1. INTEGRATED FAMILY ASSESSMENT AND INTERVENTION MODEL (IFAIM):
An integrative, collaborative, systemic approach at the crossroad of clinical, educational, community and forensic practices
The objective of this communication is to present the main guidelines and distinctive characteristics of IFAIM, the Integrated Family Assessment and Intervention Model.
Ana Teixeira de Melo
Faculty of Psychology and Education Sciences of the University of Coimbra, Portugal
Scholar of the Portuguese Foundation for Science and Technology, Portugal
(SFRH/BD/39912/2007)
Madalena Alarcão
Efta congress, Paris, October 30, 2010

2. DEFINITION, AIMS AND POPULATION
We shall begin with a definition of the model, its aims and the population more indicated for support in IFAIM.

3. WHAT IS IFAIM?
An integrative, multi-systemic, family-focused assessment and intervention model
A model with a collaborative (with narrative and solution-focused therapies influences) and strength-based orientation
A community-based and in-home approach
A model designed to support the Child Protection and Welfare system :
In regard to the production of meaningful information to inform decision-making (assessment)
In regard to the provision of family support to guarantee child’s safety and well-being (intervention)
IFAIM is an integrative, multi-systemic, family-focused assessment and intervention model.
It has a basic collaborative and strength-based orientation with particular influences from narrative and solution-focused models). It is also essentially a community-based approach which privileges work in the family’s homes in order to facilitate family involvement and the accomplishment of assessment and intervention goals.
The model was designed with the particular intention of providing support to the Portuguese Child Protection and Child and Social Welfare System in regard, on the one hand, to the need to produce meaningful information during an assessment process which may guide decision-making and the selection of appropriate actions and support to the family, when appropriate and, on the other hand, to the provision of that support.

4. POPULATION
Multi-challenged families with at-psychocial risk, maltreated or neglected children
Multi-challenged families (Melo & Alarcão, 2010):
a) have been or are currently developing in harsh living conditions (e.g., living in poverty, experiencing social exclusion, oppression or violence, etc.) with a prolonged exposition to stressful environments or circumstances;
OR have been or are experiencing harsh living conditions during short periods of time but with acute stress;
b) are or have been facing multiple concurrent challenges, often simultaneously with major normative transitions and crises.
IFAIM was also specially designed to conduct assessment and facilitate changes in multi-challenged families with children and youth in a condition of psychosocial risk, maltreated or neglected. We define multi-challenged families as those that a) have been or are currently developing in harsh living conditions (e.g., living in poverty (as these are the ones we have mainly been working with) experiencing social exclusion, oppression or violence, etc.) with a prolonged exposition to stressful environments or circumstance or that have been or are experiencing harsh living conditions during short periods of time but with acute stress and those that, at the same time are or have been facing multiple concurrent challenges or dealing with multiple stressors, often at the same time they have to deal with normative crises. We are, therefore, speaking of families with quite complex lives and are also commonly known as multi-problem or multi-stressed families

5. WHY IFAM?
Traditional approaches focused on only one dimension of the families’ life may be inadequate or insufficient to meet the needs of multi-challenged families
Therapy with poor families must take into account how the social and economical conditions constrain family’s relations and difficult family adjustment (Frankel & Frankel, 2006; Minuchin, Colapinto & Minuchin, 2007;Rojano, 2004)
One could ask why would IFAIM be needed? IFAIM was developed having in mind that traditional approaches focused on only one dimension of the family’s life may be inadequate or insufficient to meet the needs of these families. On the other hand, some authors have alerted to the fact that therapy with poor families must take into account how the social and economical conditions of the family’s lives constrain the family’s relations and difficult its adjustment.

6. WHY IFAM?
Multi-challenged families face the risk of multiple assistance and associated consequences . Integrative, systemic approaches may avoid or minimize the negative aspects of multiple assistance including family dilution (Colapinto, 1995; Coleti & Linares, 1997; Minuchin, Colapinto & Minuchin, 2007)
IFAIM also realizes that multi-challenged families face the risk of multiple assistance and associated consequences so integrative approaches may be indicated in order to avoid or minimize the negative aspects of multiple assistance, including family dilution.

