• By Laura Whybra
  • Posted on Thursday 11th December, 2014

A single intervention for multiple problems?

strong>Politicians, researchers, and program designers are increasingly aware that a segment of families – perhaps up to 5 percent – face multiple, intertwined problems. Ten for the Future, an integrated, needs-led and potentially long-term intervention, is the Dutch welfare system’s response to multi-problem families.Families that face multiple, complex problems are often badly served by programs set up to address single issues. So, policymakers and program designers are increasingly looking to personalized family coaching for more flexible solutions. These families are often dealing with some combination of ongoing risks and immediate crises – including poverty, lack of education, low income, single parenthood, immigration, social exclusion, child behavior problems, poor physical and mental health, debt, job loss, family conflict, and relationship break-ups. In the face of long-standing and complicated family issues, two types of approaches seem most promising: multi-component programs and home visiting programs.Netherlands is one of many countries that has tried to find ways to intervene with “multi-problem families,” an estimated 3-5% of all families. Ten for the Future, a flexible and potentially long-term intervention, combines the multi-component and home visiting approaches.The program uses family coaches to support families in ten areas of their life, including parenting, managing finances, creating a safe and healthy home environment, and building a supportive social network. A new study of Ten for the Future suggests that the intervention reduces parental stress. What is Ten for the Future? Ten For the Future is a multi-component, home-based intervention for families that are challenged by multiple problems. It is rooted in a variety of theories, such as systems theory, learning theory, directive and contextual therapy. Families are identified by an intake-manager who decides which families to admit to the program. Families eligible for the program have to reside at a permanent address, have at least one child under 18 years living at that address, have needs in at least four out of the 10 life domains, and pose no threat to the family coach’s safety. In case of severe mental health problems, the family has to be referred to a mental health professional. Upon admission, families are coached by professionals in ten areas of life: housekeeping, administration and finances, care responsibility, parenting, education, daily activities, mental health, care management, social network, and behavior management. The support is face-to-face and its length is negotiated with the family coach based on the progress of the family. The Dutch studyThe study of Ten for the Future (TF) followed 122 families. Although a larger number of families participated in the program, only those who followed the program for more than 90 days were included in the study. The study aimed to answer three questions. First, what were the demographic and problem characteristics of families referred to TF? This is a particularly important question because identifying and targeting multi-problem families is a challenge for all programs that aim to work with this group.Second, what factors were associated with longer care? Understanding the answers might help to highlight how the program works. In a well-functioning, flexible program, families with more intense or complex problems might be expected to use the program for a longer period of time. Third, and most crucial, did families in TF experience reduced problems during their time in the program? The measured outcomes were parental stress, family functioning, and child behavioral problems, as indicated by parental and family coach reports.Is TF a solution for multiple problems? TF does seem to be successful in identifying and enrolling families with severe difficulties. At the start of the program, the majority of parents reported above-average or high levels of stress. Levels of child behavior problems were also relatively high. Nearly 80% of families reported significant loss of income or debt in the previous year, and a majority reported an increase of conflict within the family.Overall, the study revealed that these families face socio-economical difficulties with limited social capacity to handle them. There was a lot of conflict and family disruption. Almost all the respondents were women. When the researchers looked at the factors that might influence the duration of care, parental stress stood out. The typical time in the program was 15-19 months. Parents who began the program with high levels of stress used, on average, 12 months more support than those who began with average stress levels. Finally, average levels of parental stress decreased during the first year of the program. However, neither family functioning nor child behavioral problems showed notable average improvements post intervention. The research team suggested that the program might be improved by pairing the family coach with a key worker to focus on children’s needs. *********Reference: Tausendfreund, T., Knot-Dickscheit, J., Post, W. J., Knorth, E. J., & Grietens, H. (2014). Outcomes of a coaching program for families with multiple problems in the Netherlands: A prospective study. Children and Youth Services Review, 46, 203-212.

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