Analysis of Qualitative Information - UnitingCare Burnside伯恩賽德unitingcare定性信息的分析

1、Intensive Family Support: helping to keep families safely together: the evidence Plenary paper for Intensive family Services 5th National Practice Symposium 2nd April 2004Presenter:Eileen Baldry PhD, Senior Lecturer, School of Social Work, University of NSW, NSW 2052, Australia.Ph: 0011 61 (2) 9385

2、1878; Fax: 0015 61 (2) 9662 8991; .auCo-authors:Joan Bratel BA Psych (Hons), Manager of the Intensive Family Support Options Program, NSW Spastic Centre, Sydney, Australia.Matthew Dunsire M. Psych (Clinical), Research Assistant, University of NSW, Sydney, AustraliaMichael Durrant B.A

3、.Psych( Hons), Director, Brief Therapy Institute, Sydney, Australia.This research was funded by an Australian Research Council, Industry Partnership Grant. The NSW Spastic Centre was an industry partner in the research.Intensive Family Support: helping to keep families safely together: the evidence

4、ABSTRACTIFS approaches have been used by a small number of agencies to support families with a child with a disability in crisis for some years. There had though been no research on these programs. The research discussed in this paper set out to discover whether such program(s) for children with a d

5、isability and their families significantly and positively influenced outcomes for the child and family and, if significant changes occurred which program elements, strategies and/or techniques significantly contributed to positive client outcomes. Families with a child with a disability in crisis we

6、re followed and interviewed using quantitative and qualitative methods, from instigation of intervention, immediately post-intervention, at six months and some at 12 months. Analyses indicated that the crisis interventions, taken as a set, were successful in helping families improve their general le

7、vels of well-being and functioning. They were also particularly successful immediately and over time in reducing potential for child abuse. Specific worker strategies and program elements were associated with these improvements. Observations and discussion regarding these fundamental elements and wh

8、at service providers can learn from a finer grained analysis of some aspects of IFS interventions are also addressed.Intensive Family Support: helping to keep families safely together: the evidence INTRODUCTIONDoes an IFS approach to working with families with a child with a disability help the fami

9、ly stay together and at the same time keep the child(ren) safe? Analysis of data collected in a research project conducted between 1999 and 2002 found that crisis interventions, taken as a set, were successful in helping families improve their general levels of well-being and functioning. They were

10、also highly successful immediately and over time in reducing potential for child abuse. Improvement in things measured by the support and symptom reduction inventories were predictive of that reduction. The qualitative results help explain and flesh out these findings, indicating that particular wor

11、ker strategies: listening, support, increasing parent control/empowerment and validation; and program elements: family focussed, 24-hour availability, home-based, small case loads, financial support and consistency of worker were identified by participants as being associated with the positive outco

12、mes. A finer grained analysis reveals aspects, such as the place of poverty and disadvantage in tipping families into crisis, difficulties for parents who themselves have a disability, poor agency systems and termination of intervention that require theoretical and practical consideration to further

13、 IFS program development.ContextWith the bias now falling in favour of keeping a child with a disability within his/her family (Department of Ageing, Disability and Home Care, 2002), questions regarding the capacity of the family to manage and regarding the safety of the child are emerging. Interven

14、tions by disability services with families that are referred by the New South Wales Department of Community Services (DOCS) or Department of Ageing, Disability and Home Care (DADAHC) caseworkers as being in crisis have a paramount concern for the safety of the child(ren). It is these interventions,

15、their outcomes and insights into IFS approaches that are the concern of this paper.Whilst there has been research and evaluation on intensive family support using a home-builders family preservation model (see Wells,& Biegal 1991; Lethem 1994; Russell & Bowman 1996; Cashmore & Paxman 199

16、6; Franklin, Corcoran, Nowicki & Streeter 1997; Lee 1997) interventions using brief, intensive, family centred and family goal oriented elements with families with a child with a disability, have not been well researched. The approaches taken by the agencies participating in this research includ

17、e, to a greater or lesser degree, all of the elements last mentioned. The research interest is not in the merits of particular therapeutic approaches but in strategies and program elements that may be associated with positive outcomes for children and their families. As there is growing evidence tha

18、t children with a disability are at greater risk of maltreatment than their peers (Sullivan & Knutson 2000), the safety of these children and their families is of crucial importance.METHODOLOGYThe aims of the research were:1. To discover whether support program(s) for children with a disability

19、and their families significantly and positively influenced outcomes for the child and family;and, if significant changes occurred,2. To discover which program elements, strategies and/or techniques significantly contributed to positive client outcomes.Research regarding therapy outcomes and efficacy

20、 has generally focused on client improvement measured solely by achievement of treatment goals (or symptom reduction). But recent child and family literature suggests that client improvement should be based not only on achievement of treatment goals, but also on improvement in a number of other area

21、s (Hubble et al 1999; Assay & Lambert 1999). Bailey et als (1998) framework for child/family program evaluation was adopted because it speaks directly to the kinds of interventions and circumstances in which agencies working with families with a child with a disability are involved. It provided

22、a guide to the factors (see Figure 1) that would be most indicative of improvement and progress for families and their children and thus to the selection of the quantitative instruments (see Figure 1) that would best indicate any changes in these factors. Bailey et al questionsDid the intervention .

