Background: An adaptation of multisystemic therapy (MST) was piloted to find out whether it would yield better outcomes than standard MST in families where the adolescent not only shows antisocial or delinquent behaviour, but also has an intellectual disability. Method: To establish the comparative effectiveness of MST‐ID (n = 55) versus standard MST (n = 73), treatment outcomes were compared at the end of treatment and at 6‐month follow‐up. Pre‐treatment differences were controlled for using the propensity score method. Results: Multisystemic therapy‐ID resulted in reduced police contact and reduced rule breaking behaviour that lasted up to 6 months post‐treatment. Compared to standard MST, MST‐ID more frequently resulted in improvements in parenting skills, family relations, social support, involvement with pro‐social peers and sustained positive behavioural changes. At follow‐up, more adolescents who had received MST‐ID were still living at home. Conclusions: These results support further development of and research into the MST‐ID adaptation.
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Er is in onderzoek nog relatief weinig aandacht voor de individuele en contextuele factoren en de daarbij behorende zorgbehoeften van residentieel opgenomen jeugdigen die op licht verstandelijk beperkt (LVB) of zwakbegaafd (ZB) niveau functioneren. De resultaten van dit exploratief dossieronderzoek kunnen een bijdrage leveren aan de doorontwikkeling van een individueel en contextueel hulpaanbod voor deze jeugdigen en hun gezinnen. Bij een relatief grote groep (63%) van de in dit onderzoek betrokken jeugdigen speelden problemen op zowel kind-, ouder-, gezins- als omgevingsniveau een rol. De spreiding in het aantal kenmerken liet zien dat er bij veel jeugdigen die op een LVB of ZB niveau functioneerden én hun gezinnen sprake was van een grote diversiteit aan en opeenstapeling van problemen. Dit vraagt om een op het systeem afgestemde, multidisciplinaire en traumasensitieve aanpak.
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This thesis focuses on the effectiveness of a family-centered approach (in Dutch “DMOprotocol”, further referred to as the family-centered approach), designed for monitoring and enhancing children’s social-emotional development in Preventive Child Healthcare (PCH). The effectiveness study took place at a Dutch PCH organization (Icare JGZ). In a quasi-experimental design, regions in which the family-centered approach had already been implemented (northern and southeastern part of Drenthe) were compared to regions in which care-as-usual had been maintained (northern part of Overijssel). The aim was to assess the added value of the family-centered approach from different perspectives. Therefore several research questions were answered in analyses that arereported in different chapters of this thesis.
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Objectives: Participation is considerably restricted in children and adolescents with acquired brain injury (ABI) as compared to their healthy peers. This systematic review aims to identify which factors are associated with participation in children and adolescents with ABI. Methods: A systematic search in Medline and various other electronic databases from January 2001–November 2014 was performed. All clinical studies describing determinants of participation at least 1 year after the diagnosis of ABI by means of one or more pre-defined instruments in patients up to 18 years of age were included. Extracted data included study characteristics, patient characteristics, participation outcome and determinants of participation (categorized into: health conditions (including characteristics of ABI), body functions and structures, activities, personal factors and environmental factors). The methodological quality of the studies was evaluated based on three quality aspects (selection, information and statistical analysis bias) and scored as low, moderate or high. Results: Eight studies using an explicit participation outcome measure were selected after review, including a total of 1863 patients, with a follow-up ranging from 1 up to 288 months. Three studies included patients with a traumatic or a non-traumatic brain injury (TBI or NTBI) and five studies with only TBI patients. Factors consistently found to be associated with more participation restrictions were: greater severity of ABI, impaired motor, cognitive, behavioural and/or sensory functioning, limited accessibility of the physical environmentand worse family functioning. Fewer participation problems were associated with a supportive/nurturing parenting style, higher household income, acceptance and support in the community and availability of special programmes. The overall methodological quality of the included studies was high in two and moderate in six studies. Conclusion: This systematic review shows that only a few, moderate quality, studies on the determinants of participation after paediatric ABI using recommended explicit measurement instruments are available. Various components of the ICF model: health condition, body functions and structures and environmental factors were consistently found to be associated with participation. More methodologically sound studies, using the recommended explicit outcome measures, a standardized set of potential determinants and longterm follow-up are suggested to increase the knowledge on participation in children and youth with ABI.
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De Handleiding Korte Interventie Methode KIM biedt achtergrond en uitwerking voor de interventie. De definitieve publicatie van de handleiding wordt verwacht in de zomer van 2013.
