Valutare le Comunit per minori

1
Effectiveness conditions in residential care for
children and adolescents results from an Italian
study
Palareti Laura Berti Chiara Emiliani Francesca
Department of Psychology, University of
Bologna. Italy Department of Biomedical
Sciences, University of Chieti-Pescara, Italy.
2
Some premises

• Since the 70s, the institutes have gradually
  been replaced by small, educational and
  family-type communities. A law passed in 2001
  decreed that by December 31st 2006 childrens
  institutes in Italy were to be abolished once and
  for all.
• Current debate on the appropriateness of the
  quality assessment criteria laid down by the
  applicable regulations (i.e. authorization to
  operate and accreditation) predominance of
  structural and procedural-type criteria no
  mention to outcomes and to relational aspects.
• Methodological issues (heterogeneity of services
  and settings, scarce information on the
  implementation of a treatment program, no
  experimental design) is it possible a
  scientific evaluation of residential care?

3
Deinstitutionalization is not enough to conclude
that the alternative programs (family-type and
educational communities) effect a protective
function towards children in care.
Evaluation do we need a theory?
Theory-driven evaluation (Chen, 1990 2004)?
Black box evaluation (Scriven, 1998)?
outcomes
outcomes
Black Box
4
Ecological Model for the Evaluation of
Residential Care
Microsystem Activities, roles, and relations
within the community
Mesosystem Relational network between
microsystems which the child takes part in
(community / family / school / leisure)?
Exosystem System of relations between the
institutions that take care of the
child (community / social services / juvenile
court)?
Macrosystem Socio-cultural context of the
intervention (aims and theories that drive
interventions, legislation)
5
The project Quality evaluation of residential
care
Goals

• Describe interventions in real-world contexts
• referring to the 4 ecological level of
  evaluation
• including different stakeholders (residential
  staff, adolescents in care, social services)
• Clarify conditions under which residential
  programs work or fail to work
• Identify indicators that can be employed in the
  quality evaluation of residential care

6
The Microsystem and its protective function

• Attachment theory (Bowlby, 1988)
• Warm and secure interpersonal relationships
• Therapeutic environment (Bettelheim, 1950 Redl
  Wineman, 1951 Winnicott, 1965)
• Physical environment
• Everyday routines, rituals and rules
• Meaningfulness
• Scaffolding and structuring function

7
Method

• Participants
• 59 adolescents in residential care (19
  residential communities) for at least one year
• age mean 16.2, range 12-19
• sex 33 M and 26 F
• 33 from Italy and 26 from other countries
• 22 offenders
• Instruments
• Ad hoc questionnaire with scales and open-ended
  questions
• Data from residential staff (n73) are not
  presented here

8
Scales

• MICROSYSTEM
• Daily routines. For 12 routines two scales
• FREQUENCY with which they are practiced
• IMPORTANCE for the wellbeing of people in the
  community
• Perceived communication with favourite educator.
  12 items adapted from the PACS (Barnes Olson,
  1982)
• OUTCOMES
• Adolescents satisfaction for the current
  experience in residential care
• Effects attributed to residential care

9
Hypothesis

• the relational climate in residential care
  (analyzed by their everyday routines and
  communication with the adult) is a good predictor
  of the efficacy of the intervention

10
(No Transcript)
11
(No Transcript)
12
Verifying the Hypothesis Linear regression
analyses
13
Conclusions 1

• The results clarify the specific relationships
  between dimensions of the intervention and
  dimensions of the outcome. While the actual
  possibility of sharing activities and dialogue
  with the adult reflects on the satisfaction and
  wellbeing of the adolescent, improvement from a
  psychosocial adaptation point of view is linked
  to the interiorization of the rules, patterns and
  values proposed by the community. Lastly, for
  adolescents to profoundly rethink their life
  experience, it is also crucial to forge
  meaningful relationships with adults.

14
Conclusions 2

• The results of this study not only confirm the
  theoretical hypotheses on the link between the
  relational climate in the community and the
  effects of the intervention, but also question
  the idea that residential care can be interpreted
  -- and therefore evaluated -- merely as an array
  of facilities, procedures or services without
  identifying the theory on which this set of
  resources and their organization is supposed to
  bring about the desired change.
• the absence of good logic models or theories of
  change have meant that, even where there is some
  indication that some aspects of the development
  of some children benefit from periods of
  residence, we have little idea why these
  improvements are occurring (Little, Kohm
  Thompson 2005)

15
Conclusions 3

• The choice made in this study to adopt the point
  of view of adolescents expresses our conviction
  about the importance of the way in which they
  interpret their life experience and construct
  explanations for change.
• At present the systems for the quality evaluation
  of services to people expect the user to express
  his/her own point of view prevalently in terms of
  satisfaction with the services received. Instead,
  in our study, resident satisfaction is just one
  dimension in the evaluation of residential care,
  not only because in the psychological and
  therapeutic field an effective intervention is
  not always accompanied in its path by feelings of
  satisfaction, but also because the way in which
  adolescents interpret and explain their
  experience of life in residential care
  constitutes an ineluctable point of view for
  evaluating the relation between the interventions
  and the outcomes, and bears important
  consequences for the actual objectives of the
  intervention.