7. WHY IFAM IN PORTUGAL?
Most social, child welfare , child protection and family services, in Portugal, are still orientated by expert-driven, problem and individually focused perspectives
There is a paucity in Portugal of assessment frameworks and models specifically designed to both conduct assessment in cases of child maltreatment and neglect and support the families, in an integrated way, in performing the necessary changes to ensure children’s safety and well-being. Current approaches to assessment in cases of child maltreatment and neglect are mainly expert-driven and not collaborative
IFAIM may be particularly relevant for the Portuguese context since most social, child welfare, child protection and even family services in Portugal are still orientated by an expert-driven, problem and individually focused perspective. On the other hand, there is not only paucity of integrative assessment frameworks and models for cases of child maltreatment as there are few services which may both conduct assessment and, in continuity, offer support, when family intervention is indicated.
Current approaches to assessment in cases of child maltreatment and neglect are mainly expert-driven and not collaborative.

8. AIMS To promote family strengthening
To protect and potentiate the physical, psychological and social well-being of family members
IFAIM’s aims include strengthening the family and protect and potentiate the well-being and safety of its members, particularly the children’s.

9. OBJECTIVES Specific objectives are divided in two categories:
Objectives related to assessment purposes (e.g. assessment of risk and protection dynamics; assessment of potential for change)
Objectives related to the facilitation of change and strengthening of processes which may foster family’s growth and adaptation.
Changes in factors related to the family’s social and environmental living conditions, the entire family, the parents and the children, which may contribute to achieve IFAIM’s broader aims.
These aims could be divided in specific objectives related, on the one hand, with the assessment process on child protection cases and, on the other hand, with possible results of the intervention. These results are considered at the family level, the parents and children and also of the relation of the family with broader systems and the quality of their social and environmental living conditions.

10. IN PRACTICE

11. CONTEXT OF CURRENT IMPLEMENTATION
Centers for Family Support and Parental Counseling in Portugal
(Recent family support services)
IFAIM is currently being implemented in Portugal in a recent category of social services called Centers for Family Support and Parental Counseling.

12. IN PRACTICE 5 STAGES OF IMPLEMENTATION: Referral Reception
Assessment (1 to 3 months)
Support for change (3 to 12 months)
Follow-up and closure (3 to 12 months)
Longer cases are often associated with the prevention of child removal and/or the promotion of the family’s reunification
It has 5 stages of implementations and the duration of the entire process ranges from one to two years, depending on the characteristics of the cases. The cases which extend the most in time are often associated with the prevention of removal of the child from home or the family’s reunification after it has occurred.

13. THE CORE TEAM Inter/trans disciplinary team
Standard minimum composition of 3 practitioners:
Psychologist
Social worker
Social educator
(2 practitioners assigned for each case in the initial stage)
Other extended family, community members or professionals may be involved. IFAIM’s team mediates relationships with other systems.
The referral professional are asked to assume social control functions in cases of child protection.
IFAIM is implemented by an inter/trandisciplinary team. The team normally has 3 practitioners, one psychologist, one social worker and a social educator. Two professionals are assigned to the case and constitute a core team and a third assists it and collaborates when necessary. The referral professional plays an important role by explicitly assuming social control functions in cases of child protection.

14. DISTINTICE FEATURES OF IFAIM
The integrative character: a model emerged from a crossroad of perspectives of perspectives
Due to time limits contention we will focus our attention only on some of the most distinctive aspects of IFAIM. And the most relevant of all is probably its integrative character.

15. The integrative character: INTER/TRANSDISCIPLINARITY
IFAIM is a model which emerges from a crossroad of different fields of knowledge and perspectives. Inter and trans-disciplinarity are marked characteristics of IFAIM since it is assumed that the complexity of the risk and protection dynamics of multi-challenged families pathways is best addressed in the context of an inter and trans-disciplinary approach. Systemic and ecological thinking serve as background frameworks which establish the link between different perspectives and facilitate its integration. A basic collaborative stance marks the tone of this integration and the work to be developed with the family.
IFAIM’s work emerges from a crossroad where clinical, educational, social, and community sciences meet to accomplish a kind of work which surpasses their mere accumulation. These different perspectives become blended in practice and add to them forensic concerns in cases of child protection. They are combined to achieve a better integrated understanding of the family’s reality and the opportunities to minimize the risks, dissolve the problems, and take full advantage of the opportunities for growth associated with the lives of multi-challenged families. In practice, IFAIM’s work can the therapeutic, but also preventive and educational, can seek social justice objectives and aim at the well-being of the community when all these dimensions contribute to the family’s adjustment and positive developmental outcomes.

