Working with families with complex needs is challenging and practitioners are increasingly confronted with clients who meet this criteria. This includes complex, persistent and often trans-generational and co-occurring behavioural concerns with children, parenting difficulties, family conflicts, health, psychiatric, statutory, and financial problems. Effective interventions have been developed but it is unclear which specific practices and programme elements contribute to positive outcomes.
This question was addressed by Visscher et al (2021) who termed these clients families with multiple problems (FMP). They explored both the content and the structure through which service was delivered and efficacy in relation to subgroups with child and/or parental psychiatric problems, intellectual disabilities, or substance use. Measure of both child internalizing and externalising symptoms, and parental stress and social contacts were taken at the beginning, end and at three months follow-up. Groups of families receiving similar combinations of practice elements were identified and a profile calculated. An assessment was made of how practice element profiles and program elements related to improved outcomes and whether these were different across the identified subgroups.
Three practice profiles, explorative/supportive, action oriented or a combination of these two were equally effective. However, differences in the structure of care, how the service was delivered, did influence effectiveness. Some outcome measures showed greater positive results with more regular phone calls between sessions and frequent intervision for practitioners. This is the process whereby practitioners seek knowledge and problem-solving support from a small group of colleagues by asking questions to develop new insights.
These outcomes are interesting considering work in the Bower Place Complex Needs Clinic and Bower(note), the protocols and practices guiding practice in the clinic. One of these processes is the daily briefing where the team meets to review the clients to be seen in the clinic and engage in an intervision process where the practitioner poses a question to the group in relation to their client and they respond with questions and observations. This is a time where hierarchy is collapsed and all participants from students to directors participate in a process of exploration.
One of the final items on the session’s agenda is follow-up where client and practitioner identify what each needs to do to ensure the next session is as useful as possible. This often includes plans for regular contact between sessions. This may include daily text messages, phone calls or email.
The note taking process where the session is recorded on A3 sheets of paper and given to clients to take home may also function as a way of remaining in touch and mirrors regular phone contact. Clients are encouraged to review amend and discuss notes between sessions and use them as a tool to plan the next session.
While it is rewarding to witness change in clients on an everyday basis it is invaluable to have this supported and explained through reliable and valid research.
Visscher, L., Reijneveld S. A., Knot-Dickscheit J., van Yperen T. A., Scholte R. H. J., Delsing M. J. M. H., Evenboer K. E., & Jansen D. E. M. C. (2022). Toward tailored care for families with multiple problems: A quasi-experimental study on effective elements of care. Family Process, 61, 571–590. https://doi.org/10.1111/famp.12745
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