1. Fondazione E. Zancan onlus Risk for children and solutions for contrasting it In collaboration with the Ministry of Labour and Social Policy RISC Cinzia Canali and Tiziano Vecchiato, Fondazione Zancan, Italy ISCI Conference, July 27-29 2011 COMBINING QUALITATIVE AND QUANTITATIVE METHODS FOR ASSESSING THE WELLBEING OF CHILDREN IN NEED

2. Fondazione E. Zancan onlus Goals of the RISC study 1) To explore approaches and care pathways for supporting families and preventing placements, at national and international level. 2) To “test” a personalised care model for taking care of children at risk of placement.

3. Sections of the RISC study Section 1 – Approaches in other countries Section 2 – Review of Italian literature Section 3 – Laws and norms in different regions Section 4 – Costs of children and family services Section 5 – The point of view of professionals Section 6 – A multi-site research

4. A multi-site research Fondazione E. Zancan onlus Ulss 9 Treviso Comune di Cesena e Distretto Langhirano Comune di Firenze e Zona Valdarno Inf. Comune di Torino Comune di Potenza e Ambito Basento-Bradano Ambito 29 e Ambito 33 127 children

5. The model S-P (polar scheme) The polar scheme represents the synthesis of problems and strengths of the child. Each ray represents an assessment tool: more colour indicates strengths, less colour means problems and requires interventions.

6. Fondazione E. Zancan onlus Social and relationships domain Physical domain Cognitive and behavioural domain Rationale underlying the polar scheme

7. The voice of professionals “The image obtained from the polar scheme immediately suggests the areas in which the child has the higher difficulties. It allows a deeper knowledge of the child and it is useful for intervening and planning interventions” Fondazione E. Zancan onlus

8. The research aims to 1)To identify thresholds for placement 2)To assess outcomes 3) To assess the effectiveness of a research protocol based on personalised plans 4) To look for solutions for supporting professionals in taking decisions about the child

9. Fondazione E. Zancan onlus Main steps of the research First step: Selection of families following some inclusion criteria Second step: Research protocols for the selected cases Third step: Assessment at 3 and 6 months (qualitative and quantitative assessment) H 0 : the usage of a personalised approach will give better results in terms of effectiveness

10. Fondazione E. Zancan onlus Step 1 – Selection of families 1° criterion: the condition of adults and the factors of the environmental context that describe their difficulties and strengths 2° criterion: the condition of children and possible harms (conflicts between parents or neglect)

11. Fondazione E. Zancan onlus Pre-assessment map Level of inadequate parenting Level of child suffering

12. Step 2 - Research protocols Control group: it takes care of the child “as usual” but assesses changes using the polar scheme model. Experimental group: it takes care of the child following recommendations that support the decisions for interventions and connecting actions and expected results. It also assesses changes using the polar scheme. Fondazione E. Zancan onlus

13. A software for supporting professionals

14. Fondazione E. Zancan onlus Step 3 – Assessment methods 1.S-P assessment: comparison among polar schemes in different times (T 0, T 1, T 2 ) using assessment tools pertaining to different domains (and different disciplines) 2.F-O assessment: comparison among observed condition at T 0, expected condition at T 1, observed condition at T 1 and following times, with definition of the personalised plan based on measurements.

15. Fondazione E. Zancan onlus Measurements and comparison between T 0 -T 2 Experimental (all cases)Control (all cases) S-P assessment

16. Outcomes in terms of “observable factors” at T 0 -T 1 Fondazione E. Zancan onlus Expected results NOT reached Expected results PARTIALLY reached Expected results FULLY reached Effectiveness 5,2%79,3%15,5% Indice di efficacia PO - Funzionale Organico 40,0%60,0%0,0% Indice di efficacia PO - Cognitivo Comportamentale 10,2%75,5%14,3% Indice di efficacia PO - Socioambientale Rel. 16,3%67,4%16,3% Examples: N. of visits of the father in 3 months N. of telephone calls with his father in one month N. of times he/she attend the gym in 3 months How many time he/she refuses to respect the rules (weekly) N. of times he/she accepts the activities proposed by social worker … F-O assessment