16. THEORETICAL INTEGRATION
Integrative case conceptualization build upon a Multiple Challenges Comprehensive Framework (Melo & Alarcão, 2010)- integrative theoretical framework designed to facilitate an understanding of the risks and opportunities associated with the developmental pathways of multi-challenges families
Integrative case conceptualization hypothesis as a fundamental tool during assessment and support for change
Integration in IFAIM is also theoretical. Case conceptualization relies on an integrative conceptual framework which is informed by different family development and family therapy models and organized from a resilience and strength-focused perspective. This Multiple Challenges Comprehensive Framework assists professionals in achieving a systemic understanding of the family’s functioning or its difficulties. It also guides professionals in identifying the necessary changes for the family to strengthen respecting both the children’s and its needs.

17. THEORETICAL INTEGRATION
Symptoms/ problems/
child maltreatment and neglect
MULTIPLE CHALLENGES COMPREHENSIVE FRAMEWORK
Prefered outcomes in IFAIM:
Children safety and well-bring;
Family’s preferred views and directions in life;
- Exercise of the right to freedom
Constraining and facilitating dimensions related to individual, family, environmental, social and cultural factors
Time
Integrative case readings co-constructed within this guiding framework take in consideration how the adaptation efforts of family have contributed to the emergence, and above all, maintenance of the problems, namely child maltreatment or neglect. They should also contribute to build an understanding on how the family is or has been accomplishing three preferred outcomes in IFAIM and to identify constraining and potentiating factors concerning the individual characteristics of family members, family’s functioning, relation with other systems and the family’s social and environmental living conditions.
Melo & Alarcão, 2010

18. THREE PREFERRED OUTCOMES IN IFAIM
Children’s protection and well-being- provides a direction for change and indicators of the results to be achieved
Families living according to their preferred visions and directions in life (Madsen, 2007;White, 2007)- provides the strength to change
Families exercise their right to freedom (families exercise their ability to learn know how they change and to create meaningful information about themselves, the world and their relation with it; exercise the ability to create, seek and experimenting alternatives and to make deliberated and authored choices which are integrated in their preferred views)– provides the context for change
The first of those outcomes corresponds to children’s safety and well-being and (they must be traduced in concrete indicators, provides a main direction for change). A second preferred outcome is thought to provide the strength for the change process and facilitate it. It is clearly informed and influenced by the work of Michael White (2007) and corresponds to the realization of the family’s preferred views of itself and the sense of living in pursue of its goals, dreams and values. The third outcome is both an outcome and a context for change and we call it the family’s exercise of the right to freedom. It corresponds to the way a family is able to develop flexibility and reflexivity in order to learn about its change mechanisms, the work and its relation to it and, at the same time, how it develops the ability to create, seek and experiment alternatives in order to make deliberate and authored choices which are integrated in its preferred views.

19. INTEGRATION OF PERSPECTIVES DURING ASSESSMENT
Assessment stage includes:
Risk assessment (in regard to child maltreatment and neglect)
Comprehensive assessment (parental capacity/competencies; family functioning and other factors which affect parental capacity; social and environmental factors assessment; child focused assessment)
Assessment of the potential for change assessment to inform child protection decision-making
Integration in IFAIM is also represented in the assessment stage. Assessment in IFAIM incorporates a risk assessment a comprehensive assessment, where the assessment of parental capacity is included and an assessment of the family’s potential for change.

20. INTEGRATION OF PERSPECTIVES DURING ASSESSMENT
Combination of actuarial and clinical-consensual methods in risk assessment
Combination of traditional concerns (e.g. rigour and utility of information) and assessment practices (e.g use of standardized instruments) (Munro, 2008) with a collaborative, strength and solution-focused assessment perspective to facilitate change during assessment (Berg & Kelly, 2001; Turnell & Essex, 2006; Turnell & Edwards, 1999)
This stage incorporates different methods as actuarial and clinical-based consensual risk assessment methods and also a combination of concerns and practices with a collaborative, strengths and solution-focused assessment perspective in order to support the family and facilitate change rehearsal still during assessment.

