—i.e., child and parent—of each multiproblem family. MethodsDuring well-child visits or psychosocial care, we identified 354 children and their parents who had problems in several life domains (response 69.1%). We used multivariate stepwise backward logistic regression analyses to identify the factors related to their use of overall and psychosocial care. ResultsA child's overall care use was associated with greater social support from family and friends (odds ratio, OR, 95% confidence interval, CI; OR=1.05, CI=1.01–1.08) compared to less perceived social support; and with more psychosocial problems in the child (OR=1.84, CI=1.04–3.24). Child's psychosocial care use was more likely among older children (OR=1.94, CI=1.20–3.15); greater social support by family and friend (OR=1.03, CI=1.00–1.06); more psychosocial problems (OR=1.75, CI=1.04–2.97); and when there were more parenting concerns (OR=1.19, CI=1.06–1.33). Parental overall and psychosocial care use was more likely when the family experienced a higher number of life events (OR=1.27, CI=1.17–1.38, and OR=1.39, CI=1.25–1.55). ConclusionsCare use in multiproblem families is related to family factors as well as psychosocial problems. It may be possible to use these family risk factors to identify such families early, whose intensive care use is possibly explained by the relationship with inadequate use of social support.

Patterns of Change in Collaboration Are Associated with Baseline Characteristics and Predict Outcome and Dropout Rates in Treatment of Multi-Problem Families. A Validation Study.

Objective: The present study validates the Multi-Problem Family (MPF)-Collaboration Scale), which measures the progress of goal directed collaboration of patients in the treatment of families with MPF and its relation to drop-out rates and treatment outcome.Method: Naturalistic study of symptom and competence-related changes in children of ages 4–18 and their caregivers.Setting: Integrative, structural outreach family therapy.Measures: The data of five different groups of goal directed collaboration (deteriorating collaboration, stable low collaboration, stable medium collaboration, stable high collaboration, improving collaboration) were analyzed in their relation to treatment expectation, individual therapeutic goals (ITG), family adversity index, severity of problems and global assessment of a caregiver’s functioning, child, and relational aspects.Results: From N = 810 families, 20% displayed stable high collaboration (n = 162) and 21% had a pattern of improving collaboration. The families with stable high or improving collaboration rates achieved significantly more progress throughout therapy in terms of treatment outcome expectancy (d = 0.96; r = 0.43), reaching ITG (d = 1.17; r = 0.50), family adversities (d = 0.55; r = 0.26), and severity of psychiatric symptoms (d = 0.31; r = 0.15). Furthermore, families with stable high or improving collaboration maintained longer treatments and had a bigger chance of finishing the therapy as planned. The odds of having a stable low or deteriorating collaboration throughout treatment were significantly higher for subjects who started treatment with low treatment expectation or high family-related adversities.Conclusion: The positive outcomes of homebased interventions for multi-problem families are closely related to “stable high” and an “improving” collaboration as measured with the MPF-Collaboration Scale. Patients who fall into these groups have a high treatment outcome expectancy and reduce psychological stress. For therapeutic interventions with multi-problem families it seems beneficial to maintain a stable high collaboration or help the collaboration, e.g., by fostering treatment expectation.

Collecting feedback as a tool to reduce care paralysis: something for family group conferencing coordinators?

AbstractFamily group conferencing (FGC) coordinators in public mental healthcare are confronted with clients who have little faith in professionals and organizations, who hold off decisions in their family life, who avoid care and who sometimes behave in a hostile manner. A lack of initiative to deal with their situation is not only reserved for clients – all bystanders, including professionals, can suffer from it. The multiplicity and severity of the client's problems lead to a situation wherein everyone involved waits for the initiative of the other. The independence of the FGC coordinator – a fellow citizen, who is free of organizational loyalties and comes to assist other citizens in establishing a plan – seems to work well with the client group of the public mental healthcare. However, the coordinator cannot always prevent deferral or failure of conferences. Drawing on empirical and theoretical findings, this paper considers the possibility of collecting feedback as a way to contribute positively to the alliance between FGC coordinators and those for whom a conference is deployed. We highlight findings from three case studies that centred on multiproblem families. The findings indicate the importance of feedback theory for FGC coordinators in enhancing trust and engagement.