Eight frequently used interventions for families with many problems and children who are severely difficult to parent exhibit a lot of overlap and are more or less equal in terms of effectiveness. That has become apparent from research carried out by the consortium Multiproblem families and severe parenting problems. Consortium leader Danielle Jansen recommends improving and refining the existing provision of interventions.
‘When we started the research, 28 interventions were available for tackling severe parenting problems and helping multiproblem families’, says consortium leader Danielle Jansen from University Medical Centre Groningen. ‘I found that an unacceptable situation. How can a professional make wise choices when there are so many options? And how do you know which intervention works for which family? I’m therefore pleased that we have shown that most of the interventions investigated contain many of the same elements.’
The researchers first of all developed a taxonomy list of potentially effective elements. They used that to analyse eight frequently used interventions for which the effectiveness had already been demonstrated to a certain extent. That is how they discovered the overlap. Jansen states a few examples: using a timeout, mapping a family’s problems, and determining goals together with the parents. ‘All of these elements are found in the manuals, but they are not all used with equal frequency. We wanted to know how often and at which time, which elements are used in practice. We also supplemented our taxonomy list with elements that were used by professionals, but that had not been included in the manuals. We then determined the effectiveness of the elements actually used in practice.’
Therapists who used one of the eight interventions scored their approach using our taxonomy. Niels Tibben did that at Mediant GGZ, where he supervises parents and children with psychiatric disorders using intensive ambulant (pedagogical) home care (Dutch acronym IAG). By completing the score list, he and his colleagues acquired more insight into their own approach, he says. For example, they noticed that they made little use of the family’s social network. ‘As a result of this, the workgroup promotion of expertise organised a study day for our regional IAG network about how we could make better use of the family’s network during the treatment.’
By completing the taxonomy score list Tibben and his colleagues obtained more insight into their own approach
The analysis of the scores revealed that the structural elements of interventions mainly determine the difference in whether a certain treatment is effective, says Jansen. ‘Important elements are good coaching and maintaining good contact with the family, for example by contacting them by telephone in between sessions. In a nutshell: the interventions overlap considerably in terms of content but are more or less equal in terms of effectiveness. The variation mainly lies in the structure of the treatment offered. These structural elements make the help offered more effective. We therefore advise including structural elements like telephone contact and coaching in the interventions.’
Telephone contact with the family in between sessions was found to be important for an intervention’s success
The researchers therefore conclude that the existing provision provides sufficient possibilities. The interventions contain enough effective elements. And although the research into cost-effectiveness is complex and the analyses have not yet been fully completed, it seems that the intensive use of certain elements leads to less healthcare consumption after treatment. We definitely do not need to develop new interventions, concludes Jansen. ‘We therefore advise against investing money and effort in this. However, there are points for improvement for existing interventions, for example more attention for the social network and coaching. And we can also refine the current provision to maximise the benefit for a specific group.’
Furthermore, besides the research results described, therapists can also make use of the interviews held with parents and children. These reveal, for example, that parents want their child to be more involved in the help provided. At present, most attention goes to the parents, observes Jansen. Tibben recognises that, but also understands the conflicting interests therapists face. ‘The question is: how do you involve a registered but hesitant child in the help process? And what about the brother or sister? Indeed, that does not happen often enough yet. However, the IAG provides sufficient opportunities for this.’
Now that the research results are available, these need to be applied in a customised manner. ‘This is not a ready-made package of measures that you can offer. You need to talk with each municipality and care institution on an individual basis. Therapists need to state what they want. A follow-up project will now be established for this.’ That will allow the researchers to maintain contact with the professional field, and Jansen is pleased about that. ‘From the outset, we involved the professional field as much as possible in the research. After all, the therapist must do the work! As a team, we are very pleased with that collaboration and with the exchanges that took place. I recommend such an approach to everybody.’
* The eight interventions investigated were: multidimensional family therapy (MFT), Families First, intensive ambulant (pedagogical) home care (Dutch acronym IAG), Gezin Centraal (Focus on the Family), Parent Management Training Oregon (PMTO), Triple P, Multisystemic Therapy (MST), 10 Voor Toekomst (programme from the Salvation Army).
On Thursday 26 November, the consortia will present their findings during the online conference Building on effectiveness research: results and lessons learned from research into core elements of youth interventions. You can still register to attend this event!
In the consortia Effectiveness of Psychosocial Interventions Youth, researchers and youth care organisations are exploring new possibilities for seven larger substantive themes related to growing up and parenting. The research provides knowledge about which (aspects of) interventions can best be used when, for who and by which persons. The key elements of interventions with proven effectiveness are the starting point for these interventions. Through innovative impact studies, the consortia provide answers to questions such as: What actually makes an intervention effective? Are there effective factors that can be found in all interventions? How can the care provider exert an influence on the impact? And: which interventions or aspects of these are cost-effective? Realising impact studies in an appropriate form is a challenge. Each consortium takes a different approach, but they work together to ensure that their approaches are well aligned with each other. The research from the consortia must improve the interventions and enable professionals and municipalities to choose an effective approach. The outcomes will make it possible to improve the effectiveness of professional practice and provide better help to children and families.
The consortia Effectiveness of Psychosocial Interventions Youth are working on these seven themes:
In the consortia, key elements of interventions will be investigated. But what exactly are those key elements? Key elements are the things that a care provider can do to teach desired behaviour to young people or their parents, guardians or carers. Or to diminish undesirable behaviour. This is given various names in the literature (e.g. components, elements, ingredients, kernels and techniques). We have chosen the term “key element” because this is used by most of the consortia and ties in well with the literature. As it is often not yet clear whether the element actually works, we ought to use the term “potentially effective key elements”. However, that is quite a mouthful. A collection of these key elements defines an intervention. Structural elements also play a role in defining an intervention. For example, the sequence, frequency and intensity of the key elements involved.
The researchers from the consortium Multiproblem families and severe parenting problems investigated eight interventions with proven effectiveness for these families. They investigated the potentially effective elements of these. They first of all worked with professionals to draw up a taxonomy (score list) of these elements so that these could be scored. The professionals completed this taxonomy for the interventions that they provide to families. The researchers linked these data about the content of the help provided to data collected about (changes in) psychosocial problems and parenting problems of the parents and young people concerned. This gave insight into what works for whom. The knowledge led to recommendations about how the care for families can better match the specific problems concerned.
The developed taxonomy is an initial research outcome. Professionals can use this score list to analyse their own actions and reflect on these. Using this information, both they and their organisation can provide families with a more targeted treatment. The completed research provides insight into the content of interventions in everyday practice and the similarities and differences in (cost-)effective combinations of elements for families with severe parenting problems and with multiple and complex problems. As a result of this, professionals gain tools for choosing, realising and optimising the care that they provide. Together with developers, therapists and professionals from municipalities it will be explored how they can use the knowledge from the research to strengthen interventions and to determine which (combinations of) elements or interventions best match the problems of a specific family.
Text Veronique Huijbregts. Translation Dave Thomas. Portrait Danielle Rita Smaniotto. Portrait Niels Martin de Bouter. Photography header Studio Oostrum.