INTEGRATED FAMILY ASSESSMENT AND INTERVENTION MODEL (IFAIM):

1. Ana Teixeira de Melo FacultyofPsychologyandEducationSciencesoftheUniversityof Coimbra, Portugal ScholarofthePortugueseFoundation for ScienceandTechnology, Portugal (SFRH/BD/39912/2007) E-mail: anamelopsi@gmail.com Madalena Alarcão FacultyofPsychologyandEducationSciencesoftheUniversityof Coimbra, Portugal INTEGRATED FAMILY ASSESSMENT AND INTERVENTION MODEL (IFAIM): Anintegrative, collaborative, systemicapproachatthecrossroadofclinical, educational, communityandforensicpractices Efta congress, Paris, October 30, 2010

2. DEFINITION, AIMS AND POPULATION

3. WHAT IS IFAIM? • An integrative, multi-systemic, family-focused assessment and intervention model • A model with a collaborative (with narrative and solution-focused therapies influences) and strength-based orientation • A community-based and in-home approach • A model designed to support the Child Protection and Welfare system : • In regard to the production of meaningful information to inform decision-making (assessment) • In regard to the provision of family support to guarantee child’s safety and well-being (intervention)

4. POPULATION • Multi-challenged families with at-psychocial risk, maltreated or neglected children • Multi-challenged families (Melo & Alarcão, 2010): • a) have been or are currently developing in harsh living conditions (e.g., living in poverty, experiencing social exclusion, oppression or violence, etc.) with a prolonged exposition to stressful environments or circumstances; OR have been or are experiencing harsh living conditions during short periods of time but with acute stress; b) are or have been facing multiple concurrent challenges, often simultaneously with major normative transitions and crises.

5. WHY IFAM? • Traditional approaches focused on only one dimension of the families’ life may be inadequate or insufficient to meet the needs of multi-challenged families • Therapy with poor families must take into account how the social and economical conditions constrain family’s relations and difficult family adjustment (Frankel & Frankel, 2006; Minuchin, Colapinto & Minuchin, 2007;Rojano, 2004)

6. WHY IFAM? • Multi-challenged families face the risk of multiple assistance and associated consequences . Integrative, systemic approaches may avoid or minimize the negative aspects of multiple assistance including family dilution (Colapinto, 1995; Coleti & Linares, 1997; Minuchin, Colapinto & Minuchin, 2007)

7. WHY IFAM IN PORTUGAL? • Most social, child welfare , child protection and family services, in Portugal, are still orientated by expert-driven, problem and individually focused perspectives • There is a paucity in Portugal of assessment frameworks and models specifically designed to both conduct assessment in cases of child maltreatment and neglect and support the families, in an integrated way, in performing the necessary changes to ensure children’s safety and well-being. Current approaches to assessment in cases of child maltreatment and neglect are mainly expert-driven and not collaborative

8. AIMS • To promote family strengthening • To protect and potentiate the physical, psychological and social well-being of family members

9. OBJECTIVES • Specific objectives are divided in two categories: • Objectives related to assessment purposes (e.g. assessment of risk and protection dynamics; assessment of potential for change) • Objectives related to the facilitation of change and strengthening of processes which may foster family’s growth and adaptation. • Changes in factors related to the family’s social and environmental living conditions, the entire family, the parents and the children, which may contribute to achieve IFAIM’s broader aims.

10. IN PRACTICE

11. CONTEXT OF CURRENT IMPLEMENTATION • Centers for Family Support and Parental Counseling in Portugal (Recent family support services)

12. IN PRACTICE • 5 STAGES OF IMPLEMENTATION: • Referral • Reception • Assessment (1 to 3 months) • Support for change (3 to 12 months) • Follow-up and closure (3 to 12 months) • Longer cases are often associated with the prevention of child removal and/or the promotion of the family’s reunification

13. THE CORE TEAM • Inter/trans disciplinary team • Standard minimum composition of 3 practitioners: • Psychologist • Social worker • Social educator • (2 practitioners assigned for each case in the initial stage) • Other extended family, community members or professionals may be involved. IFAIM’s team mediates relationships with other systems. • The referral professional are asked to assume social control functions in cases of child protection.