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Research on follow-up outcomes of systemic interventions for family members with an intellectual disability is scarce. In this study, short-term and long-term follow-up outcomes of multisystemic therapy for adolescents with antisocial or delinquent behaviour and an intellectual disability (MST-ID) are reported. In addition, the role of parental intellectual disability was examined. Outcomes of 55 families who had received MST-ID were assessed at the end of treatment and at 6-month, 12-month and 18-month follow-up. Parental intellectual disability was used as a predictor of treatment outcomes. Missing data were handled using multiple imputation. Rule-breaking behaviour of adolescents declined during treatment and stabilized until 18 months post-treatment. The presence or absence of parental intellectual disability did not predict treatment outcomes. This study was the first to report long-term outcomes of MST-ID. The intervention achieved similar results in families with and without parents with an intellectual disability.
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Multiple studies have shown that Multisystemic Therapy (MST) is, at group level, an effective treatment for adolescents showing serious externalizing problem behavior. The current study expands previous research on MST by, first, examining whether subgroups of participants who respond differently to treatment could be identified. Second, we investigated if the different trajectories of change during MST could be predicted by individual (hostile attributions) and contextual (parental sense of parenting competence and deviant and prosocial peer involvement) pre-treatment factors. Participants were 147 adolescents (mean age = 15.91 years, 104 (71%) boys) and their parents who received MST. Pre-treatment assessment of the predictors and 5 monthly assessments of externalizing behavior during treatment took place using both adolescent and parents’ self-reports. Six distinct subgroups, showing different trajectories of change in externalizing problem behavior during MST, were identified. Two of the 6 trajectories of change showed a poor treatment response, as one class did not change in externalizing problem behavior and the other class even increased. The remaining 4 trajectories displayed a positive effect of MST, by showing a decrease in externalizing behavior. Most of these trajectories could be predicted by parental sense of parenting competence. Additionally, lower involvement with prosocial peers was a predictor of the group that appeared to be resistant to MST. Adolescents do respond differently to MST, which indicates the importance of personalizing treatment. Protective factors, such as parental sense of parenting competence and prosocial peers, seem to require additional attention in the first phase of MST.
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Background: Art therapy (AT) is frequently offered to children and adolescents with psychosocial problems. AT is an experiential form of treatment in which the use of art materials, the process of creation in the presence and guidance of an art therapist, and the resulting artwork are assumed to contribute to the reduction of psychosocial problems. Although previous research reports positive effects, there is a lack of knowledge on which (combination of) art therapeutic components contribute to the reduction of psychosocial problems in children and adolescents. Method: A systematic narrative review was conducted to give an overview of AT interventions for children and adolescents with psychosocial problems. Fourteen databases and four electronic journals up to January 2020 were systematically searched. The applied means and forms of expression, therapist behavior, supposed mechanisms of change, and effects were extracted and coded. Results: Thirty-seven studies out of 1,299 studies met the inclusion criteria. This concerned 16 randomized controlled trials, eight controlled trials, and 13 single-group pre–post design studies. AT interventions for children and adolescents are characterized by a variety of materials/techniques, forms of structure such as giving topics or assignments, and the use of language. Three forms of therapist behavior were seen: non-directive, directive, and eclectic. All three forms of therapist behavior, in combination with a variety of means and forms of expression, showed significant effects on psychosocial problems. Conclusions: The results showed that the use of means and forms of expression and therapist behavior is applied flexibly. This suggests the responsiveness of AT, in which means and forms of expression and therapist behavior are applied to respond to the client's needs and circumstances, thereby giving positive results for psychosocial outcomes. For future studies, presenting detailed information on the potential beneficial effects of used therapeutic perspectives, means, art techniques, and therapist behavior is recommended to get a better insight into (un)successful art therapeutic elements.
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In deze notitie wordt de curriculumanalyse waarover Kees Freriks, directeur van de Theo Thijssen Academie en Kees van der Wolf, lector van het Lectoraat Gedragsproblemen in de Onderwijspraktijk hebben gesproken nader uitgewerkt. Zij zijn overeengekomen dat de kenniskring het curriculum van de Theo Thijssen Academie gaat analyseren. Dit krijgt gestalte vanuit een Critical Friend-rol. Onderzocht wordt op welke wijze speciale zorg voor kinderen met leer- en gedragsmoeilijkheden in het curriculum is opgenomen en op welke wijze dit mogelijk kan worden verbeterd. De analyse van wat er aangeboden wordt op het gebied van speciale zorg voor kinderen met leer- en gedragsmoeilijkheden gaat uit van de nota De Inhoudelijke Pit waarin de kern van de onderwijsinhoud en de pedagogische basis voor het werken op de Theo Thijssen Academie wordt beschreven.
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