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Since failed reunification is a detrimental outcome for children, particularly infants and toddlers, the aim of this study was to gain insight into support to families in multiple-problem situations to help them achieve sustainable good-enough parenting. Therefore, we examined outcomes of an assessment-based inpatient family preservation program. We prepared a thorough target-population description (n = 70) using file analysis. Next, we examined atypical parental behavior during the intervention using the Atypical Maternal Behavior Instrument for Assessment and Classification with a repeated measures design (n = 30). The family files revealed a great number of issues at the family, parent, and child levels, such as practical matters, problems in parent functioning and between parents, and difficulties in the broader environment. We found a significant decline in three dimensions of atypical parental behavior over time. This program has great potential in supporting vulnerable families in their pursuit of family preservation., (© 2019 The Authors. Infant Mental Health Journal published by Wiley Periodicals, Inc. on behalf of Michigan Association for Infant Mental Health.)

Psychosocial care systems have been designed so that specific problems are treated by specific care types. There is insufficient evidence as to which problem types are actually presented to the various care types. This study assessed types and severity of problems among children and adolescents upon enrolment in psychosocial care, compared to children not enrolled; also outcomes after 3 and 12 months, overall and per care type. We obtained data on a cohort of 1382 Dutch children aged 4-18 years (response rate 56.6%), included upon enrolment in psychosocial care, and on 443 not-enrolled children (response rate 70.3%), all from one region. Results showed that enrolled children had more problems than children not enrolled in care. In child and adolescent mental healthcare (CAMH), relatively many children had internalizing problems, and in child and adolescent social care (CASC) relatively many children had externalizing, parenting, family and multiple problems. Regardless of the type of problem, care duration in preventive child healthcare (PCH) was relatively short; and in CASC and CAMH longer. After 3 and 12 months, rates of problem solution were highest in PCH. These rates were also substantial among children not in care. To conclude, our findings show that the system of psychosocial care functions as intended regarding the distribution of problems across care types. Extended demarcation of clients by problem type and severity towards type and contents of care may further improve the system.

Since a substantial portion of infants and toddlers reenter care after reunification, the question of whether family reunification is feasible needs to be answered very cautiously. How parenting is assessed is of major importance in answering this question, but the quality of these assessments is often poor. With an eye to improving current practice, we conducted an integrative review, in which we analyzed the challenges related to the assessment of parenting vis-à-vis reunification and linked relevant knowledge from research with significant know-how from practice. The challenges appear to be embedded in the struggle to define (especially good enough) parenting and the complex context of child protection. As an answer to the challenges, the integrative review resulted in a framework of four key components required for sufficient parenting-assessment practice: (a) the use and development of expertise; and (b) providing families aiming for reunification with an intervention that is intensive, (c) flexible, and (d) organized as teamwork. Providing families with such an intervention gives them the opportunity to make substantial changes in their parenting and helps professionals assess the capacity of parents to grow to an acceptable level of caretaking for their child. Further implications for research and practice are discussed., (© 2017 Michigan Association for Infant Mental Health.)

Knowledge about determinants of child and adolescent enrolment in psychosocial care concerns only single types of care and usually only socio-demographic factors. The social environment is also a likely key determinant but evidence is lacking. The aim of this study was to examine the associations between family social support, parenting skills and child and adolescent enrolment in psychosocial care. We obtained data on 1,331 children (response rate 56.6%), 4-18 years old, enrolled in preventive child health care, and child and adolescent social care and mental health care because of psychosocial problems, and on 463 children (response rate 70.3%) not enrolled in psychosocial care. Results showed that enrolment in psychosocial care was associated with low family social support (odds ratio; 95%-confidence interval: 3.2; 2.4-4.4), and with poor parenting skills, i.e. poor supervision (1.5; 1.1-2.1) and inconsistent disciplining (1.5; 1.1-2.1). Children's psychosocial problems partially mediated the associations with family social support and completely with parenting skills. Children's problems did not moderate the associations. Positive parenting was not associated with care enrolment. We conclude that low family social support and poor parenting are important factors associated with enrolment, in particular because they are associated with more frequent occurrence of children's psychosocial problems. This implies that professionals and policymakers need to be aware that factors in children's social environment are related with enrolment in psychosocial care, in addition to children's psychosocial problems.

Abstract High rates of failed reunification indicate that family preservation (FP) does not necessarily lead to permanency for children. It could be argued that, in such failed cases, the decision-making process leading to the preservation of the family was inadequate. In order to gain insight into the role that decision-making plays in family preservation practice, we studied decision-making within an FP-intervention program provided by the Expertise Center. The Expertise Center explicitly combines treatment and decision-making in an assessment-based intervention that is provided to families seeking either to be reunited with their young child (0–2) or to avoid an out-of-home placement of the child. In addition, at least one of the parents has psychiatric problems. We hereby attempted to a) map decision-making trajectories in practice and b) provide feedback about Expertise Center decision-making based on evidence regarding the – sometimes evolving – quality of parental behavior as observed in the participants. We have used a descriptive design (n = 100) as well as a one-group repeated measures design (n = 28) to examine parental behavior using the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE). We hypothesized that a negative recommendation regarding family preservation would manifest itself in the display of more frequent and more severe atypical parental behavior. Our results indicate that the Expertise Center succeeded in contributing broadly to timely decision-making in the context of permanency planning, and that implementation of the Decision-making Continuum potentially improved the quality of clinical decision-making. Furthermore, our hypothesis was confirmed by four out of five measurements of parental behavior that have been proven to be significant for children's attachment security. Since these are promising results, the Expertise Center program could serve as an inspiration for the practice field. Highlights • The Expertise Center contributes to timely permanency planning decision-making. • Clinical decision-making may be improved using the Decision-making Continuum. • Decisions of the Expertise Center are underlined with evidence of parental behavior. • More knowledge on clinical decision-making is urgent to achieve permanency. [ABSTRACT FROM AUTHOR]