14. DISTINTICE FEATURES OF IFAIM The integrative character: a model emerged from a crossroad of perspectives of perspectives

15. The integrative character: INTER/TRANSDISCIPLINARITY

16. THEORETICAL INTEGRATION • Integrative case conceptualization build upon a Multiple Challenges Comprehensive Framework (Melo & Alarcão, 2010)- integrative theoretical framework designed to facilitate an understanding of the risks and opportunities associated with the developmental pathways of multi-challenges families • Integrative case conceptualization hypothesis as a fundamental tool during assessment and support for change

17. THEORETICAL INTEGRATION • Prefered outcomes in IFAIM: • Children safety and well-bring; • Family’s preferred views and directions in life; • - Exercise of the right to freedom Symptoms/ problems/ child maltreatment and neglect MULTIPLE CHALLENGES COMPREHENSIVE FRAMEWORK Time Constrainingandfacilitatingdimensionsrelated to individual, family, environmental, social and cultural factors Melo & Alarcão, 2010

18. THREE PREFERRED OUTCOMES IN IFAIM • Children’s protection and well-being- provides a direction for change and indicators of the results to be achieved • Families living according to their preferred visions and directions in life (Madsen, 2007;White, 2007)- provides the strength to change • Families exercise their right to freedom (families exercise their ability to learn know how they change and to create meaningful information about themselves, the world and their relation with it; exercise the ability to create, seek and experimenting alternatives and to make deliberated and authored choices which are integrated in their preferred views)– provides the context for change

19. INTEGRATION OF PERSPECTIVES DURING ASSESSMENT • Assessment stage includes: • Risk assessment (in regard to child maltreatment and neglect) • Comprehensive assessment (parental capacity/competencies; family functioning and other factors which affect parental capacity; social and environmental factors assessment; child focused assessment) • Assessment of the potential for change assessment to inform child protection decision-making

20. INTEGRATION OF PERSPECTIVES DURING ASSESSMENT • Combination of actuarial and clinical-consensual methods in risk assessment • Combination of traditional concerns (e.g. rigour and utility of information) and assessment practices (e.g use of standardized instruments) (Munro, 2008) with a collaborative, strength and solution-focused assessment perspective to facilitate change during assessment (Berg & Kelly, 2001; Turnell & Essex, 2006; Turnell & Edwards, 1999)

21. INTEGRATION IN THE SUPPORT FOR CHANGE STAGE • A narrative perspective (Sluzki, 1992, 1998; White 2007) informs the view of change as ultimately supported by the family’s narratives and the ones constructed in relation with other meaningful systems. Behavioral, emotional and cognitive changes are seen as ultimately supported by the family’s narratives. • Support for change sessions as change rehearsal sessions. • Change rehearsals sessions prepared using knowledge from different disciplines and targeting different factors from the individual to the social contexts.

22. INTEGRATION IN THE SUPPORT FOR CHANGE STAGE • Narrative practices are combined with different intervention strategies, from different disciplines, approaches and models to facilitate the rehearsal of alternative behaviors, emotions, cognitions and discourses.

23. INTEGRATION IN THE CONCEPTUALIZATION AND SUPPORT FOR CHANGE • Regular integrative family sessions ,are a common feature to all cases • Aim to help the family recruit and expand abilities and the preferred outcomes of the change rehearsal sessions to elaborate more useful meanings and to develop reflexive abilities which may help them adapt, grow and strengthen. • Resilience processes are specially targeted (Walsh, 2006) • Narrative approaches are particularly influential (Sluzki, 1992; Madsen, 2007 White, 2007; )

24. TRAINING

25. TRAINING • Inter/transdisciplinary training common to all professionals • Common set of skills reflecting the integration of contributions from different models of family therapy • Outcome orientated training process focused on the acquisition and/or development of: • Integrative theoretical case conceptualization skills • Practical skills divided in 5 categories

26. TRAINING • 5 categories of practical skills targeted and periodically assessed with corresponding rating scales: • Basis session management skills • Skills specific to the referral and assessment stages • Skills to support change • Skills to conduct in-home sessions • Skills to conduct sessions with other professionals or significant elements • IFAIM and its training program are manualized

27. CURRENT AND FUTURE RESEARCH

28. RESEARCH FOCUS • Multiple case studies of the process and outcome of implementation of IFAIM in local communities • Case studies of the process of training and exploratory evaluation of its efficacy in promoting practitioners’ skills acquisition and development • Preliminary feasibility study of the efficacy of IFAIM in achieving its aims and objectives • Instrument development and evaluation (e.g. Rating scales to assess practitioner’s skills to implement IFAIM) • ... Future research is expected and welcomed

29. THANK YOU FOR YOUR ATTENTIONE-MAIL : anamelopsi@gmail.com