21. INTEGRATION IN THE SUPPORT FOR CHANGE STAGE
A narrative perspective (Sluzki, 1992, 1998; White 2007) informs the view of change as ultimately supported by the family’s narratives and the ones constructed in relation with other meaningful systems. Behavioral, emotional and cognitive changes are seen as ultimately supported by the family’s narratives.
Support for change sessions as change rehearsal sessions.
Change rehearsals sessions prepared using knowledge from different disciplines and targeting different factors from the individual to the social contexts.
Integration is also represented in the support for change stage. A narrative perspective informs the view of change as ultimately supported by the family’s narratives, constructed in relation with other meaningful systems.
Behavioral, emotional and cognitive changes are seen as ultimately supported by the family’s narratives.

22. INTEGRATION IN THE SUPPORT FOR CHANGE STAGE
Narrative practices are combined with different intervention strategies, from different disciplines, approaches and models to facilitate the rehearsal of alternative behaviors, emotions, cognitions and discourses.
IFAIM?s seeks to offer the family change rehearsal opportunities during the sessions and also help it create these opportunities outside them
Change rehearsal sessions may be focused on different variables from the individual to the social contexts

23. INTEGRATION IN THE CONCEPTUALIZATION AND SUPPORT FOR CHANGE
Regular integrative family sessions ,are a common feature to all cases
Aim to help the family recruit and expand abilities and the preferred outcomes of the change rehearsal sessions to elaborate more useful meanings and to develop reflexive abilities which may help them adapt, grow and strengthen.
Resilience processes are specially targeted (Walsh, 2006)
Narrative approaches are particularly influential (Sluzki, 1992; Madsen, 2007 White, 2007; )
Regular integrative family sessions are a common feature to all cases. They aim to help the family recruit and expand the abilities rehearsed and use the results of the change rehearsal sessions to elaborate more useful meanings and develop reflexive abilities which may help them adaptat, grow and strengthen diverse processes associated with resilient outcomes and to accomplish the preferred outcomes in IFAIM. Narrative approaches are particularly influential in how these sessions are conducted.

24. TRAINING

25. TRAINING Inter/transdisciplinary training common to all professionals
Common set of skills reflecting the integration of contributions from different models of family therapy
Outcome orientated training process focused on the acquisition and/or development of:
Integrative theoretical case conceptualization skills
Practical skills divided in 5 categories
IFAIM’s training program is also inter/transdisciplinay. All professionals receive the same training independently of their professional background and are expected to master a common set of skills, which reflect the integration of contributions of different family therapy approaches.
The training is outcome orientated and focused on the acquisition and development of integrative theoretical case conceptualization skills and 5 sets of practical skills including:

26. TRAINING
5 categories of practical skills targeted and periodically assessed with corresponding rating scales:
Basis session management skills
Skills specific to the referral and assessment stages
Skills to support change
Skills to conduct in-home sessions
Skills to conduct sessions with other professionals or significant elements
IFAIM and its training program are manualized
basis sessions management skills (to assure a systemic, collaborative, strength and solution focused orientation); specific skills asssociated to the referral and assessment sessions associated with the definition of particular aspects related to the forensic implications of assessment and the negotiation of the contract terms and, on the other hand, the solution and strength-focused orientation of assessment; a third set of skills is particularly associated with a collaborative support for change and narrative practices to amplify preferred outcomes and, finally, a specific set of skills to work in the families’ homes and to manage sessions with other professionals and significant elements

27. CURRENT AND FUTURE RESEARCH
IFAIM and its training program are manualized which facilitates research

28. RESEARCH FOCUS
Multiple case studies of the process and outcome of implementation of IFAIM in local communities
Case studies of the process of training and exploratory evaluation of its efficacy in promoting practitioners’ skills acquisition and development
Preliminary feasibility study of the efficacy of IFAIM in achieving its aims and objectives
Instrument development and evaluation (e.g. Rating scales to assess practitioner’s skills to implement IFAIM)
... Future research is expected and welcomed
Current research focuses include multiple case studies of the process and outcomes of the implementation of IFAIM in local communicates; case studies of the process of training and exploratory evaluations of its efficacy; a preliminary feasibility study of the efficacy of IFAIM in achieving its aims and objectives; and the development of instrument to assess families and professionals’ performance. Future research is expected and welcomed.

29. THANK YOU FOR YOUR ATTENTION E-MAIL : anamelopsi@gmail.com