23、Interpreted Factor Relevance to study / Instrument measuring changeEnhance family's perceived ability to negotiate systems and services?Perception of empowermentFamily Empowerment Scale (Koren et al 1992)Enhance child -parent interaction, help child learn?Parent-child relationshipParent-Child Re

24、lationship Inventory - interaction subscale (Boothroyd 1996)Assist building social and community supports?Perceived supportParent-Child Relationship Inventory - support subscale (Boothroyd 1996)Make an appropriate difference to the child's life?Child abuse Child Abuse Potential Inventory - distr

25、ess, problems from others subscales (Milner 1986)Make a difference to the family's life?andEnhance perceived quality of life?Perceived family functioningSymptom reduction and general outcomesHappiness McMaster Family Assessment Device - general functioning subscale (Epstein et al 1983)Outcome qu

26、estionnaire (Lambert et al 1998)Happiness Measures (Fordyce 1988)Enhance positive view of the future?Hope State Hope Scale(Snyder et al 1996)Figure 1: Bailey et al (1998) factors framework and their measuresMETHODNine quantitative measures, and various qualitative methods were used to collect inform

27、ation from both family and support-worker participants. The measures noted in Figure 1 were chosen due to their strong reliability & validity. The instruments were also chosen for their proven sensitivity to change over reasonably short time spans as it was intended to administer the questionnai

28、res pre-intervention, post, at six and then 12 months after intervention.Qualitative interviews were conducted with family members & support-workers to determine the effects of the services/intervention. Other qualitative data were collected via diary records kept by support workers, and video-r

29、ecordings of sessions between support-workers and family participants. The qualitative analysis explored the difference the support-workers had made, and what specifically helped changes (if any) to occur. ProcedureA number of agencies across Sydney were identified by a group of experts in the field

30、 as being key providers of support to families with a child with a disability (aged 0-18 years) that are under severe stress. Ethics approval was granted by the Human Research Ethics Committee of the University of NSW and agency ethics committees provided with an opportunity to ask questions about t

31、he project. Consent was sought from support workers that involved them agreeing to recruit family-participants for the project. The criteria for a family being eligible to participate in the study were that:§ the family had a child with a disability living at home and § the family was in c

32、risis and at risk of breaking up and was being referred to one of the participating agencies, usually by one of the government agencies, DoCS or DADAHC. The researchers phoned or visited families willing to be contacted, before the intervention began and sought consent from parents and family member

33、s (such as older siblings or grandparents).The instrument questionnaires (noted above) were used with each participant to determine base-line scores. During the intervention, the support-workers were asked to keep detailed diary notes. Also, where possible the first, middle and a later sessions were

34、 videotaped. At the end of the intervention, quantitative and qualitative post-interviews were held. The same pre intervention questionnaires were administered, plus a ninth questionnaire assessing the therapeutic relationship. An open-ended interview was conducted that explored the participants tho

35、ughts about the intervention. Each support-worker was also interviewed at the end of the intervention to explore what elements/strategies/techniques he/she believed were helpful.Six months after the end of the intervention (and 12 months later for families where time permitted the same questionnaire

36、s were administered in the same manner, and a semi-structured interview was conducted which explored whether benefits had persisted.Participants70 participants took part in this study. Six participants were support workers who provided varying support-services to families with a child (0-18 years) w

37、ith a disability. The six support-workers were from three different agencies servicing separate regions in the North, West, and South-West of Sydney. The workers came from varied disciplines including social work, psychology, nursing, family-therapy and counselling. The remaining 64 participants (fr

38、om 44 different families) were parents, grandparents and siblings of a child with a disability. Families participating in the project were identified as being “under severe stress and not sure if the family can stay together. Indicators of high risk for the families participating included: breakdown

39、 in parent/carer/ family relationships, significant change in the physical and/or emotional health of parent/ caregiver or child, repeated emergency respite use or a significant increase in use over the past 12 months, significant increase in requests for additional support services, abuse and/or ne