17. Each professional is asked to take decisions about observations to use (qualitative approach) and then to transform them in measures (quantitative approach). Measurements are then evaluated through a professional judgement (qualitative approach) that leads to a new plan or to confirm the same plan. Fondazione E. Zancan onlus Qualitative and quantitative measures

18. “The personalised protocol gives to us the possibility to think about our decisions and to ‘image’ the care pathways that it will be monitor and assess in its development” Fondazione E. Zancan onlus The voice of professionals

19. Effectiveness 1) Effectiveness based on measurement taken with assessment tools (E v ) 2) Effectiveness based on observable factors (E o ) Fondazione E. Zancan onlus

20. Polar scheme Observable factors

21. Fondazione E. Zancan onlus Did we meet our H 0 ? At the first glance of data, we DID NOT find differences between experimental and control groups considering the effectiveness reached through assessment tools.

22. Fondazione E. Zancan onlus Fidelity index It measures how much professionals followed the methodological recommendations of the protocol, documenting the steps: 1. intake, 2. assessment of the problem, 3. personalised plan, 4. outcome assessment respecting the assessment times.

23. Fondazione E. Zancan onlus Research units and their fidelity

24. Fidelity index > 60% The group of children was reduced by the 25%, from 127 children (74s, 53c) to 96 (51s, 45c). Professional, even good and motivated, did not followed the research protocol as recommended. This fidelity index highlights the need of supporting professionals in being more adherent to such recommendations. Fondazione E. Zancan onlus

25. Social and affective domain -The effectivess T 0 -T 2 is higher in the experimental group for children who have a more severe situation at T 0 -The effectivess T 0 -T 2 is higher in the control group for children who have a less severe situation at T 0

26. Fondazione E. Zancan onlus Social and affective domain Profile T0 Effectiveness T0-T2 Experimental Control 0,64 01 SevereNot severe

27. This result shows the higher capacity of the experimental group to reach a positive outcome (and a reduction of risk) for children who have a high level of suffering (and for this reason at higher risk of placement). Fondazione E. Zancan onlus Conclusion

28. Fondazione E. Zancan onlus Future perspectives Dove si posiziona in una scala da 1 a 10 l’indice di inadeguatezza genitoriale e di contesto relazionale? Dove si posiziona in una scala da 1 a 10 il grado di sofferenza (da abbandono, maltrattamento…) che sta vivendo il bambino?

29. Fondazione E. Zancan onlus Strengths 1. This approach facilitates the information sharing among professionals of different disciplines 2. It allows a global vision of the child obtained through measurement tools 3. It highlights non only problems but also strengths of the child 4. It helps professionals in taking decisions if they monitor and document correctly the care pathways 5. It helps to highlight the effectiveness of work (and the cost/effectiveness)

30. Fondazione E. Zancan onlus Some critical elements that can be transformed in strenghts 1. It forces professionals to think together for defining a personalised plan 2. It requires some time to devote to assessement 3. It requires thedaily usage of a software 4. It needs the collaboration of different professionals in terms of integration 5. It needs a structured and regular documentation

31. Fondazione E. Zancan onlus Developments 1. The Fondazione Zancan is implementing this outcome-based approach (S-P and F-O methods) in different need areas (children at risk, young adults with severe disabilities, families with multiple problems...) 2. We are working with groups of professionals interested in developing such an approach in a common platform called PersonaLAB (“Personalised Environment for Research on Services, Outcomes and Needs Assessment”) for comparing problems and solutions (15 research units in different Regions and a research unit in New Zealand)

32. Thank you for your attention www.fondazionezancan.it cinziacanali@fondazionezancan.it Fondazione E. Zancan onlus