Although parental problems and poor parenting are commonly associated with adolescents' admission to secure residential care, few studies examined these parental characteristics. This study aims to identify parental problems and strengths and their association with parenting styles for 64 of these parents. We assessed perspectives of both adolescents and their parent figures shortly after admission. Parents often report high levels of psychopathology for both mothers and fathers, respectively, including depression (54.7% and 39.1%), anxiety (29.7% and 12.5%), substance dependence (14.1% and 26.6%), antisocial behaviour (1.6% and 21.1%), and psychosis (11.0% and 9.4%). Parents also report high parenting stress specifically related to the behaviour of their child. In contrast to our expectations, most parents experience a high quality of life. Living in a 1‐parent family, being unemployed and having debts are most frequently mentioned risk factor combinations. We found limited support for the hypothesis that parents with more risk and less protective factors show poorer parenting. Parents with more psychopathology and parenting stress do show poorer parenting than parents without these problems. Based on our findings, we describe several implications for engaging and supporting parents of adolescents in secure residential care. [ABSTRACT FROM AUTHOR]

TAKECARE is a prospective cohort study designed in The Netherlands to obtain evidence on the care chain for children and adolescents with psychosocial problems, and its long-term outcomes. Little is known about the content of care as offered and on whether the care is adequate. The cohort consists of children and adolescents entering care for psychosocial problems (care sample, n = 1382) and a random sample of the general population (community sample, n = 666). Children were eligible for participation if they were aged 4-18 years (inclusive) and had estimated IQs of 70 and over. The care sample covers the fields of Preventive Child Healthcare (PCH), Child and Adolescent Social Care (CASC) and Child and Adolescent Mental Healthcare (CAMH). Children, parents or guardians and involved practitioners completed five questionnaires (baseline, and at 3, 12, 24 and 36 months thereafter). The main categories of data concern the sociodemographic characteristics of children and their parents or guardians, the characteristics of entry into care and care content, and intermediate and final treatment outcomes. Information about data access can be requested by e-mail: c4youth@umcg.nl. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe the development and application of the KIPP-list of care activities. The acronym KIPP stands for Knowledge and Insight into Primary Processes. The instrument is intended as a tool for family coaches to systematically report care activities conducted in the Dutch family support programme Ten for the Future (in Dutch: Tien voor Toekomst). Design/methodology/approach -- The design of the instrument was based on the components of the programme and a literature search for similar instruments used in the Netherlands, complemented by a staff survey. A series of three studies was carried out to test the instrument's validity and user-friendliness, and to assess its potential for programme evaluation. Findings -- The majority of care activities were performed in cooperation with one or both parents alone, and less frequently with children or external professionals. Although the main focus of the work of the family coaches fell into the categories of "collecting information" and "working towards (behavioural) change" with families, the relatively high frequency of all the types of care contacts emphasises the intensity of this family support programme with a complex target group. Originality/value -- Data gathered with the instrument provided meaningful information by descriptive analysis. KIPP thereby proved its general feasibility in increasing insight into service provision. The instrument can be useful in several stages and on several levels of quality assurance and service optimisation, including reflective practice, supervision, team management and research. [ABSTRACT FROM AUTHOR]

ABSTRACT Foster children experience a lot of stress because of their life histories and changes in their family circumstances, such as foster care placement. It is important that foster parents recognize the early signs of stress in foster children and learn how to act in a non-threatening and understanding manner. Family-based interventions may help in this. In this paper, we report on a meta-analysis of studies ( n= 19) of the effectiveness of such interventions. All studies used a pre-test/post-test design. Both problem behaviour in foster children and the parenting skills of foster parents improved by 30%; however, none of the interventions were specifically intended to help young children (<4 years) to cope with stress. The importance of interventions for young foster children is discussed, as well as the necessary elements these interventions should include. [ABSTRACT FROM AUTHOR]

Families who face a multitude of severe and persistent problems in a number of different areas of life are commonly referred to as multi-problem families in Dutch child welfare. Although evidence suggests that short-term crisis interventions can have positive effects in these families, they have up to now not sufficiently succeeded in facilitating sustainable change. Interventions, which offer integrated care over longer periods of time, have been piloted in different European countries, but only few evaluation studies are available yet. In our study we therefore explored an integrated flexible family support program from the Netherlands, called ‘Ten for the Future’ [in Dutch: Tien voor Toekomst]. The research included 122 families over a period of four years and seven months. Analyses on group level and individual case level were carried out. Our results suggest that the intervention is associated with a decrease in family stress. Furthermore, families with lower initial parental stress were found to have a higher chance to end the program significantly earlier. Child behavior problems and family functioning, as perceived by care workers, show less coherent patterns of change. This might be connected to a main focus of family coaches on the direct work with parents alone. We conclude that the care program has potential to decrease family stress and suggest focusing on the further development of a dual key worker approach that offers allocated care for children next to parenting support in families with multiple problems. [ABSTRACT FROM AUTHOR]