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To preserve or not to preserve: That is the question. Decision-making about family preservation among families in multi-problem situations
- Authors:
- VISCHER Anne-Fleur W.K., et al
- Journal article citation:
- Children and Youth Services Review, 99, 2019, pp.441-450.
- Publisher:
- Elsevier
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, the authors studied decision-making within an FP-intervention programme 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. The authors 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 behaviour as observed in the participants. They used a descriptive design (n = 100) as well as a one-group repeated measures design (n = 28) to examine parental behaviour using the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE). The authors hypothesized that a negative recommendation regarding family preservation would manifest itself in the display of more frequent and more severe atypical parental behaviour. The 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, the authors' hypothesis was confirmed by four out of five measurements of parental behaviour 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. (Edited publisher abstract)
Can Assertive Community Treatment remedy patients dropping out of treatment due to fragmented services?
- Authors:
- DRUKKER Marjan, et al
- Journal article citation:
- Community Mental Health Journal, 50(4), 2014, pp.454-459.
- Publisher:
- Springer
Previously, many patients with severe mental illness had difficulties to engage with fragmented mental health services, thus not receiving care. In a Dutch city, Assertive Community Treatment (ACT) was introduced to cater specifically for this group of patients. In a pre–post comparison, changes in mental health care consumption were examined. All mental health care contacts, ACT and non-ACT, of patients in the newly started ACT-teams were extracted from the regional Psychiatric Case Register. Analyses of mental health care usage were performed comparing the period before ACT introduction with the period thereafter. After the introduction of ACT, mental health care use increased in this group of patients, although not all patients remained under the care of ACT teams. ACT may succeed in delivering more mental health care to patients with severe mental illness and treatment needs who previously had difficulties engaging with fragmented mental health care services. (Publisher abstract)