40、glect of child/ren (IFSO, 1998).Four families carers were not able to provide reliable responses to the quantitative measures because they themselves have intellectual disabilities and when administered the questionnaires found them difficult and anxiety producing. Thus forty families (40 primary an

41、d 15 secondary carers) quantitative data is included. These families carers were still included in the qualitative interviews.74.5% of the sample was female (n = 47) and 25.5% was male (n = 16). 71.5% was a primary caregiver (n = 45), and the remaining 28.5% was a secondary caregiver (n = 18). Two c

42、hildren (siblings) were also included in the data collection and analysis.Qualitative data was categorised and thematised.RESULTSQuantitativeThe participants pre-intervention, post-intervention, 6- and 12-month follow-up scores on eight separate measures (empowerment, emotional support, parent-child

43、 involvement, abuse potential, family functioning, symptom reduction, hope and happiness) were analysed using SPSS version 11. To avoid bias due to over-representation of families where two or more members participated compared to those where only one participated, members of the same family were sp

44、lit into primary caregiver and secondary caregiver categories and analysed separatelyA repeated measures MANOVA was run for primary caregivers pre- and post- intervention scores on the 8 measures used (ie 8 dependent variables with each cell containing 40 participants. The primary caregivers scores

45、on the 8 measures (taken as a set) changed significantly (p<.05) between the pre-intervention and post-intervention intervals. This finding suggests the primary caregivers lives, in regard to the set of aspects being measured, improved as a result of support work because the change was in a posit

46、ive direction.Having obtained a significant multivariate effect for time, it was possible to interpret the univariate effects. Abuse potential, emotional support, empowerment, happiness, and hope all had a significant univariate main effect (p<.01). This finding suggests that not only did the sup

47、port work make a difference, it significantly improved primary caregivers scores on 5 different variables being measured (most significantly abuse-potential).A repeated measures MANOVA was used to determine the effect of support work on the primary caregivers pre-, post- and 6 month scores on the 8

48、measures used. The primary caregivers scores on the 8 measures (taken as a set) changed significantly and positively between the pre-, post- and 6 month intervals. This finding suggests the primary caregivers' lives improved positively as a result of support work, and these improvements were mai

49、ntained 6 months following the intervention.Having obtained a significant multivariate effect for time, it was possible to interpret the univariate effects. Examination of the univariate effects over pre, post, 6 and 12 months suggested abuse potential and emotional support had a significant univari

50、ate main effect (p<.01). This indicates that the significant dependent variables contributing to the multivariate effect were abuse potential and support. Other variables, such as empowerment, happiness, family functioning and hope, although not significant at the .014 level, showed that particip

51、ants changed in the right direction.Analysis of the effect of support work on the secondary-caregivers pre-, post- and 6 month scores showed that the 8 measures (taken as a set) changed significantly (p<.05) suggesting that their lives improved as a result of support work, and these improvements

52、were maintained 6 months following their intervention.The univariate test indicated that only emotional support was significant (p<.01). This finding suggests that the support work made a difference to the secondary caregivers feelings of emotional support only.The significant multivariate effect

53、 for primary caregivers found at 6 months, endured to 12 months. This is indicated by the progressive reduction of mean scores on child abuse potential (see Graph 1).Graph 1: Mean Scores on Child Abuse potentialThe relationships between the 8 variables were explored further using Pearson correlation

54、 matrixes. For the primary caregivers, the most significant relationships (p<.01) were between child abuse potential and symptom reduction, child abuse potential and emotional support, hope and happiness, and symptom reduction and emotional support. The results suggest that when parents are emoti

55、onally supported their abuse scores decrease and their stress and other symptoms are reduced, and that when they are hopeful their happiness scores increase. These should be understood as correlation rather than a causative effects. For the secondary caregivers, the correlation results suggested the

56、 strongest relationships were between child abuse potential and emotional support, child abuse potential and symptom reduction, child abuse potential and hope, symptom reduction and hope, symptom reduction and happiness, and between hope and happiness. The results suggest similar trends as for the p

57、rimary caregivers, that is, when secondary caregivers are emotionally supported their abuse scores decrease, when they are more hopeful their abuse scores decrease, stress and other negative symptoms are reduced and they are happier.As child safety was the key area of interest for this research, the

58、 relationships between abuse potential and other correlated variables were explored further using regression analysis. These indicated that improvements in symptom reduction and emotional support scores explained around 80% of the reduction in abuse potential scores and that emotional support and sy

59、mptom reduction are very good predictors of abuse potential especially 6 and 12 months after support-work has ceased.A similar pattern was seen with secondary caregivers.SummaryThe crisis interventions, taken as a set, were successful in helping families improve their general levels of well-being and functioning. They were al